Development of telemedicine in the Czech Republic from patients' and other key stakeholders' perspective.

Telemedicine is a way to improve healthcare outcomes with greater efficiency for both patients and care providers. The great potential of digital technologies also lies in strengthening the patient-centered approach. The early successes and benefits of telemedicine in the Czech Republic, amplified by the COVID-19, have contributed to the fact that wider implementation of telemedicine is already generally supported at the expert and public levels. Our research focuses on the identification of key issues in the implementation of telemedicine and the challenges of telemedicine in the future, from the perspective of patients and other stakeholders. The study is based on a qualitative research approach, combining focus groups with key stakeholders, patient panels and expert panels (2021-2022). The lack of rules and uncoordinated development of various activities proved to be the main barriers to the integration of telemedicine in the health system. This regulatory uncertainty can generate a number of problems in the patient-doctor relationship in practice, including ethical ones, and can also lead to inequalities in access to healthcare and affect the overall quality of care provided. Furthermore, it has been shown that patients' interests in the implementation of telemedicine are: 1. a predictable and reliable framework that guarantees them certainty and security in the provision of telemedicine services, 2. telemedicine solutions that increase the availability and efficiency of the care provided while bringing comfort, and 3. user-friendly and simple solutions. At the same time, patients want to understand the new environment and be active participants in the process of digital innovation, including the practical implementation of telemedicine. The research team has developed recommendations for further developments in the implementation of telemedicine that reflect the patient's interest and can be implemented at three levels - the health system, institutional, and community level. In countries with a well-developed and institutionalized patient movement, the community level can be represented by patient organizations, thus becoming the link between telemedicine policy making and implementation at the individual level of healthcare provision. For the further development of telemedicine, the development of a national strategy involving all key stakeholders, including patients, in the implementation has proven essential.

Health aspects of the behaviour of the Czech population during the COVID-19 pandemic from a public health perspective.

The paper presents the outcomes of the WHO European Region research project, Ministry of Health of the Czech Republic and the First Faculty of Medicine, Charles University which concerned Czech population behaviour during the COVID-19 pandemic. In the Czech Republic the research was carried out in three waves on a representative sample of respondents using methodology of a questionnaire survey. The results showed that the risk perception in connection with the pandemic was low in the Czech environment, regardless of the growing number of infected and deceased. Optimism persisted about the perception of personal susceptibility to infection and self-efficacy. General wellbeing was above average after successfully coping with the first wave, but it decreased slightly in connection with the worsening of the pandemic situation. Compliance with preventive measures has been relatively low for a long time and the trend has been rather declining. By the time, it became increasingly difficult to understand the communication of state authorities regarding the measures being implemented, and trust in the media decreased. A positive finding was the increase in the proportion of those who tried to improve the lifestyle in connection with the pandemic.

Physicians' experiences of intercultural differences in communication with Ukrainian refugees during the Russian-Ukrainian armed conflict.

The aim of the study was to identify and explore barriers to communication between refugees from Ukraine and physicians providing health care, the perspective of physicians was embraced. The focus of the work reflects on the arrival of many forced migrants from Ukraine in 2022. Further, it focuses on the pressure that the presence of migrants' places on the Czech healthcare system, especially in doctor-migrant patient communication. The objectives of this study are also motivated by existing international evidence that misunderstandings and poor-quality communication can lead to lower patient satisfaction and adherence, and consequently poorer healthcare outcomes. The research was carried out in the form of qualitative research, 16 in-depth semi-structured interviews were conducted with physicians providing health care to Ukrainian refugees. Informants were selected using a purposive sampling method to obtain as diverse a sample as possible. The resulting data were analysed by applying thematic coding. The results showed that four main areas of intercultural barriers play a key role in the relationship between physicians and Ukrainian patients. These are: (1) language, (2) differences in healthcare systems, (3) different attitudes towards health and illness and (4) prejudice. The major source of misunderstanding was the difference between the Czech and Ukrainian healthcare systems, which leads to a different position of the patient in the healthcare system. The conclusions prove that intercultural barriers play a significant role in the provision of health care to Ukrainian refugees but can be addressed to a large extent. The current situation in Czechia and the increasing diversity in society call for the need to acquire intercultural competencies in undergraduate and continuing medical education. Similarly, the adoption of measures that promote culturally competent health care is needed.

The challenges of telemedicine in the Czech Republic from an expert perspective.

Health policy makers are striving to implement new approaches in healthcare with a focus on digital solutions. The COVID-19 pandemic has contributed to an unprecedented acceleration in the spread of information and communication technologies (ICT) in healthcare and has accelerated the use of telemedicine. The aim of the research was to identify problems related to the implementation of telemedicine in practice, to propose possible solutions and to identify the challenges of telemedicine in the Czech Republic in the future. The study is based on the results of a two-phase qualitative expert investigation. Data collection in the first phase took the form of individual semi-structured interviews with experts who have practical experience in the field of telemedicine. The follow-up second phase was conducted in the form of guided group discussions with experts focusing on health, financial and legislative aspects of telecare. It turned out that the introduction and expansion of telemedicine requires changes in the technological infrastructure, in the organization of care and work, and in the adjustment of the legislative environment. It is also necessary to consider the need to overcome several barriers at the level of the healthcare system, healthcare providers, healthcare professionals and patients. On the other hand, a condition for the successful introduction and development of telemedicine is coordinated cooperation between various institutions and stakeholders. The introduction of telemedicine should also be preceded by studies (research) and in-depth analyses. Telemedicine education of healthcare professionals and support for patients in developing their digital competences are also important.

[National Database of Genotypes--ethical and legal issues]. / Národní databáze genotypu--etické a právní aspekty.

National Database of Genotypes--ethical and legal issues The aim of the project National Database of Genotypes is to outline structure and rules for the database operation collecting information about genotypes of individual persons. The database should be used entirely for health care. Its purpose is to enable physicians to gain quick and easy access to the information about persons requiring specialized care due to their genetic constitution. In the future, another introduction of new genetic tests into the clinical practice can be expected thus the database of genotypes facilitates substantial financial savings by exclusion of duplicates of the expensive genetic testing. Ethical questions connected with the creating and functioning of such database concern mainly privacy protection, confidentiality of personal sensitive data, protection of database from misuse, consent with participation and public interests. Due to necessity of correct interpretation by qualified professional (= clinical geneticist), particular categorization of genetic data within the database is discussed. The function of proposed database has to be governed in concordance with the Czech legislation together with solving ethical problems.