Exploring healthcare providers’ perspectives on virtual care delivery: insights into telemedicine services

Governments and health organizations worldwide have been developing services and regulations dedicated to providing the general population with a high-quality healthcare system. This system aims to reduce the burden of disease or injury, disability, and to improve peoples’ overall health status, as well as functioning level. However, booming public expectations, transforming health-related needs, and new aspiring goals are raising the bar for health systems to aim for better health outcomes. For that to be achieved, a high-quality health system is needed to optimize healthcare by the continuous provision of care, thus, improving or maintaining health [1]. One of the ways healthcare can be improved is by implementing different forms of technology [2]. Since we are living in a digital world, where communications, computer sciences, informatics, and medical technologies continue to progress rapidly, one must have heard about the term telehealth or telemedicine. As the name implies, the prefix tele- from Greek telos- means at a distance and health or medicine refers to different kinds of services and outcomes related to healthcare [3]. Throughout the past few decades, the swift development in technology led to a concurrent telemedicine advancement, resulting in a sophisticated targeted service used in homes, hospitals, and other healthcare facilities [2].

According to the World Health Organization (WHO), telemedicine is defined as “the provision of healthcare services at a distance with communication conducted between healthcare providers seeking clinical guidance and support from other healthcare providers (provider-to-provider telemedicine) or conducted between remote healthcare users seeking health services and healthcare providers (client-to-provider telemedicine)’’ [3]. Televisits are healthcare services provided through telemedicine and are defined as medical acts in which doctors communicate with patients remotely and might result in medicine or treatment prescriptions [3, 4]. In our study, we will use the term ‘telemedicine’ and choose ‘televisits’ as the healthcare service under question.

The rapidly spreading Coronavirus Disease 2019 (COVID-19) led to devastating consequences on healthcare systems, health workers, and patients, as well as the economy worldwide [5]. The challenge of the consistently growing number of COVID-19 cases and deaths warranted the establishment of an alternative method of care delivery and disease control. The emergence of COVID-19 was a turning point in the journey of telemedicine into practice [6]. During the pandemic, social isolation and extreme lockdown measures were implemented, this resulted in using telemedicine not only to take care of COVID-19 patients, but also in public awareness, research, and teaching [7]. These versatile areas of applications suggest using telemedicine even after the COVID-19 pandemic is over, due to the enhanced HCPs’ perception of such technology [8].

Telemedicine is considered a viable option by patients and healthcare professionals for providing healthcare services. Quality of care and confidentiality, as well as ensured privacy, are prerequisites for patients to accept telemedicine [9]. Moreover, telemedicine use would save time and is cheaper for patients considering the transportation cost, unpaid leaves, and gas prices [4]. However, the presence of perceived barriers to telemedicine, for example, the lack of physical examination and problems with the devices used, is linked to low utilization.Moreover, HCPs’ perceptions of this care delivery method are also a crucial factor in adoption. The importance of telemedicine in Kuwait, however, has not yet been properly established.

This study aims to evaluate the perceptions of HCPs for healthcare services provided virtually in Kuwait, and to assess their acceptance and intention to implement this service.

This study uses mixed methods to explore HCPs’ perceptions of telemedicine use in practice in Kuwait. The mixed methods design was best suited to understand the experiences of healthcare professionals since the questionnaire included a variety of aspects that helped in generating themes after interviewing the HCPs. Overall, our findings show that telemedicine is viewed as a beneficial, easy, and efficient way of healthcare delivery that could be a suitable alternative to traditional methods of care delivery. Our study explored HCPs’ experiences of using televisits to provide and access healthcare services in Kuwait during and after the COVID-19 pandemic. The healthcare professionals found telemedicine beneficial in many aspects; however, this was accompanied by an acknowledgment of barriers and challenges. Time and cost-saving spurred telemedicine use and the baseline HCPs' high intention rate to use telemedicine paves the way for official incorporation into healthcare systems.

Findings from the present study show that knowledge of telemedicine, previous experience, and perceived usefulness or ease of use are the main driving forces of healthcare providers' telemedicine use intention. Participants in the current study had moderate to high attitudes towards telemedicine. This was consistent with a study, where participants cited self-care improvement, hospitalizations reduction, and provision of high-quality care using telemedicine [16]. The interviews showed that although some HCPs accepted telemedicine, others were resistant. In Ayres et al. (2021), resistant HCPs focused on the limitations of telemedicine and perceived it as a temporary substandard substitute to in-person visits [17]. Also, many interviewees mentioned reduction in risk of infection as a benefit that encouraged them to implement televisits in their practice [18]. Less than a quarter of our HCPs were concerned for privacy violation when using telemedicine, however, more participants in older studies cited this issue [8, 19]. Our interviews and other studies suggested using HIPAA-compatible platforms which are easy to use, help in reaching patients, and maintain privacy [9, 17, 18].

The current study showed that the majority of participants were knowledgeable about telemedicine, which was in line with a similar study conducted in Norway and Lithuania [16], and this knowledge may have enhanced participants’ telemedicine use intention. Previous experience with telemedicine appeared to be positively correlated with HCPs' use preference, where almost three-quarters of phase 1 participants who have a previous telemedicine experience preferred using it in the future as well. This correlation was consistent with Ruiz Morilla et al. (2017), who noted a positive view in those who utilized telemedicine in their workplace [20].

By assessing correlations, use intention was modulated by knowledge and experience with telemedicine, perceived usefulness, ease of use, and attitude. Attitude towards telemedicine was the most significant factor, where 82.8% of those with high attitude scores had a high use intention score as well. This was consistent with one study that showed a positive effect of attitude on use intention [13].

The interviews in the present study showed that good communication skills, patience, and sympathy are the components of a trustful relationship between HCPs and patients. In addition to the previous qualities, empathy and emotional support were also mentioned in other studies [21]. In our interviews, we only asked the participants who had already tried telemedicine before if they thought that training was required, and 8 out of 11 said yes. One healthcare professional noted that the MOH system is complicated and requires training before usage; however, those who opposed training emphasized the ease with which platforms may be used. From this finding we can infer the importance of providing education and training in this field to improve providers' opinions and provide a technologically capable working team, thus facilitating telemedicine implementation [20].

Results from interviews revealed that the lack of physical examination was the most mentioned barrier by HCPs as they could not read patients' body language, make eye contact, or complete an objective examination. These findings were similar to current literature that addressed the importance of physical examination and non-verbal communication [21, 22]. Patient-related factors such as their age, hearing, visual, as well as language abilities were found to be barriers to conducting successful televisits [23]. Furthermore, patients’ level of education is critical, as not all of them can use applications or gain access to this type of service. Unlike other studies that showed an effect of age [20] on perceived usefulness and gender on attitude [24], sociodemographic characteristics had no significant effect on the results of this study. Additionally, some patients refuse to appear on camera because they fear being recorded. However, a study conducted in Kuwait looked at patients’ perceptions of virtual healthcare services and found that 24.3% were concerned about privacy, while 48.5% believed video calls were secure [9].

In the present study, we assessed whether providers thought virtual visits dehumanize interpersonal interactions or make them uncomfortable. Less than a quarter perceived dehumanized patient care, while half of the respondents felt comfortable using telemedicine. This might be explained by the familiarity with technology generally as it is implemented in almost all daily activities and used by healthcare providers during conferences and continuous medical education programs.

Findings from this study show that many participants were uncertain whether telemedicine leads to increased cost by increasing workload or not. When workload was further investigated through interview, some perceived increased workload using telemedicine, while others claimed it saves time. Another study conducted in 2021 also cited increased workload [25]. On balance, other studies expected more cost and time saving because of reduced travel time and transportation expenses [26, 27].

Our study revealed several benefits of telemedicine. One promising finding is the HCPs perceived high telemedicine usefulness. Amodt et al. (2019) produced similar findings where participants cited the feasibility of timely feedback and decreased workload by enabling the assessment of more patients in less time. Enhanced communication was also cited by Crilly et al. (2019), which noticed improved pharmacist-patient relationships after implementing telemedicine in community pharmacies. Interviews revealed that HCPs use televisits to triage patients and meet patients’ needs, which is a desired benefit as well as a facilitator of telemedicine implementation.

Nearly half of HCPs highly believed telemedicine is easily used, which exceeds the results of other studies. In this study, 54.9% find it easy to control telemedicine technology and get it to do what they command, but in Mammen et al. (2018), 46.9% faced technical problems while applying this technology [14]. Another discussed aspect is the flexibility of telemedicine stated by 48.9% of HCPs, yet inflexibility was stated in Helou et al. (2020) by physicians who could not manage consultation times adequately. Another mentioned inflexibility was the inability to retrieve patients' records [7].

Further elaboration during interviews were done to assess how these barriers could be overcome and increase use intention. One point is the need for highly qualified HCPs who are aware of strategies promoting a strong relationship with patients to enhance patient acceptance of telemedicine. Another point addressed how essential it is to have an IT team available at healthcare institutions, to ensure continuity of care and solve technical issues [27, 28]. A previous study also conducted in Kuwait addressed the importance of cooperation between HCPs and IT team [29].

The COVID-19 pandemic resulted in a dramatic shift of traditional in-person visits to virtual healthcare services. HCPs supported the incorporation of telemedicine in their practice in Kuwait, acknowledging the benefits and barriers of its implementation. Moreover, they suggested solutions to overcome the barriers. Future studies may consider comparing the perceptions of both patients and HCPs about telemedicine to evaluate their overall satisfaction and quality of care.