Historical perspective of telemedicine and accessibility in health care

The essence of this article is to explain Telemedicine from a historical perspective with regards to few of the jurisdictions where the concept has been successfully implemented, and also show the benefits it can bring to Nigerian community members if our healthcare practitioners embrace the new paradigm.

Telemedicine allows healthcare professionals to assess, diagnose, plan, implement and evaluate patients centered care and treatment in diverse locations, using telecommunications technology. Telemedicine allows patients to access medical expertise quickly and efficiently without the need to travel. Thus, the chance of further spread of infection is greatly reduced.

One of the most critical issues in rural populations is the lack of accessibility to health care because of the lack of physicians and dentists (Heath et al., 2009). Heath et al. 16 (2009) studied telemedicine in rural areas and addressed the accessibility to medicine. Three percent of paediatricians care for 21 per cent of the adolescent population in rural locations within the United States. The researchers applied for a pediatric telemedicine program in 10 rural emergency departments (EDs) and completed 63 conferences, which included preliminary diagnoses, acute care, [and] training and support. The findings from the study showed that patient care improved 89 per cent. Heath et al. concluded that telemedicine was feasible for urgent care of children in underserved rural locations.

Setia and DelliFraine (2010) assessed the practicality of introducing telemedicine in eight rural day care centers in Pennsylvania (USA). The average number of children in the centers was 76 (ranging from 20 to 150). Staff at the centers sent an average of 4.7 children home each month because of illness. The researchers assessed the need for telemedicine, one’s ability to use the knowledge, and the means for implementing the technology using telephone and semi-structured interviews (Setia & DelliFraine, 2010). Most day care center managers were willing to learn how to use the technology. Setia and DelliFraine noted that some centers had limited space for the equipment, although most locations were adequate. Setia and DelliFraine concluded that adopting technology in rural day care centers might save parents time and money while improving health care for children in rural areas. This demonstrably shows the feasibility of telemedicine in the educational sector.

Krakoff (2011) stressed the importance of using telemedicine in the effective control of hypertension and other cardiovascular risk factors. Karloff (Krakoff?) noted that home blood pressure monitoring devices used by physicians improved risk factors for hypertensive patients. Krakoff’s study concluded that telemedicine used by physicians improved the control of hypertension. George et al. (2012) noted that telemedicine may heighten the access for speciality care treatment for populations living in metropolitan areas, however, researchers have limited knowledge concerning the acceptability among residents. George et al. (2012) explored the perceptions about the technology to understand the demand among urban African Americans and Latino groups. George et al. (2012) used data from 10 focus groups consisting of African American and Latino participants who spoke English and Spanish.

The result of the research showed that both groups supported the use of technology because telemedicine increased provider access to several medical professionals and reduced patient wait-times. Latinos were less concerned than African Americans about confidentiality and the lack of personal contact from one’s physician (George et al., 2012). The absence of trust from African Americans may result from a history of past abuse from the medical community compared to Latinos who may not have faced the same experience (George et al., 2012). George et al. (2012) offered marketing strategies for hospital administrators to promote telemedicine in the African American and Latino populations.

In a study by Raza, Joshi, Schapira, and Agha (2009), 314 patients (684 visits) received telemedicine consultations between 1998 and 2004 because of conditions such as atypical radiology (38 per cent), chronic obstructive pulmonary disease (COPD; 26 per cent), and 19 dyspnea (13 per cent). Nurses or respiratory therapists executed assessments of patients by engaging in telemedicine in 90 per cent of the visits. Telemedicine implemented by well-trained professional (s) saved patients approximately 300,000 miles of travel during the study (Raza et al., 2009). Raza et al. concluded that the provision of a telemedicine facility enabled a remote, underserved rural population to have improved access to health care services. The findings of the study showed the role that telemedicine could provide where physicians would have access to patients’ medical records for treatment in rural populations.

Zanni (2011) noted telemedicine allows caregivers to provide health services and medical information to patients who might not otherwise receive treatment because of the distance between their home and the clinic. Telemedicine includes the potential to increase patient access by allowing physicians to monitor remotely, diagnose, and treat patients. Telemedicine is still evolving, and physicians must identify problems, such as how to manage the facilities standard of care and patient compensation strategies to increase the use of the technology (Zanni, 2011).

Talukdar and Reddy (2012) noted that in India, almost 70 per cent of people still live in villages, even after 60 years of independence. Few patients have access to appropriate health care. Talukdar and Reddy (2012) initiated a rural health care project to reduce cost-effective gastrointestinal care to rural inhabitants. Talukdar and Reddy (2012) adapted a bus into a mobile unit furnished with required diagnostic equipment including a customized endoscopy unit. A van, furnished with electronic communication equipment, accompanied the mobile unit and transmitted data back to the main telemedicine center. Talukdar and Reddy (2012) concluded that the combination of the mobile device and van allowed physicians to perform over 30,000 endoscopic procedures for patients who would otherwise not receive treatment. Rural occupants and the medical staff reported a high level of satisfaction (Talukdar & Reddy, 2012).

Sinha, Tiwari, and Kataria (2012) reported that, in India, telecommunication technology is developing rapidly in medical information and services, particularly in neurosurgical emergencies. Neurosurgical specialists work primarily in urban settings leaving a void in rural areas. Sinha et al. (2012) recommended that nations with insufficient health care access, as in India where even the most basic health care requires development, could integrate telemedicine technologies in the delivery system.

Sinha et al. (2012) asserted that issues pertaining to security, privacy, maintaining standards and legal aspects are relevant. Leaders established guidelines for adopting telemedicine and periodically updated the procedures to sustain the growth of telemedicine (Sinha et al., 2012).

Jacob, Larson, and Craighead (2012) noted that one approach used in solving mental health care disparity issues in rural areas is through use of a children’s telepsychiatry consultation practice in which psychiatrist’s use videoconferencing technology. The provider issues a treatment plan for the child’s primary care physician and family. Jacob et al. (2012) used a 2-session telepsychiatry consultation protocol consisting of a psychiatric evaluation and recommendation session for patients located in rural Georgia. The findings of the study showed that establishing a child telepsychiatry consultation practice is necessary for rural areas because of the benefits aimed for the patients.

Yellowlees et al. (2013) examined the feasibility of conducting psychiatric consultations using video-based technology from 60 nonemergency adult patient assessments. The recordings lasted 20 to 30-minutes and uploaded to an internet application along with the patient’s medical record. Yellowlees et al. (2013) discovered that psychiatrists treated patients remotely for mood and anxiety disorders and substance abuse.

Chun, Patterson, Jacobs, and Soares (2012) explained telemedicine has emerged as a useful tool for providing health care services to the elderly living in rural areas, which have fewer medical resources and specialists available. Chun et al. (2012) proposed a web-based telemedicine solution as a viable means to provide the elderly population with the required health care resources because this group has limited knowledge in the use of Internet technology. Chun et al (2012) noted that a web design would make the technology more user friendly for the elderly. Chun et al. (2012) suggested that web-based telemedicine is an effective tool physician could adopt to provide home health care services, which are more practical in rural areas.

In sum, telemedicine has been implemented successfully in urban and rural areas. It has been deployed for childcare, elderly treatment, neurosurgical emergencies, children telepsychiatry, and adult mental health. As can be seen from the various examples of where telemedicine has been successfully implemented, telemedicine adoption by healthcare workers can be of immense assistance in providing accessibility to a lot of Nigerians in the different sectors of healthcare facets, especially the rural areas. Definitely, the adoption of telemedicine would yield substantial cost savings, improved healthcare, and motivated workforce.

* Dr. Femi Obikunle, Certified Telehealth Clinical Presenter (CTCP) -USA, Doctor of Business Administration – Healthcare Management (Telemedicine), and USA. He is currently the Founder and Chief Executive Officer of Elvote Consulting Services (A Venture Capitalist company that specializes in Telemedicine, Telehealth Data Analytics Consulting, Medical Research, and Information Technology) in USA. He has presented papers with The Project Management Institute (PMI), and The American Telemedicine Association (ATA).