1. Characteristics of Study Participants ()
There were more males (84.4%, n = 184) than females (15.6%, n = 34) in the group. Those who were aged 45-54 years were most prevalent (43.1%). More than half (55%) of the participants were practicing at local clinics located in Seoul and metropolitan city. Participants owning specialty license for 10-19 years were the most prevalent (42.7%). Participants who have worked for 10-19 years at a local clinic formed the majority (38.5%). Participants seeing 50-99 patients per day were the most common (53.7%). Participants utilizing electronic medical record (75.2%) far outweighed non-users.
Characteristics of study participants.
2. Previous Experience of Telehealth Usage ()
62.4% (n = 136) of the participants were aware of the recent revisions on the telehealth legislation. Previous experience using telehealth consisted of the following: exchanges of medical information via internet (44%), teleeducation (30.3%), online medical counseling via internet or mobile device (26.1%), teleconsultation between doctors (4.1%), and telemonitoring (3.7%).
3. Factors Related with the Agreement on the Revised Telehealth Legislation ()
To the revised telehealth legislation clause allowing direct teleconsultation between doctor and patient, 20.2% (n = 44) of the participants agreed, 19.3% (n = 42) conditionally agreed and 60.6% (n = 132) disagreed. The participants who conditionally agreed to the clause proposed that the teleconsultation could be a viable option under the following conditions; if the patient has low accessibility to traditional medical system (n = 8), if the patient suffers from a chronic illness that requires continuous management (n = 7), if the doctor has already obtained sufficient information from the patient (n = 3), or if the patient's home is equipped with medical tools needed for telehealth (n = 2).
To the revised telehealth legislation clause allowing a deputy person to receive prescription by proxy, 33.5% (n = 73) of the participants agreed, 24.3% (n = 53) conditionally agreed, and 42.2% (n = 92) disagreed. The participants who conditionally agreed to the clause proposed that this could be a viable option under the following conditions; if it is allowed only for the patient whose mobility is significantly limited (n = 4) and only a lawfully designated person could receive prescription by proxy (n = 3).
To the revised telehealth legislation clause allowing electronic delivery of prescription to the pharmacy of the patient' s choice, 27.5% (n = 60) of the participants agreed, 17.0% (n = 47) conditionally agreed, and 55.5% (n = 121) disagreed. The participants who conditionally agreed to the clause proposed that this clause could be a viable option under the following conditions; the pharmacist must be under strict restriction against using alternative or similar medication (n = 3) and the qualification of the pharmacist must be strictly validated (n = 2).
shows the characteristics of the participants according to the agreement to the revised telehealth legislation, in which conditional agreement was categorized to 'agreement'. There was a significant association between the duration of working at a local clinic and agreement on doctor to patient teleconsultation (P = 0.035). A detailed analysis of this group revealed that participants who worked for 10-19 years at a local clinic were more likely to agree to it than participants who worked at a local clinic for less than 10 years (P = 0.013, not shown in the table).
There was a significant association between the duration of working at a local clinic (P = 0.005) as well as the number of daily patient visits (P = 0.028) and the agreement to the clause that allowing a deputy person to receive prescription by proxy. Further analysis of this group revealed that participants who worked for 10-19 years at a local clinic were more likely to agree to the clause than participants who worked at a local clinic for less than 10 years (P = 0.009, not shown in the table) or for more than 20 years (P = 0.003, not shown in the table). Furthermore, participants who saw 50-99 patients per day agreed to the clause more than those who saw less than 49 patients per day (P = 0.009, not shown on the table).
Factors related with the agreement on the revised telehealth legislation.
4. The Anticipated Outcome Following the Introduction of Doctor-Patient Teleconsultation ()
Overall, greater number of participants tended to agree to the negative anticipated outcomes than to the positive anticipated outcomes that may occur after the enforcement of the revised telehealth legislation. Notably, 52.8% agreed to that there will be an 'improvement in accessibility to health services'. However, the participants did not show favoritism towards other positive items. Only 34.4% agreed to an anticipation of 'decrease in medical expense at individual level'. 33.0% agreed to 'increase in patients' concern about health'. 31.2% agreed to 'improvement in imbalance of regional allocation of medical resources'. 30.7% agreed to 'improvement in medical knowledge of patient'. A mere 22.9% agreed to 'decrease in medical expense at national level'. 22.5% agreed to 'increase in number of outpatient consultation'. 15.6% agreed to 'improvement in doctor-patient relationship' and only 7.8% agreed to 'increase in physician's income'.
Subsequently, more than 90% of the participants agreed to negative anticipated outcomes from the revised telehealth legislation. 95.4% felt there would be 'unclear legal responsibility for medical malpractice'. 93.6% agreed to worries regarding the 'flooding of patients to tertiary health care centers'. 92.2% agreed to 'troubles related with setting teleconsultation fee'. 91.3% agreed to concerns regarding the 'technical problems for running telehealth system'. Finally, 90.4% agreed to worries about 'issues regarding protection of patient information'.
Participants who agreed to a direct doctor-patient teleconsultation also showed significant tendency for anticipating positive outcomes. Participants who disagreed to doctor-patient teleconsultation showed significant agreement to only one of the nine items of negative anticipated outcome (i.e., there would be troubles related with setting teleconsultation fee) (P = 0.026).
The anticipated outcomes based on the introduction of doctor-patient teleconsultation.
5. Participants' Views on the Introduction of Telehealth System in Accordance with Revised Telehealth Legislation ()
To the question asking the scope of telehealth, 'teleconsultation between doctors' was most frequently selected (in 83.9% of participants), which was followed by 'telemonitoring of patient' (in 80.3%), 'online medical counseling via internet or mobile device' (in 65.6%), 'teleeducation' (in 46.3%), and 'exchange of medical information via internet' (in 43.6%).
Participants chose radiology (61.9%), pathology (41.3%), cardiology (33.5%), and endocrinology (28.0%) as the most likely medical field to benefit from adopting telehealth systems. Participants also chose residents in rural areas (74,3%), handicapped persons or senior citizens (63.8%), residents in restricted areas (e.g., soldiers, prisoners) (59.6%), patients in need of nursing care (39.9%), and patients with chronic diseases (38.5%) to benefit most from telehealth systems. 75.4% participants believed that primary care clinics should apply telehealth while 44.6% believed tertiary care clinics should.
Participants' views on the introduction of telehealth system.
6. Readiness to Adapt to the Revised Telehealth ()
When participants were asked about their intention to put telehealth into practice if the revised legislation would be enforced, 45.4% (n = 99) replied they would introduce telehealth after a period of observing the situation. 31.7% (n = 69) replied they would absolutely not use telehealth. Finally, 4.6% (n = 10) replied they would utilize telehealth as soon as they could. Participants' intention to adopt telehealth was significantly related to their agreement on doctor-patient teleconsultation. A detailed analysis revealed that participants who disagreed with the use of doctor-patient teleconsultation did not wish to adopt telehealth at a significant level (P < 0.001, not shown on the table).
Around 89% of participants suggested telehealth service fee to be similar (47.2%) or higher (41.7%) than current medical consultation fee. There was no significant relation between fee and their agreement on doctor-patient teleconsultation.
Readiness to adapt to the revised telehealth.