Editorial
Acceptance of Telemedicine Among Healthcare Professionals
Aceptación de la telemedicina por los profesionales sanitarios
a Servicio de Neumología, Unidad de Cuidados Intermedios Respiratorios, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
b Servicio de Neumología, Hospital Universitario Sant Joan d’Alacant, San Juan, Alicante, Spain
c Servicio de Neumología, Consorcio Hospital General Universitario de València, Valencia, Spain
d Coordinador Año SEPAR 2014/2015 del Paciente Crónico y las Terapias Respiratorias Domiciliarias
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class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Telemedicine (TLM) consists of a set of information and communication technologies (ICT) that facilitate the remote practice of medicine.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The use of TLM programs is becoming more widespread, and in the field of respiratory medicine its use has extended to sleep apnea, asthma, smoking cessation, chronic obstructive pulmonary disease, and others. Most of the experience has been gained from programs monitoring patients in their own home,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> an approach which has led to a reduction in the number of exacerbations and hospital admissions.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite its potential benefit, implementation of TLM has been a slow and difficult process. Some of the factors preventing widespread implementation of this strategy are well-known and include: poor organization in healthcare institutions, lack of cost-effectiveness studies and specific laws governing use of the information generated, and resistance to change.</p><p id="par0020" class="elsevierStylePara elsevierViewall">While we know that patients are willing to accept TLM, its acceptance among healthcare professions has not been studied in depth.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Several questionnaires are available for assessing the acceptance of technologies among users, the most widely used being the Technology Acceptance Model (TAM). This tool, proposed by Davis in 1989,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> is based on Ajzen and Fishbein's theory of reasoned action (1980).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> The TAM attempts to explain how users come to accept and use a certain technology, in terms of the causal relationship between the design of the technology, perceived ease-of-use, perceived usefulness, and the user's attitude toward using the system (determined by a series of non-technological variables).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The TAM is structured as follows: 3 dimensions address perceived ease-of-use, intention to use, and perceived usefulness. Each dimension is subdivided into different items, and answered “yes/no”<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>: perceived ease-of-use, 6 items; intention to use, 3 items; and perceived usefulness, 6 items.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Several standard studies have demonstrated the validity and ease-of-use of the TAM,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> its high pre-test reliability, and its ability to predict intention to use and attitude to usage.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> One of the main criticisms of applying TAM to TLM programs is that the perceived usefulness dimension is not a significant determinant of the attitude and intention to use dimensions.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The TAM is now widely used in TLM programs and other healthcare programs.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Studies have so far reported a high level of acceptance among healthcare professionals, yet uptake of different ICTs and TLM initiatives has been disappointing.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">This appears to be due to external motivational factors, previously identified by Davis,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> which decisively influence how these resources are used.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Motulsky et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> and Cresswell et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> divided these external factors into 3 groups, as follows: (1) institutional organization, (2) clinical practice guidelines and performance standards in TLM, and (3) training. Other factors related with the use of ICTs include accessibility to resources and a feeling of self-sufficiency.</p><p id="par0060" class="elsevierStylePara elsevierViewall">One of the main resistance factors reported in the scientific literature is the healthcare professional's belief that TLM will increase their work burden. Several studies have shown that protocols for implementing these programs and prior training help overcome this attitude.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Telemonitoring schemes generate large amounts of clinical data,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> so clinical response must be protocolized, and data must be stratified according to relevance. For this reason, specialized personnel must be specifically trained in using TLM,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> and tangible objectives must be defined before it is implemented.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Since the acceptance of TLM among healthcare professionals in the field of respiratory medicine has not been specifically studied, we invited all the members of the Spanish Society of Pulmonology (SEPAR, <a href="http://www.separ.es/">http://www.separ.es</a>) to share their opinion by responding to an anonymous survey, designed along the lines of the TAM (Davis, 1989), to evaluate the degree of acceptance of TLM programs.</p><p id="par0075" class="elsevierStylePara elsevierViewall">We received a total of 348 responses, 254 (73%) of which were submitted by pulmonologists. Mean age of participants was 41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 years.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In total, 57% (200 participants) did not have any previous experience in TLM programs. The degree of experience was not associated with the respondents’ professional role (<span class="elsevierStyleItalic">P</span>=.067), but it was statistically significantly related with age (51% in respondents aged ≥50 years vs 38% in respondents <50 years; <span class="elsevierStyleItalic">P</span>=.035 and 95% CI: −0.02–0.25).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Overall satisfaction (defined as the total percentage of “yes” answers in the questionnaire) was 77%; when stratified by TAM dimensions, satisfaction was for: perceived usefulness, 75%; perceived ease-of-use, 75%; and intention to use, 81%,</p><p id="par0090" class="elsevierStylePara elsevierViewall">The main resistance factors among respondents were grouped in the perceived usefulness and perceived ease-of-use dimensions.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Within the intention to use dimension, the item “I intend to use telemedicine <span class="elsevierStyleItalic">routinely</span> with my patients” was the main resistance factor reported, irrespective of previous experience or age.</p><p id="par0100" class="elsevierStylePara elsevierViewall">This point, in our opinion, is of great importance, since it explains why several studies<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> have highlighted the need to restrict TLM to those patients who would most benefit from it and avoid the routine use of these resources.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Naturally, healthcare professionals with no experience of TLM – who were also the youngest – expressed more concern about whether they would be able to “do what telemedicine wants me to do” (item included in the perceived ease-of-use dimension). This response underlines the importance of conducting specific TLM training programs for improving acceptance among professionals. Trained users make better use of TLM programs and thus give more positive feedback.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion, healthcare professionals involved in respiratory medicine have a generally good opinion of TLM. We have detected some resistance factors, which appear to be associated with need for specific information on TLM and defined guidelines and performance standards. These factors must be taken into account when setting up TLM programs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Segrelles-Calvo G, Chiner E, Fernández-Fabrellas E. Aceptación de la telemedicina por los profesionales sanitarios. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 37 | 27 | 64 |
| 2024 September | 46 | 24 | 70 |
| 2024 August | 61 | 37 | 98 |
| 2024 July | 37 | 23 | 60 |
| 2024 June | 65 | 34 | 99 |
| 2024 May | 80 | 43 | 123 |
| 2024 April | 38 | 34 | 72 |
| 2024 March | 45 | 21 | 66 |
| 2024 February | 36 | 23 | 59 |
| 2023 March | 3 | 3 | 6 |
| 2023 February | 35 | 17 | 52 |
| 2023 January | 29 | 30 | 59 |
| 2022 December | 50 | 40 | 90 |
| 2022 November | 46 | 27 | 73 |
| 2022 October | 37 | 44 | 81 |
| 2022 September | 40 | 56 | 96 |
| 2022 August | 35 | 45 | 80 |
| 2022 July | 51 | 45 | 96 |
| 2022 June | 51 | 30 | 81 |
| 2022 May | 64 | 46 | 110 |
| 2022 April | 88 | 54 | 142 |
| 2022 March | 73 | 56 | 129 |
| 2022 February | 74 | 47 | 121 |
| 2022 January | 71 | 55 | 126 |
| 2021 December | 66 | 45 | 111 |
| 2021 November | 75 | 48 | 123 |
| 2021 October | 101 | 48 | 149 |
| 2021 September | 98 | 64 | 162 |
| 2021 August | 81 | 74 | 155 |
| 2021 July | 73 | 46 | 119 |
| 2021 June | 104 | 68 | 172 |
| 2021 May | 92 | 60 | 152 |
| 2021 April | 312 | 139 | 451 |
| 2021 March | 187 | 63 | 250 |
| 2021 February | 110 | 61 | 171 |
| 2021 January | 108 | 47 | 155 |
| 2020 December | 114 | 68 | 182 |
| 2020 November | 124 | 47 | 171 |
| 2020 October | 106 | 45 | 151 |
| 2020 September | 87 | 35 | 122 |
| 2020 August | 66 | 32 | 98 |
| 2020 July | 83 | 39 | 122 |
| 2020 June | 59 | 26 | 85 |
| 2020 May | 69 | 27 | 96 |
| 2020 April | 36 | 29 | 65 |
| 2020 March | 51 | 19 | 70 |
| 2020 February | 54 | 17 | 71 |
| 2020 January | 55 | 27 | 82 |
| 2019 December | 53 | 31 | 84 |
| 2019 November | 54 | 19 | 73 |
| 2019 October | 43 | 13 | 56 |
| 2019 September | 45 | 13 | 58 |
| 2019 August | 41 | 14 | 55 |
| 2019 July | 35 | 15 | 50 |
| 2019 June | 51 | 26 | 77 |
| 2019 May | 68 | 25 | 93 |
| 2019 April | 73 | 45 | 118 |
| 2019 March | 58 | 27 | 85 |
| 2019 February | 60 | 14 | 74 |
| 2019 January | 60 | 16 | 76 |
| 2018 December | 53 | 28 | 81 |
| 2018 November | 71 | 23 | 94 |
| 2018 October | 72 | 26 | 98 |
| 2018 September | 32 | 13 | 45 |
| 2018 May | 15 | 0 | 15 |
| 2018 April | 24 | 7 | 31 |
| 2018 March | 16 | 3 | 19 |
| 2018 February | 27 | 5 | 32 |
| 2018 January | 23 | 5 | 28 |
| 2017 December | 30 | 6 | 36 |
| 2017 November | 28 | 7 | 35 |
| 2017 October | 30 | 9 | 39 |
| 2017 September | 15 | 7 | 22 |
| 2017 August | 25 | 12 | 37 |
| 2017 July | 12 | 6 | 18 |
| 2017 June | 30 | 30 | 60 |
| 2017 May | 21 | 5 | 26 |
| 2017 April | 28 | 3 | 31 |
| 2017 March | 13 | 5 | 18 |
| 2017 February | 17 | 8 | 25 |
| 2017 January | 13 | 10 | 23 |
| 2016 December | 24 | 6 | 30 |
| 2016 November | 39 | 12 | 51 |
| 2016 October | 47 | 13 | 60 |
| 2016 September | 34 | 2 | 36 |
| 2016 August | 37 | 8 | 45 |
| 2016 July | 36 | 8 | 44 |
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