ABSTRACT
Background: Telemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at health care facilities. However, its adoption in health care is not entirely realized due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian health care system, observed at the infrastructural, sociocultural, regulatory, and financial levels, from the perspectives of health care providers, patients, patient caregivers, society, health organizations, and the government. Methods: This review complies with the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015. A total of 2,706 peer-reviewed studies published from December 2016 to September 2023 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE, and PsycInfo databases were considered for the title and abstract screening, after which 334 articles were chosen for the full-text review. In the end, 46 studies were selected for data synthesis. Results: Analysis of the literature revealed key barriers such as data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), infrastructure issues, and ICT training gaps. Facilitators included reduced health care delivery costs, enhanced patient access to health care in remote areas, and shorter patient wait times. The real-world experiences of Indian telemedicine practitioners and pioneers are also explored to complement literature-based perspectives on telemedicine implementation. Both stress the need for reliable internet connectivity, technological adoption, comprehensive ICT training, positive sociocultural attitudes, stringent data privacy measures, and viable business models as crucial for effective telemedicine adoption, with experts emphasizing practical adaptability alongside the literature-recognized facilitators.
Subject(s)
Telemedicine , Telemedicine/organization & administration , Humans , India , Health Services Accessibility/organization & administration , Stakeholder Participation , Attitude of Health PersonnelABSTRACT
In this work, we examined healthcare seeking behavior (HSB) of patients visiting public healthcare facilities in an urban context. We conducted a cross-sectional survey across twenty-two primary and secondary public healthcare facilities in the South-west Delhi district in India. The quantitative survey was designed to ascertain from patients at these facilities their HSB-i.e., on what basis patients decide the type of healthcare facility to visit, or which type of medical practitioner to consult. Based on responses from four hundred and forty-nine participants, we observed that factors such as wait time, prior experience with care providers, distance from the facility, and also socioeconomic and demographic factors such as annual income, educational qualification, and gender significantly influenced preferences of patients in choosing healthcare facilities. We used binomial and multinomial logistic regression to determine associations between HSB and socioeconomic and demographic attributes of patients at a 0.05 level of significance. Our statistical analyses revealed that patients in the lower income group preferred to seek treatment from public healthcare facilities (OR = 3.51, 95% CI = (1.65, 7.46)) irrespective of the perceived severity of their illness, while patients in the higher income group favored directly consulting specialized doctors (OR = 2.71, 95% CI = (1.34, 5.51)). Other factors such as having more than two children increased the probability of seeking care from public facilities. This work contributes to the literature by: (a) providing quantitative evidence regarding overall patient HSB, especially at primary and secondary public healthcare facilities, regardless of their presenting illness, (b) eliciting information regarding the pathways followed by patients visiting these facilities while seeking care, and (c) providing operational information regarding the surveyed facilities to facilitate characterizing their utilization. This work can inform policy designed to improve the utilization and quality of care at public primary and secondary healthcare facilities in India.
