Abstract
Background - The ongoing policy debate about the value of communications technology in promoting development objectives is diverse. Some view computer/web/phone communications technology as insufficient to solve development problems while others view communications technology as assisting all sections of the population. This paper looks at evidence to support or refute the idea that fixed and mobile telephones is, or could be, an effective healthcare intervention in developing countries.
Methods - A Web-based and library database search was undertaken including the following databases: MEDLINE, CINAHL, (nursing & allied health), Evidence Based Medicine (EBM), POPLINE, BIOSIS, and Web of Science, AIDSearch (MEDLINE AIDS/HIV Subset, AIDSTRIALS & AIDSDRUGS) databases.
Results - Evidence can be found to both support and refute the proposition that fixed and mobile telephones is, or could be, an effective healthcare intervention in developing countries. It is difficult to generalize because of the different outcome measurements and the small number of controlled studies. There is almost no literature on using mobile telephones as a healthcare intervention for HIV, TB, malaria, and chronic conditions in developing countries. Clinical outcomes are rarely measured. Convincing evidence regarding the overall cost-effectiveness of mobile phone " telemedicine" is still limited and good-quality studies are rare. Evidence of the cost effectiveness of such interventions to improve adherence to medicines is also quite weak.
Conclusion - The developed world model of personal ownership of a phone may not be appropriate to the developing world in which shared mobile telephone use is important. Sharing may be a serious drawback to use of mobile telephones as a healthcare intervention in terms of stigma and privacy, but its magnitude is unknown. One advantage, however, of telephones with respect to adherence to medicine in chronic care models is its ability to create a multi-way interaction between patient and provider(s) and thus facilitate the dynamic nature of this relationship. Regulatory reforms required for proper operation of basic and value-added telecommunications services are a priority if mobile telecommunications are to be used for healthcare initiatives.
My Opinion:
With the rise in science & technology, information lies at our fingertips. A patient may be more up to date on the latest treatment around the globe compared to their family doctor. This perk can actually be used to benefit doctors. The one way to do so is the use of mobile phones for telemedicine as mentioned in the article. There are many pros and cons to this approach and they vary from one social demographic to another.
I will be looking at the benefits (or detriment) of telemedicine. In Canada, patients were assigned to telephone groups and told to report their blood glucose levels. They also received counselling every week as to how much to adjust their insulin and food duration. Significant improvement was seen in the treatment group after 12 weeks. In the United States, voice-interactive telephone system that required patients to daily self-measure glucose levels or report hypoglycemic symptoms. After 12 months, the yearly prevalence of diabetes-related crises or hypoglycemia decreased and a concomitant statistical significant decrease in type 2 diabetic HbA1c was observed. Similar results were observed in proactive telephone intervention for type 1 diabetes in the United States. In the Spanish island of Tenerife, 75% expressed that they were more comfortable in sending their data via the mobile phone SMS. A 3 month research in Korea showed improvement in HbA1c levels as well. However not all approaches proved to bear fruits. A 1 year study carried out in Finland among type 1 diabetic patients proved not beneficial to all due to low measurement activity and was suggested to be limited to those having high motivation to use telemedicine.
For an Asian setting, it has been proven to be effective in South Korea. Large, urban cities with fast internet connectivity will be the most suitable hub for such an approach. Educated patients will be able to benefit much from this method and in the process ease the work of doctors in monitoring their patients. However, for a setting like the city of Yogyakarta, diabetes is seen in all age groups and in all demographic levels. For patients without a mobile phone or patients who do not know how to use one, telemedicine may be difficult and would require patients to regularly come for check ups to their local primary health centers or secondary hospitals.
Nevertheless, telemedicine does have a lot of prospect and should be mastered by general physicians to benefit their line of work in the near future.
Reference:
http://globalizationandhealth.biomedcentral.com/articles/10.1186/1744-8603-2-9
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