Perception of the current ECG testing system
Table
2 presents the results of the descriptive analysis regarding the perception of the current ECG testing system by type of participant. Patients and patient guardians were grouped, and other occupations, such as administrators, were grouped into “others.”
Table 2
Perception of the current electrocardiography testing system by type of participant
Usage experience | Yes | 161 | 10 | 10 | 7 | 188 |
| No | 63 | 8 | – | 6 | 77 |
Degree of knowledge | Very much | 18 | 8 | 6 | – | 32 |
| Much | 47 | 5 | 1 | 3 | 56 |
| Average | 61 | 2 | 3 | 3 | 69 |
| Little | 76 | 1 | – | 6 | 83 |
| None | 22 | 2 | – | 1 | 25 |
Perceived need | Very much | 44 | 12 | 7 | 1 | 64 |
| Much | 69 | 3 | 2 | 7 | 81 |
| Average | 75 | 2 | 1 | 5 | 83 |
| Little | 18 | – | – | – | 18 |
| None | 18 | – | 1 | – | 19 |
Overall, the number of participants who had experience with conventional ECG tests was greater in patient and guardian, nurse, and doctor groups. The number was equal in the “others” group.
The patient and guardian, nurse, and doctor groups had more than a little knowledge of ECG testing, whereas the others group was neutral (factor subtotal n = 157, 59.25%). The degree of knowledge of the patient and guardian, nurse, doctor, and others groups was 2.83 ± 1.05, 3.89 ± 1.37, 4.3 ± 0.95, and 2.62 ± 0.96, respectively, with all results higher than the median.
In all of the groups, most participants answered that there was at least more than a little need for current ECG testing (factor subtotal n = 228, 86.03%). The perceived need for current ECG testing by the patient and guardian, nurse, doctor, and others groups was 3.41 ± 1.14, 3.68 ± 1.09, 4.60 ± 0.70, and 3.69 ± 0.63, respectively, with all results higher than the median.
When asked why they thought that current ECG testing is useful and needed, most of those who gave their opinion in the open-ended questions provided similar answers “Measuring ECG is the most basic process of knowing about heart diseases” (Participant #13), and “Because the doctor told me to do so” (Participant #45).
For those who thought that current ECG testing was not useful, most of the answers were similar to “Because I don’t think it’s doing me much good” (Participant #18), or “I do not know about the test, so I cannot see why it is useful” (Participant #20).
Prior to the regression analyses, a correlation analysis (Pearson) was conducted between usage experience and perceived need, and between the degree of knowledge and perceived need. The correlation results were both significant, with correlation values of 0.35 (p < 001) and 0.48 (p < 001), respectively. In the regression analysis, perceived need was used as the dependent variable. In the case of the independent variables, experience of ECG testing and degree of knowledge regarding current ECG testing were used. The results of the simple linear regression analysis between the perceived need for current ECG testing and relevant independent variables are the following.
In all regression analysis, (simple and multiple) all of the variables were similar to the normal distribution curve. The statistical analysis was conducted using the 95% confidence level. The simple linear regression analysis results showed that the perceived need of those who had experience with ECG testing was higher than the perceived need of those who had no experience (coefficient = 0.89, p < 0.001). In addition, it was found that the higher the degree of knowledge, the higher the perceived need (coefficient = 0.47, p < 0.001). R2 values were 0.13 and 0.23, respectively.
In the multiple linear regression analysis between perceived need for current ECG testing and the relevant independent variables, the socio-demographic factors were adjusted. Collinearity testing was conducted and the results showed that there was no correlation between the independent variables that could cause statistical bias (tolerance limit > 0.01 and variance inflation factor < 100).
The multiple regression analysis results showed that the perceived need of those who had experience with ECG testing was higher than the perceived need of those who had not (coefficient = 0.57, p < 0.001). Furthermore, it was found that the higher the degree of knowledge, the higher the perceived need (coefficient = 0.32, p < 0.001). The R2 value was 0.35.
Perception of remote ECG monitoring
The findings of the descriptive analysis of perception of a telemedicine service in a cardiology ward (remote ECG monitoring) by type of participant are summarized in Table
3.
Table 3
Perception of a remote electrocardiography monitoring system by type of participant
Perceived need | Very much | 27 | 3 | 1 | 3 | 34 |
Much | 119 | 5 | 3 | 10 | 137 |
| Average | 63 | 4 | 6 | – | 73 |
| Little | 12 | 6 | – | – | 18 |
| None | 3 | – | – | – | 3 |
Most important featurea | Home monitoring | 106 | 6 | 9 | 5 | 126 |
Monitoring while out | 51 | 5 | – | 1 | 57 |
Monitoring all the time | 57 | 1 | 1 | 7 | 66 |
| Other | 8 | 6 | – | – | 14 |
Usage intentions | Yes | 168 | 10 | 5 | 11 | 194 |
No | 56 | 8 | 5 | 2 | 71 |
Desired service provider | Government | 62 | 2 | – | 4 | 68 |
Hospitals | 147 | 13 | 10 | 8 | 178 |
No matter | 15 | 3 | – | 1 | 19 |
Desired main agenta | Public institution | 181 | 12 | – | 10 | 203 |
Private institution | 43 | 6 | 10 | 2 | 61 |
Development barriersa | Low IT | 42 | 8 | – | 6 | 56 |
| Lack of advertisement | 62 | 3 | 1 | – | 66 |
| Lack of knowledge | 58 | 3 | 3 | 1 | 65 |
| Fear of low personal information security | 53 | 4 | 5 | 4 | 66 |
| Other | 8 | – | 1 | 2 | 11 |
All groups replied that remote monitoring is needed (above average, overall n = 171, 64.52%). The perceived need of the patients and guardian, nurse, doctor, and others groups was 3.72 ± 0.82, 3.28 ± 1.13, 3.50 ± 0.71, and 4.23 ± 0.44, respectively, with all results higher than the median.
Patient and guardian (n = 106, 47.75%), nurse (n = 6, 33.33%), and doctor (n = 9, 90.0%) groups answered that the most important feature when developing remote ECG monitoring is home monitoring. The others group thought that remote monitoring should be available all of the time (n = 7, 53.85%).
In addition, most participants were willing to use a remote ECG monitoring system (patient and guardian n = 168, 75.0%; nurse n = 10, 55.56%; others n = 11, 84.62%; overall n = 101, 73.21%). The doctors group was neutral (n = 5, 50.0%).
All of the groups desired the hospital to provide a telemedicine service (patient and guardian n = 147, 65.63%; nurse n = 13, 72.22%; doctor n = 10, 100%; others n = 8, 61.54%; overall n = 178, 67.17%).
The patient and guardian (n = 181, 80.80%), nurse (n = 12, 66.67%), and others groups (n = 10, 83.33%) thought that public institutions should be the main agents of the telemedicine system (overall n = 99, 77.34%), whereas the doctor group thought that a private institution should be the main agent (n = 10, 100%).
Most critical barriers to telemedicine development were fear of personal information security, lack of knowledge, and lack of advertisement (each approximately 25%). The perceived need for a remote ECG monitoring system by location is presented in Table
4.
Table 4
Perceived need for a remote electrocardiography monitoring system by location
Perceived need | Very Much | 16 | 10 | 2 | 4 | 2 | – | 34 |
| Much | 85 | 14 | 6 | 10 | 12 | 10 | 137 |
| Average | 39 | 17 | 3 | 3 | 4 | 7 | 73 |
| Little | 10 | 4 | 2 | – | 1 | 1 | 18 |
| None | 3 | – | – | – | – | – | 3 |
Most of the participants in all locations answered that remote ECG monitoring will be needed more than average in the future. Chungcheong showed the highest score in perceived need with a mean and standard deviation of 4.06 ± 0.66, followed by Jeonla (3.79 ± 0.71), Gyeonggi (3.67 ± 0.93), Seoul (3.66 ± 0.83), Gangwon (3.62 ± 0.96), and Gyeongsang (3.50 ± 0.62).
In open-ended questions regarding the intention to use remote ECG monitoring, replies were the following: “Because you can prevent heart-related diseases at an early stage” (Participant #4), “Because it is efficient and convenient so you will not have to come to the hospital in person more often” (Participant #45), or “If the doctor tells me to do so, I will follow the decision” (Participant #90).
Regarding opinions about why participants do not have the intention to use remote ECG monitoring, most of the answers were similar to “I do not trust the current state of medical technology” (Participant #24).
There were some participants who gave additional insight to account for barriers to developing and implementing telemedicine, such as “Lack of discussion between social parties” (Patient #17) or “Opposition from doctor groups” (Participant #21).