Abstract
BackgroundTraumatic injury is a serious global health burden, particularly in low- and middle-income countries where medical care often lacks resources and expertise. In these contexts, diagnostic telemedicine could prove a cost effective tool, yet it remains largely underused here, and knowledge on its potential impact is limited. Particularly scarce is the view of the expert user physicians, and how they themselves relate to this technology.MethodsThis qualitative study investigated tele-experts’ (n = 15) views on the potential for image based teleconsultation to be integrated in trauma and emergency care services. A semi-structured interview guide was used to gather data concerning an mHealth app for burns diagnostics in the acute care setting, in the Western Cape, South Africa. Questions examined challenges and opportunities in user acceptance and outcomes, in specific case management and in the wider healthcare system. Resulting data were subject to qualitative content analysis.ResultsExperts perceived remote diagnostic support through mHealth as linking directly to several key ideas in medicine, including barriers to care, medical culture and hierarchy, and medical ethics within a society. Ideas running through the data pertained to the widening and narrowing of inherent gaps in the healthcare system, and the formalisation of processes, practices and relationships, effected by the introduction of an app. Wide consensus was stated on positive outcomes such as increased education opportunities, improved professional relationships and a better ability to advise and diagnose, all further facilitated through greater ease of access. The belief was that these could achieve a narrowing of systemic divides within healthcare, although it was acknowledged that the possibility to induce the opposite effect also arose. Differing opinions were voiced relating to the involvement of allied health professionals and feedback.ConclusionExperts see several aspects to an mHealth app for remote diagnostic support which could enhance provision of trauma and emergency care in a resource poor setting, relating to reduced delays, streamlined care and improved outcomes. Attention is also drawn, however, to specifics of the environment which would demand further and careful consideration for success – time pressure, intensity and the wide range of subspecialties to be considered.
Highlights
Traumatic injury is a serious global health burden, in low- and middle-income countries where medical care often lacks resources and expertise
Specific characteristics which complicate trauma and emergency cases can be exacerbated in such settings, such as the following three which are critical for both research and intervention
Gold standard practice and achievable practice The first category on “power and personality” included three sub-categories of ‘Emotional dilemmas’, ‘Sensitivity and ethics’ and ‘Tools for the future’, capturing areas in which a discrepancy was highlighted between a ‘gold standard’ practice, and that which was achievable within the realities of the setting (Fig. 1)
Summary
Traumatic injury is a serious global health burden, in low- and middle-income countries where medical care often lacks resources and expertise. In these contexts, diagnostic telemedicine could prove a cost effective tool, yet it remains largely underused here, and knowledge on its potential impact is limited. Remote Presentation; Often the initial presentation of these cases is outside of the emergency department, to poorly resourced or remote facilities, a situation compounded by a lack of pre-hospital emergency services [3], and inadequate road and transportation systems [4] Where specialists exist they are often clustered in major cities, expert knowledge is not widely dispersed. Hesitance in diagnosis and initiating treatment, may lead to diminished outcomes for the patient
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