Assessment of health provider readiness for telemedicine services in Uganda.

Abstract

There are few telemedicine projects in Africa that have reached scale. One of the reasons proposed for this has been failure to assess health provider readiness for telemedicine prior to implementation. To assess health provider readiness for implementation and integration of telemedicine services at three levels of Uganda's health facilities, namely, a national referral hospital (NRH), regional referral hospitals (RRHs) and level 4 health centres (HC-IVs) and to investigate factors associated with readiness for telemedicine. A cross-sectional descriptive study was conducted at public healthcare facilities in Uganda. One RRH and HC-IV was identified from each of the Western, Eastern and Northern regions using a multistage random sampling technique. Mulago Hospital, which doubles as an RRH and HC-IV in the central region, was purposively identified for the study. After validation, a questionnaire was distributed for self-administration to senior administrators and doctors selected at the NRH, RRHs and HC-IVs. Data were analysed using bivariate associations between the outcome and the potential independent variables. In total, 114 healthcare workers completed the questionnaire. Of the respondents, 24 (21%) were from HC-IVs, 44 (39%) were from RRHs, and 46 (40%) from NRH. Doctors made up 45.8% (11) of respondents at HC-IVs, 59% (26) at RRHs, and 30.4% (14) at NRH. Administrators across all health facility levels were more likely to integrate telemedicine into the healthcare system than doctors (odd ratio = 1.39 [95% confidence interval = 0.38-4.95]). A significant association existed between the state of readiness and type of health facility, p < 0.001. The NRH and RRHs are more likely to integrate telemedicine into their systems than the HC-IVs. Among the factors investigated (job title, health facility, technology type, reason for referral and frequency of electronic communication), the level of health facility and title or role of healthcare worker were found to have a significant statistical association with being ready to integrate telemedicine into the healthcare system. Health provider readiness to integrate telemedicine services varies at the different levels of the health facility and job title or role. However, referral hospitals and administrators were more likely to integrate telemedicine than HC-IVs and doctors, respectively. While this study shows physicians and administrators are ready, other sectors (nurses, allied healthcare workers, public) will also need to be assessed.