Sulaman Hira, Akhtar Tasneem, Naeem Humera, Saeed Gulshan Ara, Fazal Shamin
United Medical and Dental College (UMDC), Korangi Creek Road, Karachi 74900, Pakistan.
Shifa Tameer-e-Millat University - (STMU), Sector H-8/4, Islamabad 44000, Pakistan.
Int J Med Inform. 2021 Nov 23;158:104653. doi: 10.1016/j.ijmedinf.2021.104653.
To explore obstetrics patients' experiences with telemedicine during COVID-19 and assess their intent for its future use.
An exploratory design was applied considering that telemedicine was a new phenomenon in Pakistan particularly for antenatal care services during COVID-19.
Primary data was collected through a telephonic survey of 132 respondents randomly selected from the pool of obstetrics patients who used telemedicine services of Shifa International Hospital (SIH) in Islamabad, Pakistan during the pandemic. We changed the survey tool of Medical Group Management Association to the study purpose. Required information included the respondents' socioeconomic and antenatal characteristics and their telemedicine use experience on four parameters, namely, Appointment, Staff Attitude, Communication, and Telemedicine Services. Patients were inquired about their intent to use telemedicine beyond COVID-19 and the reasons supporting their answer. The data was analyzed descriptively and through t-test mean comparisons and binary logistic regression.
Majority (54%) intend to use telemedicine in future. Average age of respondents was 30 years with gravidity 2.36, parity 1.40 and gestational amenorrhea 27.3 weeks. The respondents average schooling was 9.5 years, marriage duration was 4.5 years and monthly household income was PKR ∼83,000. However, the overall experience of those who were confident in future use of telemedicine was 0.677 points higher and significantly different than those who were not inclined to use it in future. Of those lacking interest in future use of telemedicine, nearly two-third felt in-person visit was more satisfying, 11% needed physical examination, ∼6% experienced long waiting time, 5% each had inadequate access to ICT and online payment facilities, and 6% faced other issues such as excess payments. The binary logistic regression analysis (R2 37.3%) held Medical Consultations and Communications as the most important determinants and could predict nearly two-fifth of variation in respondents' intent for future use of telemedicine.
Uptake of telemedicine for obstetrics patients is one of the positive externalities of COVID-19 and may appear as a cost-effective and culturally acceptable way to ensure universal coverage of antenatal care in Pakistan. However, telemedicine's future beyond COVID-19 for obstetrics hinges upon improving users' experience primarily through consultant and staff trainings and provision of effective communication e.g., in regional languages. Besides, offering physical examination facility and ability to use mobile wallet payment solutions may motivate future use of telemedicine in obstetrics.
探讨新冠疫情期间产科患者使用远程医疗的体验，并评估他们未来使用远程医疗的意愿。
鉴于远程医疗在巴基斯坦是一种新现象，尤其是在新冠疫情期间用于产前护理服务，因此采用了探索性设计。
通过电话调查收集原始数据，从巴基斯坦伊斯兰堡希法国际医院（SIH）在疫情期间使用远程医疗服务的产科患者群体中随机抽取132名受访者。我们将医疗集团管理协会的调查工具改为适合本研究的目的。所需信息包括受访者的社会经济和产前特征，以及他们在预约、工作人员态度、沟通和远程医疗服务这四个参数方面的远程医疗使用体验。询问患者在新冠疫情之后使用远程医疗的意愿以及支持其回答的原因。对数据进行描述性分析，并通过t检验均值比较和二元逻辑回归分析。
大多数（54%）受访者打算在未来使用远程医疗。受访者的平均年龄为30岁，妊娠次数为2.36次，产次为1.40次，妊娠闭经27.3周。受访者的平均受教育年限为9.5年，婚姻时长为4.5年，家庭月收入约为83,000巴基斯坦卢比。然而，对未来使用远程医疗有信心的受访者的总体体验比那些未来不倾向于使用远程医疗的受访者高出0.677分，且差异显著。在那些对未来使用远程医疗缺乏兴趣的受访者中，近三分之二的人认为面对面就诊更令人满意，11%的人需要体格检查，约6%的人经历过长时间等待，5%的人各自存在信息通信技术和在线支付设施使用不便的问题，6%的人面临其他问题，如支付过多。二元逻辑回归分析（R2为37.3%）表明医疗咨询和沟通是最重要的决定因素，并且可以预测近五分之二的受访者未来使用远程医疗意愿的变化。
产科患者对远程医疗的接受是新冠疫情的积极外部效应之一，可能成为确保巴基斯坦产前护理普遍覆盖的一种具有成本效益且在文化上可接受的方式。然而，新冠疫情之后产科远程医疗的未来取决于主要通过对顾问和工作人员的培训以及提供有效的沟通（如使用地区语言）来改善用户体验。此外，提供体格检查设施以及使用移动钱包支付解决方案的能力可能会促使未来产科远程医疗的使用。
