Prospects and Challenges of Telemedicine at the Primary Health Care Level: A Basis for Certification of Providers in Ghana

Abstract

Background: Telemedicine has proven to be one of the modern medical discoveries in recent times, serving as a technological tool to deliver healthcare at a distance and providing medical solutions to remote communities with limited access to quality healthcare. However, the challenges associated with the use of telemedicine in Ghana make it difficult to scale up its application at the Primary Healthcare (PHC) level. Aim: The aim of the study was to assess the current trends and applications of telemedicine in health care delivery at the primary health care level in Ghana. The study also sought to identify the prospects and challenges of telemedicine implementation in Ghana.  Study Design: The study employed both qualitative and quantitative design involving 200 respondents made up of 80 healthcare professionals and 120 patients from four primary healthcare facilities in the Ahafo-Ano North District of the Ashanti region of Ghana Methods: Survey questionnaire, semi-structured interview guide, and field observations were used to find out the knowledge of providers, capacity, availability of network infrastructure, and challenges of implementing telemedicine at the PHC level from the viewpoint of healthcare 'professionals' and to verify factors that can persuade patients to participate in the implementation of telemedicine. Logistic regression analysis was conducted to estimate the factors influencing 'patients' decision to participate in telemedicine, while the qualitative data were analyzed using thematic content analysis. Results: The results show that knowledge and education about telemedicine, easy access to specialist care at home, widespread use of mobile telephony, and reduction in travel cost due to telemedicine significantly influence both providers' and patients' participation in telemedicine at the primary healthcare level. The minimum educational level for patients to participate in telemedicine implementation is a primary education (OR = 0.233, p<0.025). On the other hand, inadequate infrastructure, legal issues such as non-certification of providers, reimbursement and confidentiality challenges are some of the factors that impede telemedicine implementation. Conclusion: The authors suggest that developing countries need to take advantage of the massive use of mobile telephony and embrace telemedicine application to increase access to healthcare in rural areas. Again, certification of care providers is critical for effective application and integration of telemedicine and this should be adaptive to local needs, high internet connectivity and the demands of both healthcare professionals and patients especially in rural communities.