Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Family Medicine, Kuala Lumpur, Malaysia.
Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Community Health, Kuala Lumpur, Malaysia.
Med J Malaysia. 2023 Jul;78(4):449-457.
Teleconsultation gained popularity to provide safe medical care during the pandemic. However, literature on the sustainability of teleconsultation service at primary care beyond pandemic situations is scarce. This study aimed to determine the use of teleconsultation services for non-communicable disease (NCD) follow-up and explore the benefits and challenges of the service implementation during and beyond COVID-19 pandemic in Malaysia.
An exploratory qualitative study was conducted using videoconferencing. Fourteen medical officers working in public primary healthcare clinics from various regions of Malaysia were chosen using purposive sampling process, and participants underwent a total of seven paired in-depth interview (IDI) sessions. IDIs were video recorded, transcribed and subjected to interpretive thematic analysis.
The two main themes which emerged were the benefits and challenges of NCD teleconsultation service. Various categories relating to benefits of teleconsultation for NCD care are as follows: (1) Improved efficiency for patient care delivery (improved effectiveness, convenient, improved safety, better disease monitoring, patient empowerment) and (2) Benefits for Health Care Providers (improved healthcare and service delivery). Main challenges identified were as follows: (1) Challenges for Delivery of Care (Patients' adaptation in using teleconsultation service, Patients abusing the system, Poor digital literacy, No proper disease monitoring record), (2) Challenges for Health Care Providers (Lack of dedicated team and training, Higher workload and time-consuming) and (3) Challenges for Health Care System (Institutional policy, legal and regulatory weakness, Medical record documentation and prescription updates).
Optimisation of NCD patient healthcare delivery via teleconsultation is beneficial during and after pandemic. Targeted improvements to address current challenges are crucial to optimise its use beyond the pandemic period in the Malaysian public healthcare system.
远程咨询在大流行期间为提供安全的医疗服务而广受欢迎。然而，关于大流行情况以外的初级保健中远程咨询服务可持续性的文献却很少。本研究旨在确定远程咨询服务在非传染性疾病（NCD）随访中的使用情况，并探讨在马来西亚大流行期间和之后实施该服务的益处和挑战。
采用视频会议进行探索性定性研究。从马来西亚不同地区的公立初级保健诊所中选择了 14 名医疗官，采用目的抽样法进行选择，参与者共进行了 7 次配对深入访谈（IDI）。对 IDI 进行了录像、转录和解释性主题分析。
出现了两个主要主题，即 NCD 远程咨询服务的益处和挑战。与 NCD 远程护理相关的各种类别的益处如下：（1）改善患者护理交付效率（提高效果、方便、提高安全性、更好的疾病监测、增强患者能力）和（2）对医疗保健提供者的益处（改善医疗保健和服务交付）。确定的主要挑战如下：（1）护理交付挑战（患者适应远程咨询服务、患者滥用系统、数字素养差、没有适当的疾病监测记录），（2）对医疗保健提供者的挑战（缺乏专门的团队和培训、工作量增加和耗时）和（3）对医疗保健系统的挑战（机构政策、法律和监管薄弱、医疗记录文件和处方更新）。
通过远程咨询优化 NCD 患者医疗保健服务在大流行期间和之后是有益的。针对当前挑战进行有针对性的改进对于在马来西亚公共医疗体系中优化其在大流行后的使用至关重要。
