Telemedicine services through “Telekyanmar online clinics” following the military coup in Myanmar: Clients’ and providers’ satisfaction

Introduction

Telemedicine, also known as telehealth, refers to the provision of healthcare services remotely by healthcare professionals utilizing information and communication technologies to facilitate data exchange. Its goal is to enhance access to healthcare for populations in geographically underserved areas. Telehealth encompasses various healthcare services such as diagnosis, treatment, monitoring, and follow-up, eliminating the need for in-person visits to healthcare providers and thereby saving time (https://telehealth.hhs.gov/patients/understanding-telehealth/).^1–3

Patient satisfaction plays a crucial role in the widespread adoption of telehealth services. The expansion of telehealth offerings hinges on the satisfaction levels of both patients and healthcare providers.⁴ Previous research extensively delved into the satisfaction of both parties regarding telemedicine utilization. A comprehensive review study on telemedicine highlights high levels of patient satisfaction, with reported rates ranging from 95% to 100% when comparing telemedicine to traditional in-person appointments. Patients attribute their satisfaction to various factors, including the convenience of reduced travel times and cost savings.⁴ Similarly, studies in Norway and the United States (US) also reveal significant proportions of satisfied patients with telemedicine.^5,6 When it comes to service quality, studies in the US suggest that telehealth services may offer comparable quality to face-to-face consultations.^6–8 Additionally, factors such as the quality of care received, telehealth’s convenience, overall understanding of telehealth, and being female were identified as predictors of satisfaction with telehealth.⁶

On the other hand, providers were satisfied with telemedicine if they had been included in the development of the program, there was administrative support, technology was reliable and easy to use.⁴ Besides, physicians perceived that the quality of healthcare through telemedicine services are comparable to in-person care and had positive attitudes towards the use of telemedicine.⁹

In Myanmar, the country has been struggling with a challenging situation following a military coup. The healthcare system, already ranked as one of the weakest globally, is now experiencing further decline. The situation in Myanmar is exacerbated by ongoing violations, torture, and arbitrary arrests of medical professionals by the military junta. Distressingly, reports from Insecurity Insight, Physicians for Human Rights (PHR), and the John Hopkins University Center for Public Health and Human Rights (CPHHR) highlight at least 252 attacks and threats against healthcare workers and facilities within the first six months following the coup. A recent report has identified at least 387 attacks on Myanmar’s health care system between 1^st January 2023 to 8^th December 2023.^10,11 Evidence indicates that the third wave of COVID-19 in Myanmar saw a notable surge in new infections and preventable deaths due to the paralysis of the healthcare system.¹²

Just a few months after the military coup in Myanmar and amidst the onset of the third wave of COVID-19, the Ministry of Health of the National Unity Government launched a telemedicine initiative named “Telekyanmar” (meaning Telehealth) (https://www.telekyanmar.org/mm/) in June 2021. The objective of this program is to address the challenges faced by the community in accessing healthcare services and to mitigate the potential risks posed by the military junta. The implementation of Telekyanmar aims to offer a remote medical assistance solution for the population through telecommunication technologies.

Telekyanmar was initiated to address the urgent requirement for accessible medical services and health education for Myanmar’s increasingly vulnerable population. Its reach spans not only within Myanmar but also extends to 50 other countries, enabling any Myanmar citizen with internet access to seek healthcare advice through the platform. Within a mere three months of its launch, Telekyanmar’s telehealth clinics were operational in 210 townships across the nation. Presently, its coverage has expanded to 321 townships out of Myanmar’s total 330 townships. As of May, 2024, a total of more than 71,000 patients have registered with Telekyanmar, and there have been over 178,000 consultations provided by both general practitioners and specialist doctors.

Given the pivotal role of both clients’ and providers’ satisfaction in the success of telemedicine services, it is crucial to gauge their satisfaction in utilizing and providing the Telekyanmar services. Hence, the aim of the study is to explore the clients’ and providers’ satisfaction regarding the telehealth services offered by the Telekyanmar project in Myanmar.

Methods

Results

Table 1 describes the background characteristics of clients and providers included in the study. A total of 306 clients and 79 clinicians took part in the assessment. The majority, comprising 73.9% and 69.6%, were female. The mean age of the clients was 33.2 ± 13.6 years and the mean age of the clinicians was 35.6 ± 6.8 years. Over 85% of the clients reside within the country while 58.2% of clinicians reside inside the country. Among the participants, 78.8% of the clients sought care at general clinics, while 21.2% opted for specialist clinics for their current illness. Over half (50.6%) of the clinicians were from the general clinics.

The reasons for choosing Telekyanmar for the current illness by the patients are illustrated in Figure 1. Most common reason was “noticed from Telekyanmar Facebook (FB) posts” indicated by 48% of the clients which was followed by “satisfied with previous service” (46.7%), “short/no waiting time” (37.3%), and “free of charge” (30.1%).

Figure 1. Reasons for choosing Telekyanmar for current illness as responded by clients (Multiple responses).

As shown in Table 2, various aspects of Telekyanmar services were examined, with the question regarding “health staff respect for privacy” receiving the highest proportion of “good” and “excellent” responses at 96.1%. The questions on “health staff answered your questions” and “thoroughness, carefulness & skillfulness of the health staff you consult” also received the second and third highest proportions of good and excellent responses (95.1% and 91.2%). On the other hand, lowest proportion of “good” and “excellent” responses was identified as 89.9% concerning the explanation of treatment by the health staff. Regarding the overall treatment experience, 60.8% of clients reported being very satisfied, while 35.9% reported satisfied with the Telekyanmar services they had received.

Clinicians’ satisfaction scores on the different themes of telehealth service are described in Table 3. These were rated on the scale of “0” to “10”. The highest satisfaction score was 7.8 ± 1.3 which was rated for communication with patients. The second highest score was rated for quality of clinical consultation (7.6 ± 1.4) and documentation (7.6 ± 1.6). Third highest score was for treatment prescription (7.5 ± 1.3). Lowest satisfaction score was concerned with the investigation request (6.1 ± 1.7). After categorization using the score >6 as satisfied, 87.3% of clinicians reported their satisfaction on “communication with patients”, 79.7% satisfied with “quality of clinical consultation”, and 78.5% satisfied with “treatment prescription”. Overall satisfaction was reported by 88.6% of clinicians.

Discussion

This study explored the clients’ and providers’ satisfaction on the telemedicine services provided by “Telekyanmar online clinics” following the military coup in Myanmar. The results indicated that over 95% of the clients were satisfied with various aspects of Telekyanmar services, while over 88% of clinicians reported being satisfied with the telemedicine services they provided. Satisfaction was notably high regarding communication with patients, the quality of clinical consultations, and treatment prescriptions. The adoption and expansion of telehealth services rely on maintaining high satisfaction levels among both patients and providers.⁴

Prior studies have investigated patient satisfaction with telehealth services. A study in the US found that 94 to 99% of patients were satisfied with these services.⁶ A review study reported that different aspects of telemedicine services were satisfactory including addressing patients’ concerns, communication with health care providers, its usefulness, and reliability.¹⁷ Consistent with the majority of previous studies, the current assessment revealed that over 95% of clients were satisfied with their overall treatment experience.

A comprehensive review highlighted that patients’ satisfaction with telemedicine is often influenced by factors such as cost savings and reduced travel time.⁴ In the present study, although the influencing factors were not identified, reasons for choosing Telekyanmar service included satisfaction with previous services, short waiting times, and the service being free of charge. These findings may reflect the factors related the clients’ satisfaction on Telekyanmar services in Myanmar.

Similarly, prior studies have reported the clinicians’ perception and satisfaction on various aspects of using telemedicine.^9,13,18 A study in the US documented that 80% of clinicians perceived telemedicine as cost-effective and 76% believed it offered increased flexibility in patient care activities. In addition, clinicians perceived that the quality of care provided via telemedicine was comparable to that of in-person visits.⁹ According to a study done in Indonesia, 78% of the clinicians were satisfied with the telemedicine system overall, 77% were content with the ease of using telemedicine equipment, and 88% interested to continue using the telemedicine.¹³ In line with these findings, the current study found that 88.6% of the clinicians reported overall satisfaction with telehealth services.

Telekyanmar, which translates to Telehealth, was established to meet the healthcare needs of people in Myanmar, where healthcare services have been severely disrupted by the military coup. Reports from Insecurity Insight, Physicians for Human Rights (PHR), and the Johns Hopkins University Center for Public Health and Human Rights (CPHHR) indicate that healthcare providers and infrastructure have been targeted by the military.^10,11 Amid this crisis, Telekyanmar online clinics have delivered crucial healthcare services, conducting over 178,000 consultations within three years of their launch. The current study highlights high levels of satisfaction with these services among both clients and providers.

There were few limitations that should be acknowledged. The study relied on self-reported satisfaction from both clients and clinicians, which could not be verified by other measures. The cross-sectional design captures satisfaction at a single point in time, which limits the study’s ability to track potential changes in satisfaction levels over time. Both clinicians and clients included in the study were providers and users of Telekyanmar clinics which may limit the generalization of the findings to other telemedicine services in Myanmar.

Conclusion

In conclusion, Telekyanmar online clinics are effectively addressing the healthcare needs of Myanmar’s population following the military coup, with high levels of satisfaction from both clients and providers, which is essential for the continued success of telemedicine services.