AN EXAMINATION OF THE INCORPORATION OF TELEMEDICINE TO IMPROVE INTERDISCIPLINARY COLLABORATION AMONG HEALTHCARE PROVIDERS IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Telemedicine is increasingly being introduced in community and long-term care settings to enhance access to specialist care (Barbosa et al., 2021), reduce the need for unnecessary transfers to acute healthcare institutions (Champagne-Langabeer et al., 2019), and increase cost efficiency (Li et al., 2022). Telemedicine, the use of technology to provide healthcare services remotely, has gained prominence as a transformative tool in the healthcare sector. By leveraging digital communication tools, telemedicine facilitates the delivery of medical care over distances, enabling healthcare professionals to connect and collaborate across various locations (Dominick et al., 2020). While there has been growing interest in telemedicine since the early 2010s, the COVID-19 pandemic led to an exponential increase in adoption of this style of medicine (Cormi et al., 2020). Beyond the pandemic, telemedicine use will be sustained as clinicians gain better understanding of its benefits (Thomas et al., 2022). New models of care require healthcare professionals to adapt to interprofessional collaborative practices on virtual platforms (Perri et al., 2020).

Interdisciplinary healthcare professionals work together to provide various services including examination, assessment, management, interprofessional care planning, and education through telemedicine (Şahin et al., 2021). In Pappas et al. (2019), extensive interprofessional communication during telemedicine consultations is highlighted as key to clinical decision-making processes between physicians and nurses. As distance-based services are more readily available for patients as they move through various healthcare settings, these telemedicine interactions have inevitably increased. Healthcare professionals who work in different healthcare contexts have different practice patterns and expectations, all of which affect communication and collaboration. Thus, there have been calls for more emphasis on interprofessional teamwork and collaboration of multidisciplinary healthcare providers who can cater to patients' individualized needs through telemedicine platforms (Powers et al., 2023).

Interdisciplinary collaboration involves the integration of knowledge and skills from various healthcare disciplines to provide holistic patient care (Lou, 2021). Effective collaboration among healthcare providers—such as doctors, nurses, pharmacists, and therapists—can improve patient outcomes, enhance care coordination, and reduce medical errors (Effiong, 2023). Interprofessional practice has been a longstanding key quality indicator in healthcare delivery to enhance patient outcomes and work satisfaction across diverse settings (Guck et al., 2019). Much research has been conducted to investigate organizational, team, and individual-level factors influencing collaborative practice in healthcare teams (Wei et al., 2022). To ensure a collaborative practice- ready workforce at all levels, key competencies have been developed to augment interprofessional education and practice. Globally, guidelines for education and practice such as the Interprofessional Education Collaborative (2016) has been developed and widely applied across primary care settings and care models, with domains such as clarifying roles and responsibilities, augmenting communication and teamwork, and conflict resolution. However, up until now, limited programs have been implemented to enhance interprofessional practice for both students and healthcare professionals in telehealth settings (Browne et al., 2022). Also, traditional methods of collaboration can be impeded by geographical barriers, time constraints, and resource limitations (Inibehe, 2022).

In Nigeria, healthcare providers frequently encounter challenges related to poor infrastructure, inadequate staffing, and limited access to specialized care, particularly in rural areas. These challenges can impede the effectiveness of interdisciplinary collaboration—a critical component of comprehensive patient care (Inibehe, 2022). Interdisciplinary collaboration involves different healthcare professionals, such as doctors, nurses, pharmacists, and specialists, working together to deliver coordinated and holistic care to patients. Effective collaboration among these professionals is essential for ensuring that patients receive the most appropriate and timely care, especially in complex cases that require input from multiple disciplines (Monday et al, 2021). The incorporation of telemedicine offers a promising solution to enhance interdisciplinary collaboration in Nigeria. By enabling real-time communication and data sharing among healthcare providers across different locations, telemedicine can facilitate better coordination of care, improve access to specialist consultations, and reduce delays in decision-making (Stephen et al., 20023). Moreover, telemedicine can help bridge the gap between urban and rural healthcare facilities, ensuring that patients in remote areas receive the same level of care as those in more developed regions (Inibehe, 2022).

Despite its potential benefits, the integration of telemedicine into Nigeria's healthcare system faces several challenges, including technological limitations, lack of infrastructure, resistance to change, and concerns about data security and privacy (Inibehe, 2022). Understanding how telemedicine can be effectively incorporated to improve interdisciplinary collaboration requires a comprehensive examination of these challenges and the opportunities they present. Hence the need for this study.

1.2 Statement of the problem

The Nigerian healthcare system faces notable obstacles such as regional inequalities, scarcity of resources, and a dearth of healthcare practitioners in underdeveloped regions. These obstacles frequently result in care that is not cohesive and impede the ability of healthcare providers to collaborate effectively across disciplines. Interdisciplinary collaboration is essential for providing thorough and well-coordinated patient care. However, traditional methods of collaboration are sometimes hindered by physical distances, limited resources, and insufficient communication channels.

Although telemedicine has the capacity to enhance interdisciplinary collaboration, its current utilisation in Nigeria is frequently restricted and fragmented. Numerous healthcare institutions suffer from a deficiency in infrastructure and technological capacities, preventing them from completely harnessing the potential of telemedicine tools. Consequently, their ability to effectively adopt collaborative practices is hindered (Seun, 2023). Anietie (2023) argues that successful interdisciplinary teamwork necessitates smooth communication and coordination among healthcare providers. Conventional approaches may not be sufficient for surmounting geographical obstacles and limitations on time (Adelaide, 2020). Telemedicine is a possible solution, however, its effect on enhancing communication and coordination in the Nigerian context has not been comprehensively evaluated.

Moreover, the successful execution of telemedicine in Nigeria faces various obstacles, such as technology constraints, insufficient technical education, reluctance to embrace change, and regulatory complexities (Ekanem, 2023). These obstacles hinder the implementation and improvement of telemedicine technologies aimed at promoting interdisciplinary collaboration. Moreover, Nigeria's healthcare system exhibits a substantial discrepancy between urban and rural regions, as rural areas frequently suffer from insufficient healthcare infrastructure and manpower (Aliu et al., 2020). Telemedicine has the potential to close these inequalities, but there is not enough research on how well it actually addresses these inequities.

Telemedicine has faced criticism, despite its potential. It is recommended by certain organisations that all patients should have the option to request and receive a face-to-face consultation. This is to prevent negative consequences such as improper referrals to emergency rooms (Collège des médecins du Québec, 2020). Anticipated consequences of adverse impact on interprofessional collaboration include a reduction in interprofessional talks and a decrease in referrals to other professions (Breton & Hudon, 2020; Hafner et al., 2021; Schwamm et al., 2020). Notwithstanding these critiques, telemedicine care is anticipated to continue being widespread following the pandemic (Poitras et al., 2022), but with more specific usage guidelines. According to a recent survey conducted on 603 primary care respondents, it was anticipated that a significant majority, ranging from 90% to 100% of professionals, will continue to utilise telemedicine even after the pandemic. Additionally, 28% of respondents anticipate using telehealth for more than 50% of their professional activities (Breton et al., 2021). Presently, there is a requirement for greater recognition of the vital skills necessary for effective collaboration among healthcare professionals in telemedicine environments (Wong et al., 2021). The absence of information may hinder the progress of providing sufficient assistance to health and social services professionals in implementing successful collaborative practices, even in telemedicine environments (A. Wong et al., 2021; Stamenova et al., 2020).

It is necessary to assess the impact of integrating telemedicine on patient care outcomes. The potential benefits of telemedicine in enhancing patient management and care through effective collaboration have not been thoroughly investigated in Nigeria. Therefore, the necessity for this investigation arises.

Objectives of the study

The primary objective of this study is to critically examine the incorporation of telemedicine to improve interdisciplinary collaboration among healthcare providers in Nigeria. Specific objectives of this study are to:

To evaluate the existing use and integration of telemedicine within Nigerian healthcare institutions.

To investigate how telemedicine influences interdisciplinary collaboration among healthcare providers within Nigerian healthcare institutions

To explore the challenges faced in the implementation of telemedicine in Nigerian healthcare institutions

To identify best practices and strategies for effectively incorporating telemedicine into collaborative workflows within Nigerian healthcare institutions

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the current level of integration and use of telemedicine in Nigerian healthcare institutions?

How does the incorporation of telemedicine influence interdisciplinary collaboration among healthcare providers in Nigeria?

What are the main barriers to the effective implementation of telemedicine for enhancing interdisciplinary collaboration?

What best practices can be identified for incorporating telemedicine into collaborative workflows to maximize its benefits in Nigerian healthcare institutions?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: There are no significant barriers to the effective implementation of telemedicine for enhancing interdisciplinary collaboration.

Ha: There are significant barriers to the effective implementation of telemedicine for enhancing interdisciplinary collaboration.

1.6 Significance of the study

Integrating telemedicine into healthcare practices in Nigeria has the potential to greatly increase collaboration among healthcare practitioners, leading to better access, quality, and efficiency of healthcare services. This study can offer vital perspectives on how telemedicine can be utilised to tackle current obstacles and enhance the overall operation of Nigeria's healthcare system.

Nigeria exhibits extensive geographic heterogeneity, wherein rural and isolated regions frequently encounter a dearth of specialised healthcare services. Telemedicine can serve as a means to connect healthcare professionals in remote locations with experts and other practitioners located in urban centres, thus bridging the gaps in access to healthcare services. A scarcity of healthcare experts and resources is prevalent in numerous locations of Nigeria. Telemedicine enables distant consultations, allowing a broader spectrum of physicians to contribute their expertise and enhancing the delivery of care.

Furthermore, the importance of effective interdisciplinary teamwork cannot be overstated when it comes to handling intricate cases and guaranteeing comprehensive patient care. Telemedicine facilitates instantaneous contact and exchange of information among a wide range of healthcare professionals, such as physicians, nurses, chemists, and specialists. Telemedicine technologies, such as video conferencing and electronic health records (EHRs), facilitate smooth communication and coordination among various healthcare professionals, promoting a more cohesive approach to patient care.

Furthermore, telemedicine enables healthcare providers to promptly seek advice from peers and acquire second opinions, resulting in quicker and more precise diagnoses and treatment strategies. Telemedicine facilitates continuous monitoring and follow-up, which is essential for the management of chronic illnesses and ensuring that patients receive consistent and coordinated care from various healthcare professionals. Telemedicine systems facilitate training and ongoing education, allowing healthcare providers to remain informed about the latest advancements and best practices in their respective disciplines, regardless of their geographical location. Telemedicine enables the transfer of knowledge amongst healthcare professionals with varying degrees of experience and skill, fostering a culture of learning and collaboration.

Additionally, the study might offer significant perspectives on the successful incorporation of telemedicine into Nigeria's healthcare system, thereby informing policy choices and strategic preparations. Gaining insight into the influence of telemedicine on interdisciplinary collaboration can aid in developing scalable and enduring models that can be implemented in different places.

Moreover, this study addresses a gap in existing research by explicitly investigating the healthcare institutions' environment in Nigeria. This study contributes to the broader academic understanding of how telemedicine might be used to foster interdisciplinary collaboration among healthcare providers in Nigeria.

1.7 Scope of the study

Broadly, this study focus is to critically examine the incorporation of telemedicine to improve interdisciplinary collaboration among healthcare providers in Nigeria. Specifically, this study seeks to evaluate the existing use and integration of telemedicine within Nigerian healthcare institutions and investigate how telemedicine influences interdisciplinary collaboration among healthcare providers within Nigerian healthcare institutions. 

Further, this study will focus on exploring the challenges faced in the implementation of telemedicine in Nigerian healthcare institutions and collaboration in Nigerian healthcare institutions and it also seeks to identify best practices and strategies for effectively incorporating telemedicine into collaborative workflows within Nigerian healthcare institutions.

 The study is carried out in Nigeria. 

1.8 Limitations of the study

Like any human undertaking, the researchers encountered numerous minor limitations during the examination. The primary constraint was the scarcity of comprehensive literature on the topic, resulting from the limited accessibility of data about an examination of the incorporation of telemedicine to improve interdisciplinary collaboration among healthcare providers in Nigeria. Therefore, a substantial amount of time and effort was required to determine the suitable materials, books, or information and gather data. 

Moreover, this study is limited by its limited sample size and restricted geographical reach, concentrating exclusively on Nigeria. Hence, the generalizability of the findings in this study is limited, necessitating additional research. 

Furthermore, the researcher's limitations were mostly attributed to financial restraints, as they are a student without any means of money to support themselves. The expensive transportation fees at the research location presented a difficulty in covering the costs associated with transportation expenses.

In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously meeting the requirements of attending lectures and engaging in other educational endeavors.

1.9 Definition of terms

Interdisciplinary teamwork: Interdisciplinary teamwork (also known as Professional collaboration) in healthcare refers to the collaborative approach where professionals from different disciplines work together to deliver comprehensive patient care.

Patient outcome: Patient outcomes are the results from care and treatments patients have received whilst in hospital, other clinical or care settings. They focus on meeting the physical, social, and emotional needs of patients from their own perspective to highlight what is important to them.

Telemedicine: Telemedicine refers to the provision of remote clinical services, via real-time two-way communication between the patient and the healthcare provider, using electronic audio and visual means.