Discussion Topic for Seminar 3 (Presented by Tanyawat)

[Tanyawat Saisongcroh]

“Telemedicine and Socioeconomics in Orthopaedic Trauma Patients: A Quasi Experimental Study During the COVID-19 Pandemic”

Authors: Ibrahim, Ishaq O.; Bangura, Abdulai; O’Hara, Nathan N.; Pollak, Andrew N.; Slobogean, Gerard P.; O’Toole, Robert V.; Langhammer, Christopher G.
Source: Journal of the American Academy of Orthopaedic Surgeons, Volume 30, Number 18, 15 September 2022, pp. 910-916(7)
DOI: https://doi.org/10.5435/JAAOS-D-21-01143

1) In your circumstances/community/country, what are the barriers of usage of telemedicine in healthcare service, whether you are provider, caregiver or patient? (eg. Socioeconomic status/ insurance coverage, digital literacy, medicolegal liability concern, quality of care,…)

2) From the article, are there any method or solution that can prevent or reduce selection bias in this quasi-experiment study?

[Zarni Lynn Kyaw]

This is a very timely paper for me, I read it and let me share my two cents,

1) In Myanmar

Lack of infrastructure: Myanmar has a limited telecommunications infrastructure, which can make it difficult to access telemedicine services.

Lack of government support: The government of Myanmar has not yet fully embraced telemedicine, which has made it difficult to develop and implement telemedicine programs.

Cultural factors: The culture of Myanmar may also be a barrier to the use of telemedicine. For example, some patients may be reluctant to consult with a doctor through a video call, as they may feel that this is not as personal or effective as an in-person consultation.

Language barriers: Myanmar is a multilingual country, and this can pose a challenge for telemedicine. For example, patients who speak a minority language may not be able to access telemedicine services if they are not available in their language.

Socioeconomic status/insurance coverage: Patients from lower socioeconomic groups were less likely to have access to telemedicine due to lack of insurance coverage or the inability to afford the cost of the service.

Digital literacy: Patients and providers with low digital literacy skills were less likely to use telemedicine due to the difficulty of using the technology.

Medicolegal liability concern: Providers were concerned about the medicolegal liability of providing care through telemedicine.

Quality of care: Patients and providers were concerned about the quality of care that could be provided through telemedicine.

2) Bias
The study did have some limitations, including the potential for selection bias. This can happen for a variety of reasons, such as if the participants were self-selected or if the groups were not randomly assigned.

There are a number of methods that can be used to prevent or reduce selection bias in quasi-experimental studies.

Random assignment: This is the best way to ensure that the two groups being compared are truly comparable but the use of random assignment is not always feasible in quasi-experimental studies.

Matching: This involves matching the participants in the two groups on key characteristics, such as age, sex, and socioeconomic status.

Propensity score matching: This is a more sophisticated method of matching that takes into account a wider range of factors that could affect selection bias.

[Boonyarat Kanjanapongporn]

I am thinking about selection bias discussion 2, especially the characteristics of people included in this research which might not represent people who were not experienced on using technology when they started.
To extend the applicability of this kind of research toward developing countries, where general people are probably new to telemedicine, and reduce the selection toward the willing and experienced users. This research could be improved by collecting other concern characteristics such as past experiences with technology, by possibly collecting number and type of gadgets owned or years of using technology.
Thank you, your presentation was great and interesting.

[PREUT ASSAWAWORRARIT]

Thank you for your interesting topic and presentation.

1. In Thailand, there are some barriers to use telemedicine.
For physicians, the physical examination is impossible in telemedicine. Some symptoms and presentation need physical examination to gather more information, then integrate them to make the provisional diagnosis. In addition, doctor and patient relationship is another concern in some physicians during the telemedicine use.
For patients, the access to the telemedicine needs some information technology, for example, the smart phone, 5G. Therefore, patients who do not use these technologies cannot access to the telemedicine.
For hospitals, telemedicine requires high budget for initialization and maintenance. Hospital directors have to carefully consider to implement the system.

2. To minimize selection bias, propensity score matching can partially equalize baseline characteristics between groups of patients. However, they have to select variable to include in propensity score calculation.

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