Despite the increase in the utilization of telemedicine worldwide, especially during the pandemic, its implementation in Malaysia's healthcare industry remains scarce. Hence, this study aims to understand the current state of telemedicine utilization by identifying the constraints and establishing the optimum telemedicine implementation strategy.
The study proposes an integrated methodology based on strengths, weaknesses, opportunities, and threats (SWOT) analysis, analytical hierarchy process entropy (AHPE), and fuzzy technique for order performance by similarity to the ideal solution (FTOPSIS). The SWOT analysis is performed for the situational assessment of telemedicine technology in Malaysia. Each element of SWOT was assessed using AHPE to establish priorities, followed by the FTOPSIS approach to provide strategies for its successful adoption.
The findings show that continuous government support and encouragement for market acquisition, cost-cutting, profit-maximizing, and Internet of Things (IoT)-based adoption to establish a strong telemedicine network is the most important strategy for telemedicine technology implementation. While using a structured method to improve service quality, the implementation of a knowledge-sharing management program for telemedicine technology is ranked as the least preferred telemedicine technology implementation strategy.
The study suggests a systematic way of developing and evaluating telemedicine technology implementation strategies for further improving Malaysian healthcare patient experiences and policy endeavours. This study proposed alternative strategies to expand telemedicine technology implementation. It is hoped that this study could further enhance knowledge and serve as a guide for stakeholders in the healthcare industry to understand their business environment better.
The use of Magnetic Resonance Imaging (MRI) has increased significantly in recent years. Superior diagnostic capability and extension of criteria for the performance of MRI may explain this increase, but there are also non-clinical factors that influence doctors’ decisions. We aim to describe the views of doctors in the Basque Country (Spain) regarding factors affecting MRI orders.
We conducted a qualitative study using semi-structured interviews with doctors based on intentional sampling to cover a diverse range of interviewees according to personal and professional characteristics (sex, workplace, post of responsibility). We analyzed transcript content using an inductive approach.
Factors identified by doctors were classified into three themes: 1) superior diagnostic capability of the MRI compared to other imaging modalities has favoured MRI use and inclusion in Clinical Practice Guidelines; 2) patient demands, owing to lower trust and acceptance of doctors’ judgment than to technology-based medicine, leads to patient-doctor relationships that result unnecessary MRI test; 3) structural or contextual aspects of the health system, such as excessive rotation of doctors or a lack of time to carry out a thorough patient examination, which disempower doctors and favour overuse.
Doctors identified non-clinical factors that affect MRI use and that lead to unintended consequences both for the healthcare system and for patients. We recommend an organizational approach to give doctors enough resources to overcome non-clinical factors that lead to excessive MRI orders in order to optimize its use.
The COVID-19 pandemic undermines health service provision and poses threats to health systems in general. This study aims to investigate the early and long-term effects of COVID-19 on cancer screening.
We conducted a scoping review, in which we nested the Futures Wheel (FW) method and the Future Polygon (FP) method. PubMed, SCOPUS, and Web of Sciences databases were searched electronically to identify relevant studies published between 1 January 2020 and 25 July 2023. The FW method was applied to identify the early and long-term effects; the FP was applied during a focus group discussion with a group of experts with a view to estimating the lag time between COVID-19 and its effects on cancer screening.
A total of 79 studies met the inclusion criteria. We identified 31 early effects and 26 long-term effects of COVID-19, and divided them into four clusters: screening centers, at-risk persons, screening methods, and clinical staff. The first long-term effects of COVID-19 involve a tendency to shift from hospital-based to home-based screening, accompanied by an acceleration in the application of remote screening methods and emerging psychological problems among clinical staff. This may result in an increase in the number of people with serious oncological conditions, more intensive use of advanced therapeutic interventions, higher expenditure and worsening of treatment outcomes.
The effects of COVID-19 on cancer screening and its long-term effects on cancer treatment and its outcomes are ominous. A redesign of cancer screening programs may be required so as to make them more flexible and resilient to external shocks.
To select and refine evidence-informed peri-discharge complex interventions(abbrev. Interventions) for reducing 30-day hospital readmissions among Heart Failure(HF) and COPD patients in Hong Kong public healthcare system context using GRADE Evidence to Decision(EtD) framework.
Two 18-participant panels were recruited to carry out a two-step process for both conditions. In Step 1, participants were invited to prioritize Interventions and suggest important combinations of Interventions. In Step 2, based on the priority lists, participants were invited to conduct a two-round Delphi study for generating consensus-based Interventions for reducing 30-day hospital readmissions. GRADE EtD framework was used to guide the decision-making process, taking into consideration of benefits, harms, values and preferences, equity, acceptability, and feasibility.
Five out of ten Interventions reached positive consensus for HF, while six reached positive consensus for COPD. Case management, discharge planning, patient education, self-management, and telephone follow-up were common components, and were considered as core elements for reducing 30-day hospital readmissions among HF and COPD patients in Hong Kong. Preliminary implementation issues mainly included governance and leadership, financing, health workforce development, service access and readiness, as well as empowerment of patients and caregivers.
This study successfully applied the GRADE EtD framework for starting the adaptation process of complex interventions and established a list of local stakeholders-endorsed Interventions for reducing 30-day hospital readmissions for HF and COPD in Hong Kong. Before implementing and maintaining these endorsed Interventions at scale in local context, further research to improve intervention-context fit as well as piloting and evaluation is necessary.
Mobile health (mHealth) approaches are especially beneficial to Sub-Saharan Africa (SSA), which has a disproportionate disease burden and a scarcity of healthcare workers.
This study aims to assess the availability, stage, and targeted health issues of mHealth interventions in SSA and to identify the gaps.
The study employed a scoping review guided by Arksey and O'Malley's framework to explore the use of mHealth in SSA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used to report the review in a transparent and comprehensive manner. Articles published from 2000 to 2021 were searched in PUBMED, IEEE, SCOPUS, and Web of Science and evaluated with set of inclusion criteria. Data from the included publications were retrieved and synthesized.
A total of 1020 articles were found. 59 of these have met the criteria for inclusion. The results show the implementation of mHealth interventions in 21 SSA nations. Only 1 (2%) mHealth interventions used a wearable sensor-based approach. 13 (22%) were SMS text-based interventions, 17 (29%) were app-based mHealth approaches, 18 (30%) were telemedicine-based approaches, and 10 (17%) were mixed approaches. HIV, cancer, and maternal and child health problems are the most commonly discussed health issues. Proof of concept, design and development, a pilot test were the frequently documented stages of mHealth interventions.
Less than half of SSA countries incorporate mHealth platforms, highlighting the need for further development. Integrating wearable based platforms for real-time monitoring of physiological parameters demands careful consideration.
Mobile health (mHealth) technology is believed to be very beneficial for Sub-Saharan Africa (SSA) nations where there is a high disease burden but inadequate healthcare system. Evidence-based data on the use and implementation of mHealth systems is needed to trace implementation and fill existing gaps. We performed a scoping review to determine the current availability, use, and stage of mHealth interventions and targeted health services in SSA. 21 SSA nations made (few) attempts in designing and implementing of mHealth systems. HIV, cancer, and maternal and child health are some of the health services among others. Though few large-scale implementations were reported, most interventions are at an early stage. mHealth solution should be designed to be both economical and simple to use to increase its uptake and incorporate wearables for real-time monitoring of physiological parameters.
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