Telemedicine in Russia: a study of physicians' awareness and readiness for digital changes

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Relevance. The introduction and development of information technologies in the modern world is one of the most topical issues. Digitalisation of healthcare has attracted special attention and became a key topic of discussion during the COVID-19 pandemic. The transition to telemedicine (TM) has been recognised as a promising direction for modernising healthcare services, including COVID-19 prevention and diagnosis.[1].
With the accelerated pace of life and continued urbanisation, urban dwellers are increasingly opting for online interaction with experts from various fields, and healthcare services are no exception. This format of consultations saves travelling time, allows to get a professional opinion of a doctor from another city and is especially convenient for people with disabilities.
In addition, telemedicine is convenient for medical professionals themselves. It provides an opportunity to share experience with colleagues, to attract specialists from different regions for consultations and to consult patients all over the country. However, with the emergence of opportunities for the implementation of telemedicine activities, more and more often there are questions regarding the awareness of doctors and patients about Article 36, paragraph 2 of the Federal Law N323 ‘On the Fundamentals of Health Protection of Citizens in the Russian Federation’, which regulates the specifics of medical care provided through the use of telemedicine technologies.[2]

The aim of the study. To identify the level of demand for remote medical consultation, to analyse the attitude of medical specialists to the application of this type of modern technologies in healthcare, to determine its advantages and disadvantages and to propose measures to eliminate the key problems associated with the use of telemedicine technologies.

Materials and methods of research. To fulfil the set goal, a questionnaire survey was conducted among 126 physicians of Voronezh and Moscow regions, as well as residents of the 2nd year of training of N.N. Burdenko VSMU. Representatives of various medical specialties were selected for the study, namely: therapy, general practice, cardiology, oncology, paediatrics, ophthalmology, neurosurgery, neurology. The specialties listed were chosen in order to have a diverse approach to the topic under study and to analyse the data together.

In recent years, telemedicine services have been gaining popularity in Russia. However, despite investor interest in this field, the potential of telemedicine allowed by Russian legislation is not fully realised.[3] In order to convert face-to-face appointments to a remote format, clinics need to fulfil a number of conditions.

In order to provide full-fledged online patient management, services must organise an initial face-to-face examination of a doctor, who will then be able to prescribe treatment, interpret diagnostic results and adjust therapy remotely. Currently, only a few market players have such capabilities, which limits the quality of medical support and excludes prescriptions. If an initial face-to-face appointment is not held, the doctor within the telemedicine service can only collect anamnesis and use diagnostic devices, which reduces the effectiveness of consultations, making them rather informative and recommendatory.

Results of the study. In order to determine the attitude of medical specialists to the use of telemedicine technologies, a sociological study was conducted.

First of all, the participants of the study were asked to familiarise themselves with the definition of telemedicine, which refers to the remote provision of medical services (e.g. patient monitoring and online consultations) and interaction of medical professionals with each other using telecommunication technologies.[4] 

Next, the first question was asked, namely: ‘Have you ever used telemedicine technologies in your own practice?’. It turned out that 66.7% of respondents had never used the possibilities of remote communications before. However, 33.3% have used these technologies in their work. In 100% of cases, this part of the respondents used telemedicine technologies for online consultations with specialist doctors from medical institutions providing high-tech types of care. For the doctors who used telemedicine, an additional question was asked about the attitude of patients to this type of medical care. Thus, 81% of patients had a positive attitude to the possibility of preliminary online consultation with another specialist, 12% did not express their opinion, 7% were dissatisfied with this type of technology. The next question for all respondents was to determine the advantages of telemedicine, as a result the following positive features were highlighted: the possibility of providing medical care in remote regions - 38%, convenience for patients (saving time and money for travelling) - 33.3%, simplification of the process of monitoring chronic patients - 21.4%, reducing the burden on medical institutions - 6.7%. Among the existing difficulties of telemedicine, 40.8% of respondents identified technical problems (poor Internet connection, equipment malfunction).; 39.4% considered the limited possibility of physical examination as a significant disadvantage.; equally 9.9% of doctors identified such disadvantages as difficulties in establishing a trusting relationship with the patient, as well as legal and ethical issues (data confidentiality).
Due to the relevance of the active implementation of artificial intelligence (AI) in various sectors, a question was asked to clarify the attitude of interviewees to the use of AI in telemedicine. [5] The majority (55.9%) believe that it is necessary to approach this type of technology with caution, while not belittling its possible advantages; 28.9% have a positive attitude to AI, as they see in it new horizons in the effective diagnosis of groups of diseases; Only 15.2% expressed their negative attitude to the use of artificial intelligence systems in medical practice in general.
At the end, those who wished were asked to express their opinion about the possibility of introducing disciplines teaching students telemedicine technologies. So 31% of the total number of respondents indicated their vision of the above proposal.

Of these, 94.9% expressed a favourable attitude to this proposal, believing that it would make the approach to training in line with modern trends, expand the opportunities for the future doctor and simplify the process of gaining knowledge through interaction with colleagues from large cities. 5.1% decided that telemedicine technologies in medical student education may reduce the level of practical skills and empathy of the specialist with patients.

Conclusion. The conducted research allowed us to identify aspects of the introduction and development of telemedicine technologies in Russia. The results of questionnaire survey of medical specialists showed that despite the growing popularity of telemedicine, its potential is not fully realised. The main reasons for this are technical problems, such as unstable Internet connection and equipment malfunction, as well as limited opportunities for physical examination of patients. In addition, a significant proportion of doctors (66.7%) have not yet used telemedicine technologies in their practice, indicating the need for awareness raising and training of health professionals in this area. The advantages of telemedicine, such as the possibility of providing medical care in remote regions, convenience for patients and simplified monitoring of chronic patients, were highly appreciated by the respondents.

About the authors

Viktoriia Dmitrievna Poliakova

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: lyalinavika1201@gmail.com
ORCID iD: 0009-0001-3465-7735
Russian Federation, 10 Studencheskaya St., Voronezh, 394036, Russia

Nadezhda Aleksandrovna Shchetinina

Voronezh State Medical University named after N. N. Burdenko

Email: yvz@vrngmu.ru
ORCID iD: 0000-0001-8881-2019

Assistant of the Department of Health Care Management

Russian Federation, 10 Studencheskaya St., Voronezh, 394036, Russia

References

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