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Telehealth Utilization in Low Resource Settings

Chapter Overview and Statement of Objectives

In response to health access barriers, telehealth and telemedicine have grown as a supplemental healthcare delivery system to mainstream medical care. For rural and remote communities, which are mostly less well resourced, telehealth and telemedicine is increasingly a major system enabling health access and availability, bridging population health disparities by geography and socioeconomic gradients. People in low resources settings have less access to health care, while commuting for health services to the cities would be costly in terms of time, effort, and money, resulting in health inequities and social injustices on them. In this chapter, we examine the role of telehealth and telemedicine as health systems for providing sustainable community health in low resource settings. In doing so, we provide a historical overview of the research and practice in telehealth and telemedicine, followed by a discussion of current leading practices in telehealth and telemedicine. We consider the cultural and legal influences on telehealth and telemedicine services across jurisdictions highlighting responsiveness to local contexts and needs. Finally, we consider the issues for research and practice in telehealth and telemedicine, including security and privacy associated with telehealth; education for sustaining telehealth delivery; engaging high-risk populations from low-resource settings in telehealth services; and use of social networks to ensure telehealth care access for poor and remote regions.

Keywords

  • Telehealth
  • Disparities
  • Rural
  • Access
  • Technology
  • Specialty care

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Notes

  1. 1.

    http://www.pewinternet.org/report_display.asp?r=26

  2. 2.

    https://www.childrens.health.qld.gov.au/chq/health-professionals/referring-patients/telehealth-store-and-forward/

  3. 3.

    https://www.telehealthresourcecenter.org/

References

  • American Nurses Association. (1997). Telehealth: A tool for nursing practice. Nursing Trends Issues, 2(4), 1–3.

    Google Scholar 

  • Little, A. D. (1992). Telecommunications: can it help solve America’s health care problems?. Boston, MA: Arthur D. Little, Incorporated.

    Google Scholar 

  • Augusterfer, E. A., Mollica, R. F., & Lavelle, J. (2015). A review of telemental health in international and post-disaster settings. International Review of Psychiatry, 27(6), 540–546. https://doi.org/10.3109/09540261.2015.1082985

    CrossRef  PubMed  Google Scholar 

  • Balch, D. (2008). Developing a national inventory of telehealth resources for rapid and effective emergency medical care: A white paper developed by the American telemedicine association emergency preparedness and response special interest group. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association, 14(6), 606–610. https://doi.org/10.1089/tmj.2007.0127

    CrossRef  Google Scholar 

  • Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association, 22(2), 87–113. https://doi.org/10.1089/tmj.2015.0206

    CrossRef  Google Scholar 

  • Bauerly, B. C., McCord, R. F., Hulkover, R., & Pepin, D. (2019). Broadband access as a public health issue: The role of law in expanding broadband access and connecting underserved communities for better health outcomes. The Journal of Law, Medicine & Ethics, 47(2), 39–42.

    CrossRef  Google Scholar 

  • Baumann, P. K., & Scales, T. (2016). History of information communication technology and telehealth. Academy of Business Research Journal, 3, 48.

    Google Scholar 

  • Benavides-Vaello, S., Strode, A., & Sheeran, B. C. (2013). Using technology in the delivery of mental health and substance abuse treatment in rural communities: A review. The Journal of Behavioral Health Services & Research, 40(1), 111–120.

    CrossRef  Google Scholar 

  • Bohmer, R., & Edmondson, A. C. (2001). Organizational learning in health care. Health Forum Journal, 44(2), 32–35.

    PubMed  Google Scholar 

  • Bonnardot, L., Liu, J., Wootton, E., Amoros, I., Olson, D., Wong, S., & Wootton, R. (2014). The development of a multilingual tool for facilitating the primary-specialty care interface in low resource settings: The MSF tele-expertise system. Frontiers in Public Health, 2, 126.

    CrossRef  Google Scholar 

  • Brennan, D. M., Holtz, B. E., Chumbler, N. R., Kobb, R., & Rabinowitz, T. (2008). Visioning technology for the future of telehealth. Telemedicine Journal and e-Health, 14(9), 982–985.

    CrossRef  Google Scholar 

  • Brown-Connolly, N. E. (2002). Patient satisfaction with telemedical access to specialty services in rural California. Journal of Telemedicine & Telecare. 8 Suppl(2), 7–10. https://doi.org/10.1177/1357633X020080S204

  • Brown, R. A., Marshall, G. N., Breslau, J., Farris, C., Osilla, K. C., Pincus, H. A., … Miyashiro, L. (2015). Access to behavioral health care for geographically remote service members and dependents in the US. Rand Health Quarterly, 5(1), 249–254.

    Google Scholar 

  • Bursell, S. E., Zang, S., Keech, A. C., & Jenkins, A. J. (2016). Evolving telehealth reimbursement in Australia. Internal Medicine Journal, 46(8), 977–981.

    CrossRef  Google Scholar 

  • Campbell, J. I., Aturinda, I., Mwesigwa, E., Burns, B., Santorino, D., Haberer, J. E., … Siedner, M. J. (2017). The technology acceptance model for resource-limited settings (TAM-RLS): A novel framework for mobile health interventions targeted to low-literacy end-users in resource-limited settings. AIDS and Behavior, 21(11), 3129–3140. https://doi.org/10.1007/s10461-017-1765-y

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Caplan, G., & Caplan, R. (2000). Principles of community psychiatry. Community Mental Health Journal, 36(1), 7–24. https://doi.org/10.1023/a:1001894709715

    CrossRef  PubMed  Google Scholar 

  • Chan, M. (2010). Global policy recommendations. France: Graphic Design: Rasmussen/CH, 14–18. ISBN 9789241564014

  • Coleman, J. (2002). HMOs and the future of telemedicine and telehealth part 1, MCO trends.Connect2Health Task Force. (2018). Federal Communications Commission. Mapping Broadband Health in America 2017. Available at https://www.fcc.gov/reports-research/maps/connect2health/index.html#ll=48.004625,-92.460937&z=4&t=insights&inb=in_bb_access&inh=in_diabetes_rate&dmf=none&inc=none&slb=90,100&slh=10,22. Last visited 4 Oct 2020.

  • Delaigue, S., Bonnardot, L., Steichen, O., Garcia, D. M., Venugopal, R., Saint-Sauveur, J., & Wootton, R. (2018). Seven years of telemedicine in médecins sans frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value. Journal of Global Health, 8(2), 020414. https://doi.org/10.7189/jogh.08.020414

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Department of Health and Human Services [HHS]. (2016). E-Health and telemedicine: Report to congress. https://aspe.hhs.gov/system/files/pdf/206751/TelemedicineE-HealthReport.pdf. Accessed 10 Mar 2020

  • Dorstyn, D., Mathias, J., & Denson, L. (2013). Applications of telecounselling in spinal cord injury rehabilitation: A systematic review with effect sizes. Clinical Rehabilitation, 27(12), 1072–1083. https://doi.org/10.1177/0269215513488001

    CrossRef  PubMed  Google Scholar 

  • Ettinger, K. M., Pharaoh, H., Buckman, R. Y., Conradie, H., & Karlen, W. (2016). Building quality mHealth for low resource settings. Journal of Medical Engineering & Technology, 40(7–8), 431–443. https://doi.org/10.1080/03091902.2016.1213906

    CrossRef  Google Scholar 

  • Fitzner, K. K., Heckinger, E., Tulas, K. M., Specker, J., & McKoy, J. (2014). Telehealth Technologies: Changing the Way We Deliver Efficacious and Cost-Effective Diabetes Self-Management Education. Journal of Health Care for the Poor and Underserved, 25(4), 1853–1897. https://doi.org/10.1353/hpu.2014.0157

  • Fong, B., Ansari, N., & Fong, A. C. M. (2012). Prognostics and health management for wireless telemedicine networks. IEEE Wireless Communications, 2012, 83–89. Accessed at: https://web.njit.edu/~ansari/papers/12WC.pdf

    CrossRef  Google Scholar 

  • Gupta, A., & Sao, D. (2011). The constitutionality of current legal barriers to telemedicine in the United States: Analysis and future directions of its relationship to national and international health care reform. Health Matrix, 21(2), 385. (Cleveland, Ohio: 1991).

    PubMed  Google Scholar 

  • Hale, T. M., & Kvedar, J. C. (2014). Privacy and security concerns in telehealth. Virtual Mentor, 16(12), 981–985.

    PubMed  Google Scholar 

  • Hall, C. S., Fottrell, E., Wilkinson, S., & Byass, P. (2014). Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? Global Health Action, 7, 25606. Medline: 25361730. https://doi.org/10.3402/gha.v7.25606

    CrossRef  PubMed  Google Scholar 

  • Hall, J. L., & McGraw, D. (2014). For telehealth to succeed, privacy and security risks must be identified and addressed. Health Affiliation (Millwood), 33(2), 216–221.

    CrossRef  Google Scholar 

  • Hebert, M. (2001). Telehealth success: Evaluation framework development. Studies in Health Technology and Informatics, 1145–1151. https://doi.org/10.3233/978-1-60750-928-8-1145

  • Hicks, L. L., Fleming, D. A., & Desaulnier, A. (2009). The application of remote monitoring to improve health outcomes to a rural area. Telemedicine Journal and E-Health, 15(7), 664–671. https://doi.org/10.1089/tmj.2009.0009

    CrossRef  PubMed  Google Scholar 

  • Holland, J., Hatcher, W., & Meares, W. L. (2018). Understanding the Implementation of Telemental Health in Rural Mississippi: An Exploratory Study of Using Technology to Improve Health Outcomes in Impoverished Communities. Journal of Health & Human Services Administration, 41(1), 52–86.

    Google Scholar 

  • Ickenstein, G. W., Groß, S., Tenckhoff, D., Hausn, P., Becker, U., Klisch, J., & Isenmann, S. (2010). An empirical analysis of the current need for teleneuromedical care in german hospitals without neurology departments. International Journal of Telemedicine and Applications, 2010, 916868–916810. https://doi.org/10.1155/2010/916868

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Institute of Medicine. (2012). The role of telehealth in an evolving health care environment: Workshop summary. Washington, DC: The National Academies Press. https://doi.org/10.17226/13466

    CrossRef  Google Scholar 

  • Jaccard, J. J., Nepal, S., Cellar, B., & Yan, B. (2016). WebRTC-based video conferencing service for telehealth. Computational Informatics, 98, 169–193. https://doi.org/10.1007/s00607-014-0429-2

    CrossRef  Google Scholar 

  • Joseph, A., Kadri, A. M., Krishnan, A., Garg, B. S., Ahmed, F. U., Kumar, P., … Srivastava, V. K. (2018). IAPSM declaration 2018: Definition, role, scope of community medicine and functions of community medicine specialists. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 43(2), 120–121. https://doi.org/10.4103/ijcm.IJCM_115_18

    CrossRef  Google Scholar 

  • Khatri, K., Haddad, M., & Anderson, D. (2013). Project ECHO: Replicating a novel model to enhance access to hepatitis c care in a community health center. Journal of Health Care for the Poor and Underserved, 24(2), 850–858. https://doi.org/10.1353/hpu.2013.0093

    CrossRef  PubMed  Google Scholar 

  • Kim, J. A. (2010). Telehealth in the developing world. Healthcare Informatics Research, 16(2), 140–141.

    CrossRef  Google Scholar 

  • Kruse, C., Bouffard, S., Dougherty, M., & Parro, J. (2016). Telemedicine Use in Rural Native American Communities in the Era of the ACA: a Systematic Literature Review. Journal of Medical Systems, 40(6), 1–9. https://doi.org/10.1007/s10916-016-0503-8

  • Kun, L. G. (2001). Telehealth and the global health network in the 21st century. From homecare to public health informatics. Computer Methods and Programs in Biomedicine, 64(3), 155–167. https://doi.org/10.1016/s0169-2607(00)00135-8

    CrossRef  PubMed  Google Scholar 

  • Lambert, D., Gale, J., Hartley, D., Croll, Z., & Hansen, A. (2016). Understanding the business case for telemental health in rural communities. The Journal of Behavioral Health Services & Research, 43, 366. https://doi.org/10.1007/s11414-015-9490-7

    CrossRef  Google Scholar 

  • Lee, A. C., & Harada, N. (2012). Telehealth as a means of health care delivery for physical therapy practice. Health Policy in Perspective, 92(3), 463–469.

    Google Scholar 

  • Lee, S., Black, D., & Held, M. L. (2019). Factors associated with telehealth service utilization among rural populations. Journal of Health Care for the Poor and Underserved, 30(4), 1259–1272. https://doi.org/10.1353/hpu.2019.0104

    CrossRef  PubMed  Google Scholar 

  • Louder, D. & Solomon, A. (2017). Review of the telehealth landscape and fundamentals of telehealth program development, telehealth overview. Making connections with technology: The issues, benefits and barriers to using telehealth in behavioral. Healthcare, Maine Behavioral Healthcare Workforce Development Collaborative.

    Google Scholar 

  • Makaroun, L. K., Bowman, C., Duan, K., Handley, N., Wheeler, D. J., Pierluissi, E., ... Chen, A. H. (2017). Specialty Care Access in the Safety Net—the Role of Public Hospitals and Health Systems. Journal of Health Care for the Poor and Underserved, 28(1), 566–581. https://doi.org/10.1353/hpu.2017.0040

  • Mathieson, K., Leafman, J. S., & Horton, M. B. (2017). Access to Digital Communication Technology and Perceptions of Telemedicine for Patient Education among American Indian Patients with Diabetes. Journal of Health Care for the Poor and Underserved, 28(4), 1522–1536. https://doi.org/10.1353/hpu.2017.0131

  • McLennan, J. D. (2018). Video-conferencing telehealth linkage attempts to schools to facilitate mental health consultation. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal De l’Academie Canadienne De Psychiatrie De l’Enfant Et De l’Adolescent, 27(2), 137–141.

    PubMed  Google Scholar 

  • Médecins Sans Frontières (MSF) International. Available: http://www.msf.org/en/about-msf. Accessed 4 Jan 2020.

  • Miller, T. W., Clark, J., Veltkamp, L. J., Burton, D. C., & Swope, M. (2008). Teleconferencing model for forensic consultation, court testimony, and continuing education. Behavioral Sciences & the Law, 26(3), 301–313. https://doi.org/10.1002/bsl.809. Accessed 4 Jan 2020.

  • Moehr, J. R., Schaafsma, J., Anglin, C., Pantazi, S. V., Grimm, N. A., & Anglin, S. (2006). Success factors for telehealth—A case study. International Journal of Medical Informatics, 75(10–11), 755–763. https://doi.org/10.1016/j.ijmedinf.2005.11.001

    CrossRef  PubMed  Google Scholar 

  • Mooi, J. K., Whop, L. J., Valery, P. C., & Sabesan, S. S. (2012). Teleoncology for indigenous patients: The responses of patients and health workers. Australian Journal of Rural Health, 20(5), 265–269. https://doi.org/10.1111/j.1440-1584.2012.01302.x

    CrossRef  Google Scholar 

  • Mupela, E. N., Mustarde, P., & Jones, H. L. C. (2011). Telemedicine in primary health: The virtual doctor project Zambia. Philosophy, Ethics, and Humanities in Medicine, 6(1), 9–9. https://doi.org/10.1186/1747-5341-6-9

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Muttitt, S., Vigneault, R., & Loewen, L. (2004). Integrating telehealth into aboriginal healthcare: The Canadian experience. International Journal of Circumpolar Health, 63(4), 401–414. https://doi.org/10.3402/ijch.v63i4.17757

    CrossRef  PubMed  Google Scholar 

  • Myers, C. R. (2019). Using telehealth to remediate rural mental health and healthcare disparities. Issues in Mental Health Nursing, 40(3), 233–239.

    CrossRef  Google Scholar 

  • Nakamura, Y., Laberge, M., Davis, A., & Formoso, A. (2019). Barriers and Strategies for Specialty Care Access through Federally Qualified Health Centers: A Scoping Review. Journal of Health Care for the Poor and Underserved, 30(3), 910–933. https://doi.org/10.1353/hpu.2019.0064

  • Nickelson, D. W. (1998). Telehealth and the evolving health care system: Strategic opportunities for professional psychology. Professional Psychology: Research and Practice, 29(6), 527.

    CrossRef  Google Scholar 

  • Olayiwola, J. N., Magaña, C., Harmon, A., Nair, S., Esposito, E., Harsh, C., … Wexler, R. (2020). Telehealth as a bright spot of the COVID-19 pandemic: Recommendations from the virtual frontlines (“Frontweb”). JMIR Public Health and Surveillance, 6(2). https://doi.org/10.2196/19045

  • Ricketts, T. C. (2000). The changing nature of rural health care. Annual Review of Public Health, 21(1), 639–657.

    CrossRef  Google Scholar 

  • Rotheram-Borus, M. J., Tomlinson, M., Swendeman, D., Lee, A., & Jones, E. (2012). Standardized functions for smartphone applications: Examples from maternal and child health. International Journal of Telemedicine and Applications, 1–16. https://doi.org/10.1155/2012/973237

  • Rural Health Information Hub. (2020). Telehealth use in rural healthcare. Accessed at: https://www.ruralhealthinfo.org/topics/telehealth#resource-centers

  • Saeed, S. A., Diamond, J., & Bloch, R. M. (2011). Use of telepsychiatry to improve care for people with mental illness in rural North Carolina. NC Med J, 72(3), 219–222.

    Google Scholar 

  • Schmeida, M., & McNeal, R. S. (2007). The telehealth divide: Disparities in searching public health information online. Journal of Health Care for the Poor and Underserved, 18(3), 637–647. https://doi.org/10.1353/hpu.2007.0068

    CrossRef  PubMed  Google Scholar 

  • Schneider, P. (2011). Telehealth core to WHO’s missions. Healthcare Informatics: The Business Magazine for Information and Communication Systems, 15(7), 59.

    Google Scholar 

  • Shandle, J. (2008). A new telehealth dawns: Remote medical monitoring. Electronic Engineering Times, October, 24–26.

    Google Scholar 

  • Sikka, N., Paradise, S., & Shu, M. (June, 2014). Telehealth in emergency medicine: A primer (pp. 1–11). American College of Emergency Physicians: Telemedicine Primer.

    Google Scholar 

  • Singh, R., Mathiassen, L., Stachura, M. E., & Astapova, E. V. (2010). Sustainable rural telehealth innovation: a public health case study. Health Services Research, 45(4), 985–1004. https://doi.org/10.1111/j.1475-6773.2010.01116

  • Slifkin, R. T., Silberman, P., & Reif, S. (2001). The effect of Medicaid managed care on rural public health departments. The Journal of Rural Health, 17(3), 187–196.

    CrossRef  Google Scholar 

  • Stephens, S. (2014). Telehealth is calling. PT in Motion, 6(4), 30–38.

    Google Scholar 

  • Sugijarto, D. P., Safie, N., Mukhtar, M., & Sulaiman, R. (2013). Telehealth model information flow: A case study on laboratory information system. Procedia Technology, 11, 740–747.

    CrossRef  Google Scholar 

  • Toh, N., Pawlovich, J., & Grzybowski, S. (2016). Telehealth and patient-doctor relationships in rural and remote communities. Canadian Family Physician, 62, 961–963.

    PubMed  PubMed Central  Google Scholar 

  • United Nations [UN]. (2009). The millennium development goals report. http://www.un.org/millenniumgoals/pdf/MDG.Report.2009.ENG.pdf. Accessed 4 Jan 2020.

  • White, A., Thomas, D. S. K., Ezeanochie, N., & Bull, S. (2016). Health worker mHealth utilization: A systematic review. CIN: Computers, Informatics, Nursing, 34(5), 206–213. https://doi.org/10.1097/CIN.0000000000000231

    CrossRef  PubMed  Google Scholar 

  • Wootton, R., & Bonnardot, L. (2015). Telemedicine in low-resource settings. Frontiers in Public Health, 3, 3. https://doi.org/10.3389/fpubh.2015.00003

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Wootton, R., Patil, N. G., Scott, R. E., & Ho, K. (Eds.). (2009). Telehealth in the developing world. New Brunswick, NJ: IDRC.

    Google Scholar 

  • World Health Organization. (2010). World health report. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  • World Health Organization. (2016). Be healthy, be mobile: Annual report 2018. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  • Zakus, D., Moussa, M., Ezechiel, M., Yimbesalu, J. P., Orkar, P., Damecour, C., & Nganga, G. (2019). Clinical evaluation of the use of an mhealth intervention on quality of care provided by community health workers in Southwest Niger. Journal of Global Health, 9(1), 010812. https://doi.org/10.7189/jogh.09.010812

    CrossRef  PubMed  PubMed Central  Google Scholar 

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Bernacchio, C.P., Wilson, J.F., Ginige, J.A. (2020). Telehealth Utilization in Low Resource Settings. In: Mpofu, E. (eds) Sustainable Community Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-59687-3_11

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