Ng Sock Wen, Hwong Wen Yea, Husin Masliyana, Ab Rahman Norazida, Nasir Nazrila Hairizan, Juval Kawselyah, Sivasampu Sheamini
Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
JMIR Form Res. 2022 May 9;6(5):e34485. doi: 10.2196/34485.
The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries.
The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics.
A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic.
In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97).
Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service.
远程会诊作为现有医疗方式的补充融入医疗保健系统的速度正在迅速加快。然而，关于其在低收入和中等收入国家的实施程度的信息有限。
本研究的目的是确定马来西亚基层医疗诊所中远程会诊的可及性和程度。
于2020年11月至2020年12月对马来西亚的公立基层医疗诊所进行了一项横断面研究。招募了马来西亚所有每日接待患者超过300人的诊所。向每个诊所的主管医务人员发放了一份基于网络的自填式问卷，问卷内容包括服务的可及性、是否使用视频或电话以及所提供的服务类型。
总共有97.6%（249/255）的诊所做出了回应。在这些诊所中，45.8%（114/249）提供远程会诊。大多数提供会诊的诊所（69/114，60.5%）仅提供电话会诊，而24.6%（28/114）的诊所提供视频和电话会诊，14.9%（17/114）仅提供视频会诊。80%（92/114）的诊所位于城市地区。按州划分显示，17.5%（20/114）和16.7%（19/114）的诊所来自两个较大的州；其他州的诊所占比均不到10%（范围为7 - 9/114）。对于提供视频会诊的诊所，该服务的资金大多（42/45，93%）来自卫生部。相反，提供电话会诊的诊所中，近四分之一（23/97）的服务资金来自捐赠或自筹。大多数诊所为糖尿病和高血压患者提供远程会诊。不到50%的提供远程会诊的诊所与专职医疗服务提供者或药剂师进行随访时使用该服务（视频会诊，20/45；电话会诊，36/97）。
我们的研究结果表明，尽管电话会诊四分之一的资金是自筹或通过捐赠获得的，但它的使用比视频会诊更为广泛。此外，专职医疗服务提供者和药剂师对远程会诊的利用率较低。马来西亚初级卫生保健中远程会诊的扩展计划应考虑这些结果，以确保更好且更具成本效益地实施该服务。
