1 University of KwaZulu-Natal, South Africa.
2 University of Calgary, Canada.
Health Inf Manag. 2019 Jan;48(1):33-41. doi: 10.1177/1833358317749369. Epub 2018 Jan 23.
: There are few telemedicine projects in Africa that have reached scale. One of the reasons proposed for this has been failure to assess health provider readiness for telemedicine prior to implementation.
: To assess health provider readiness for implementation and integration of telemedicine services at three levels of Uganda's health facilities, namely, a national referral hospital (NRH), regional referral hospitals (RRHs) and level 4 health centres (HC-IVs) and to investigate factors associated with readiness for telemedicine.
: A cross-sectional descriptive study was conducted at public healthcare facilities in Uganda. One RRH and HC-IV was identified from each of the Western, Eastern and Northern regions using a multistage random sampling technique. Mulago Hospital, which doubles as an RRH and HC-IV in the central region, was purposively identified for the study. After validation, a questionnaire was distributed for self-administration to senior administrators and doctors selected at the NRH, RRHs and HC-IVs. Data were analysed using bivariate associations between the outcome and the potential independent variables.
: In total, 114 healthcare workers completed the questionnaire. Of the respondents, 24 (21%) were from HC-IVs, 44 (39%) were from RRHs, and 46 (40%) from NRH. Doctors made up 45.8% (11) of respondents at HC-IVs, 59% (26) at RRHs, and 30.4% (14) at NRH. Administrators across all health facility levels were more likely to integrate telemedicine into the healthcare system than doctors (odd ratio = 1.39 [95% confidence interval = 0.38-4.95]). A significant association existed between the state of readiness and type of health facility, p < 0.001. The NRH and RRHs are more likely to integrate telemedicine into their systems than the HC-IVs. Among the factors investigated (job title, health facility, technology type, reason for referral and frequency of electronic communication), the level of health facility and title or role of healthcare worker were found to have a significant statistical association with being ready to integrate telemedicine into the healthcare system.
: Health provider readiness to integrate telemedicine services varies at the different levels of the health facility and job title or role. However, referral hospitals and administrators were more likely to integrate telemedicine than HC-IVs and doctors, respectively. While this study shows physicians and administrators are ready, other sectors (nurses, allied healthcare workers, public) will also need to be assessed.
非洲很少有远程医疗项目达到规模。造成这种情况的原因之一是在实施远程医疗之前，未能评估卫生提供者对远程医疗的准备情况。
评估乌干达三级卫生设施（即国家转诊医院、地区转诊医院和 4 级卫生中心）实施和整合远程医疗服务的卫生提供者的准备情况，并调查与远程医疗准备情况相关的因素。
在乌干达的公立医疗机构进行了一项横断面描述性研究。使用多阶段随机抽样技术，从西部、东部和北部地区各确定了一家地区转诊医院和一家 4 级卫生中心。位于中心地区的穆拉戈医院既是地区转诊医院又是 4 级卫生中心，因此被专门选定用于该研究。在验证后，向国家转诊医院、地区转诊医院和 4 级卫生中心的高级行政人员和医生分发了一份自我管理的问卷。使用二变量关联分析方法，将结果与潜在的独立变量进行关联分析。
共有 114 名卫生工作者完成了问卷。在答卷者中，24 人（21%）来自 4 级卫生中心，44 人（39%）来自地区转诊医院，46 人（40%）来自国家转诊医院。医生在 4 级卫生中心占答卷者的 45.8%（11 人），在地区转诊医院占 59%（26 人），在国家转诊医院占 30.4%（14 人）。所有卫生设施级别的行政人员比医生更有可能将远程医疗纳入医疗保健系统（优势比=1.39[95%置信区间=0.38-4.95]）。准备状态与卫生设施类型之间存在显著关联，p<0.001。国家转诊医院和地区转诊医院比 4 级卫生中心更有可能将远程医疗纳入其系统。在所调查的因素（职称、卫生设施、技术类型、转诊原因和电子通信频率）中，发现卫生设施级别和卫生保健工作者的职称或角色与将远程医疗纳入医疗保健系统的准备情况具有显著的统计学关联。
卫生提供者整合远程医疗服务的准备情况因卫生设施级别和职称或角色而异。然而，转诊医院和行政人员比 4 级卫生中心和医生更有可能整合远程医疗。虽然这项研究表明医生和行政人员已经做好了准备，但还需要评估其他部门（护士、辅助医疗工作者、公众）。
