Telemedicine started in the 1950s with several hospital systems that shared images and information over the phone and developed with the advent of the internet, laptops and later smartphones(10). Further advances were spearheaded on March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic and in this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission.
With the second largest burden of COVID-19 in the world, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service. No formal input was given on telemedicine by health authorities, despite high pressure on health services during the first phase of the epidemic.
Therefore, we tried to understand how much misinformation or other factors such as computer skills are determining in the application of telemedicine systems.
For this purpose, a telephone questionnaire was designed with different questions ranging from computer skills to knowledge of telemedicine. This survey was submitted to adult participants with OSA in CPAP treatment and in follow-up at our sleep clinic during pandemic-related limitations. Although studies on telemedicine have demonstrated its usefulness in reducing geographical and time barriers, there are several barriers that need to be addressed for the application of telemedicine technology as observed in our study.
Thirty articles related to the significant barriers to implementing telemedicine around the world were reviewed and the authors showed that the age of the patient and level of education each accounted for five out of the twenty-nine patient barriers and four out of twenty-nine is the unawareness of telemedicine(11). These barriers also seem to involve the participants of our study, in fact it has shown that participants with a low level of education (21%, 11 overall) are more likely to be unaware of telemedicine, as a result of the absence of the right equipment and eventually the inability to use it (32%, 17 overall). Similar to our result, Miyawaki et al. found through a survey conducted in Japan that younger individuals were more likely to use telemedicine than older individuals, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (6,6% vs. 3,5%; p<0,001). The work of Hwang et al. also shows that telemedicine education improved participation in the clinic compared to no telemedicine education (participation rate 68,5% vs 62,7%; p=0,02)(12).
Another problem that we have addressed, and which is one of the main problems in chronic diseases such as OSA, is the long waiting lists for an in-person visit. A 5-year retrospective study by Baig et al. have compared the efficiency of a conventional protocol (in-person sleep clinic consultations) and a telemedicine protocol. They defined telemedicine efficiency by improvement in the interval between a sleep consultation and the prescription of CPAP, the total number of sleep consultations, and the waiting list time for the sleep clinic. The results indicated that telemedicine decreased the interval between sleep consultation and CPAP prescription from more than 60 days to fewer than 7 days(13).
However, in our study the participants considered these systems useful in reducing waiting lists (62%, 33 overall).
A significant result is the willingness of the study participants to perform remote visits in the future. In fact, we found an increase of 12 percentage points in the total number of subjects willing to make video calls in the future compared to baseline (57% favorable vs. 43% unfavorable overall).
A limitation of our study may be the small sample size, but it may nevertheless provide useful indications for improving and implementing telemedicine systems in the future.