A content analysis of communication between health practitionersin obstetrics and gynecology telemedicine services in Mongolia

Abstract

Title of thesis: A content analysis of communication between health practitioners in obstetrics and gynecology telemedicine services in Mongolia Author: Khandregzen Dorjsuren Thesis advised by: Wen-Shan Jian, Assistant Professor BACKGROUND: Telemedicine service, as a model of providing medical advice at distance, has been proven to be a cost effective, equity and efficient health care. These advantages are attracting policy makers, hospital managers, and health care providers worldwide and particularly, countries like Mongolia, where there are geographical and socio-economical barriers create disparities for adequate access to health services. “Telemedicine support to Promote Maternal and Newborn Health in Remote Provinces of Mongolia” project started from 2007 and Campus Medicus network is used as a platform for providing telemedicine services. OBJECTIVE: To evaluate the overall use of telemedicine platform in obstetrics and gynecology healthcare service by remote physicians in selected provinces; to identify common clinical complications where experts’ consultation are needed; to find out how remote physicians and experts are communicating via telemedicine, and to understand the complexity of the communication among physicians and experts while using store and forward telemedicine services. MATERIALS AND METHOD: This study designed to provide a content analysis of communication among remote physicians and experts for a period of 15-months from the project “Telemedicine support to Promote Maternal and Newborn Health in Remote Provinces of Mongolia. Communications of two groups of stakeholders (experts and remote physicians) were analyzed using appropriate coding scheme for each necessary category. Two independent coders (author and another physician) were involved in coding process. Both conceptual and relational content analysis was used and descriptive statistical analysis was provided using SPSS 17 software. RESULTS: Totally 137 cases were analyzed. Common request for second opinion were decision support for complicated clinical cases 81(59%), social networking 40(29%), and sharing clinical experience 16(12%). Prevalence of obstetrical complications was maternal diseases, complicating pregnancy and delivery 28 (35%) Experts’ response rate to physicians’ request was 75%. In the most of the comments, experts asked the physicians to provide additional analyses or information: 52 times out of 86 comments (60%). DISCUSSION: Remote physicians are utilizing TM service not only for obtaining experts’ advice, but also for sharing clinical experience and social networking. Obstetrical problems, particularly maternal diseases, complicating pregnancy and childbirth were leading cases for remote physicians for utilizing telemedicine services to have second opinion. CONCLUSION: It will be beneficial to both, remote physicians and experts to develop standards and templates in order to present clinical case (patient information) for the experts to review; this will lead to obtain accurate and timely consultation.