ASSESSMENT OF THE KNOWLEDGE AND PRACTICE OF TELEMEDICINE AMONG MEDICAL DOCTORS IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH), ENUGU STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

The adoption of telehealth has experienced a substantial increase in reaction to the COVID-19 epidemic, as telemedicine provides a means to communicate with healthcare providers without the requirement of direct physical contact. This is a notable advantage, considering the mode of transmission of the SARS-CoV-2 virus (Kante et al., 2022).  However, the level of acceptance and implementation of this technology is still limited in certain African countries, such as Nigeria (Muri, 2023).  Although Nigeria has recently seen the successful deployment of several noteworthy telemedicine programmes, both individuals and medical professionals maintain a sceptical attitude about the effectiveness of telehealth and are reluctant to fully adopt it (Aina, 2022).

Telemedicine has gained global recognition for its capacity to improve healthcare provision, decrease patient journey duration, decrease expenses, and enhance the effectiveness of healthcare systems (Young et al., 2021). Telemedicine can be crucial in bridging the healthcare access gap between urban and rural areas in Nigeria, where substantial inequities exist. Incorporating telemedicine into the Nigerian healthcare system is crucial for enhancing healthcare results and attaining fair healthcare availability (Bobby, 2020). The provision of health care services in Nigeria is hindered by a multitude of issues, such as deteriorating and inadequately equipped health care facilities, a shortage of medical workers who get inadequate compensation, inadequate road networks, and insufficient finance. Hence, any novel solution that efficiently links healthcare experts with patients in the shortest possible time, while also reducing expenses and enhancing clinical outcomes, will significantly enhance the quality of life for Nigerians. Telemedicine effectively addresses the obstacles that restrict access to healthcare services in both developed and poor nations. The telegraph, which was the inaugural electrical telecommunication device in human history, was initially employed for medical applications, specifically teleconsultation, in Australia in 1874 (Ashley et al., 2018).

Thomas Bird is credited with providing the initial official definition of telemedicine as the practice of medicine without the typical face-to-face interaction between physician and patient, facilitated by an interactive audio-video communication system (Gustavo, 2018). Telemedicine, as defined by the World Health Organisation (WHO, 2020), is the use of Information and Communication Technologies by healthcare professionals to provide healthcare services when distance is a significant factor. It involves the exchange of valid information for purposes such as diagnosing, treating, and preventing diseases and injuries, conducting research and evaluation, and facilitating the continuing education of healthcare providers. The ultimate goal is to improve the health of individuals and communities. Telemedicine aims to reduce the occurrence of preventable deaths, illnesses, and loss of productivity caused by limited access to specialised healthcare, delayed or inaccurate transmission of patient information, and the use of potentially harmful alternative treatments such as self-medication, quackery, and herbal remedies (Ashfaq, 2020).

In 2015, the Federal Ministry of Health and Federal Ministry of Communications Technology collaborated to create the National Health Information and Communications Technology (Health ICT) Strategic Framework. This framework outlines the shared vision and required steps for all parties involved in Nigeria's healthcare system (UNTH, 2020). The process consists of three stages: phase one (set-up), phase two (deploy, maintain, and support), and phase three (consolidate and continuously review). These stages aim to utilise existing and future ICT investments to establish a unified national health information infrastructure and achieve universal health coverage by 2020 (UNTH, 2020: NHIS, 2020: Adeoye, 2022).

Its implementation was projected to achieve this through: improved access to health services through the effective use of telemedicine and other information and communication technologies for health worker training and support; improved coverage of health services as well as tracking demand and supply of health services and commodities; increased uptake of health services through the effective use of mobile messaging and cash transfer incentives for demand creation; improved quality of care through the effective use of information and communication technologies for decision support within the continuum of care; increased financial coverage for health care services through the effective use of Information and communication technology for the National Health Insurance Scheme and other health related financial transactions and increased equity in access to and quality of health services, information and financing through the effective use of information and communication technologies for delivering appropriate health services for those who need them. At yet, there is no information regarding the successful or unsuccessful results of these resolutions (UNTH, 2020: Adeoye, 2022).

The effective deployment of telemedicine is highly dependent on the expertise and professional routines of medical doctors (Yunusa et al., 2019: Vidal, 2022). It is essential to assess the proficiency, attitudes, and actual practices of medical professionals in utilizing telemedicine in order to identify educational requirements and obstacles to its implementation. Uforo and Micah (2023) argued that medical students with a strong understanding of telemedicine's capabilities are more likely to integrate it into their future practices. This could involve conducting virtual consultations, remotely monitoring chronic conditions, and collaborating with specialists across distances. Their comfort level with the technology will directly translate into its practical application for patient care. Manasseh and Ukpono (2021) assert that students who perceive telemedicine's potential to improve diagnosis and treatment are more likely to utilize it effectively. This can lead to earlier interventions, improved adherence to treatment plans, and ultimately, better patient outcomes.

1.2 Statement of the Problem

The onset of the lethal COVID-19 has exacerbated the necessity for limited physical interaction between healthcare providers and patients who faced challenges in communication due to the physical gap, masks, personal protective equipment, and often struggled to comprehend the instructions provided by the physicians. In order to ensure efficient telemedical service delivery, it is essential to have a reliable and high-speed internet connection. This is because telemedicine services often involve tasks such as processing medical data, accessing the latest information, and facilitating real-time contact between patients and experts. 

In 2020, UNTH established a collaboration with the Federal Ministry of Health to implement telemedicine hospital response services. This initiative allows regular patients to remotely receive vital health information and engage in consultations with medical professionals. According to Nina & Godwin (2023), the primary obstacles for telemedicine are the physician's knowledge, attitude, and acceptability. Furthermore, Anjola (2023) asserts that various factors, including technological, human, organizational, societal, and individual elements, have the potential to restrict the use of telehealth in the healthcare sector. Chinedu (2023) asserts that Medical Doctors may face challenges including resistance to changing their responsibilities, developing new competencies, and the lack of a telemedicine-integrated business framework. Medical practitioners have obstacles in effectively utilizing telemedicine services due to the financial burden of obtaining licenses and equipment, as well as a lack of expertise in running telehealth devices. Whereas Anjola (2023) highlighted that A positive perception of telemedicine's ability to streamline workflows and improve patient access can lead to its wider adoption.  Students who see its value in decongesting clinics and reaching remote areas are more likely to champion its use, expanding healthcare reach within the Nigerian context.

Despite the acknowledged advantages of this technology, the extent to which telemedicine is being adopted and effectively utilized by medical professionals in Nigeria, especially at tertiary healthcare facilities such as the University of Nigeria Teaching Hospital (UNTH), is not well understood, An assessment is required to determine the level of knowledge and practical application of telemedicine among medical professionals at UNTH. The study aims to evaluate the level of understanding and implementation of telemedicine among medical professionals at the University of Nigeria Teaching Hospital, Nigeria. 

Objectives of the study

The primary objective of this study is to critically assess the knowledge and practice of telemedicine among medical doctors in University of Nigeria Teaching Hospital (UNTH), Enugu State, Nigeria. Specific objectives of this study are to:

To assess the level of awareness and understanding of telemedicine among medical doctors at UNTH.

To explore the attitudes and perceptions of medical doctors towards telemedicine in UNTH.

To identify the barriers to telemedicine adoption and practice among medical doctors at UNTH.

To suggest strategies for improving telemedicine knowledge, practice, and integration into the healthcare system at UNTH and beyond.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the level of awareness and understanding of telemedicine among medical doctors at UNTH?

What is the attitudes and perceptions of medical doctors towards telemedicine in UNTH?

What are the barriers to telemedicine adoption and practice among medical doctors at UNTH?

What are the strategies for improving telemedicine knowledge, practice, and integration into the healthcare system at UNTH and beyond?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of awareness and understanding of telemedicine among medical doctors at UNTH is low

Ha: The level of awareness and understanding of telemedicine among medical doctors at UNTH is high.

1.6 Significance of the study

The importance of evaluating the understanding and implementation of telemedicine among physicians at the University of Nigeria Teaching Hospital (UNTH), located in Enugu State, Nigeria, may be comprehended by considering numerous crucial factors. has important implications for improving access to healthcare, improving the delivery of services, managing costs, encouraging professional growth, shaping healthcare legislation, and advancing scientific knowledge in the field of telemedicine. The significance and applicability of doing this study in this particular hospital setting are emphasised by these variables taken together.

An assessment of the existing knowledge and use of telemedicine among medical professionals at UNTH can facilitate the identification of areas that require enhancement. This include the identification of necessary training, technology infrastructure prerequisites, and strategies for integrating workflows that can improve the efficiency and efficacy of healthcare delivery. The study can identify potential areas for further development of continuing medical education (CME) and training initiatives that specifically target telemedicine. Implementing this will enable medical doctors at UNTH to stay updated on technical innovations and best practices in telemedicine, promoting professional growth and continuous learning. 

Furthermore, Telemedicine has the capacity to decrease healthcare expenses by minimising the need for patients and healthcare providers to travel, optimising the use of resources, and potentially reducing the number of hospital admissions through timely remote consultations. Evaluating the telemedicine practices of medical practitioners can help to uphold or improve the quality of healthcare services offered at UNTH. This involves ensuring that telemedicine consultations comply with established clinical guidelines and standards, ultimately enhancing patient outcomes.

The study's findings can provide valuable insights for shaping healthcare policies at both the institutional and governmental levels in Enugu State and Nigeria as a whole. This encompasses promoting investments in communications infrastructure, establishing legal frameworks for telemedicine practice, and formulating reimbursement schemes for telemedicine services.

Moreover, future academics will employ it as a comprehensive analysis of the existing literature. As a result, other students who are interested in studying this subject will have the chance to use this work as existent information that may be subjected to critical examination. This study contributes to the academic discourse on evaluating the understanding and implementation of telemedicine among physicians at the University of Nigeria Teaching Hospital (UNTH) in Enugu State, Nigeria. 

1.7 Scope of the study

Broadly, this study focuses to critically assess the knowledge and practice of telemedicine among medical doctors in Nigeria. Specifically, this study seeks to assess the level of awareness and understanding of telemedicine among medical doctors in Nigeria and explore the attitudes and perceptions of medical doctors towards telemedicine in Nigeria. 

Further, this study will focus on identifying the barriers to telemedicine adoption and practice among medical doctors in Nigeria and it also seeks to suggest strategies for improving telemedicine knowledge, practice, and integration into the healthcare system in Nigeria

1.8 Limitations of the study

As is typical in any human endeavour, the researchers faced minor limitations during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data for assessment of the knowledge and practice of telemedicine among medical doctors in University of Nigeria Teaching Hospital (UNTH), Enugu State, Nigeria. Hence, a significant investment of time and effort was necessary to locate appropriate materials, publications, or information and gather data.

 Moreover, this study is constrained by its small sample size and narrow geographic scope, namely focusing solely on University of Nigeria Teaching Hospital (UNTH), Enugu State. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

The study is carried out in the University of Nigeria Teaching Hospital (UNTH), Ituku-ozalla, Enugu State

1.9 Definition of terms

Telehealth: Telehealth involves the delivery of healthcare services using digital technologies and telecommunications.

Telemedicine: Telemedicine encompasses a range of electronic communication methods, such as video calls, phone conversations, and online messaging, that enable the diagnosis, treatment, and management of patients without the requirement of face-to-face appointments 

Perception: Perception is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information or environment.