Telemedicine revolutionizes medical care by providing remote access to healthcare services, improving efficiency, reducing geographic barriers and providing timely, life-saving care for patients. Current research aims to evaluate the influence of resistance to use, facilitators to use, perceived ease of use and perceived usefulness of telemedicine on the intention to use telemedicine by citizens of Peru. The study collected responses from individuals in Peru through an online survey, and the data was analyzed by multivariate statistical techniques. The results showed that perceived ease of use had a positive and significant effect on perceived usefulness; then, perceived ease of use had a positive and significant effect on the intention to use telemedicine. Also, resistance to use did not have a significant effect on intention to use telemedicine. The bootstrapping analysis showed that the effects between the variables were statistically significant. The outcomes obtained may provide ideas to healthcare managers in public and private sectors for planning health programs based in telemedicine and can make diagnosis and treatments with remote patients.

Telemedicine, resistance to use, perceived ease of use, perceived usefulness, Perú

Accessibility to health services is a fundamental pillar for the well-being of society. Efficient and timely access to medical care is essential to prevent, diagnose and treat diseases. However, at present, the difficulty in obtaining medical appointments has become a significant challenge, especially for those suffering from chronic diseases. Chronic diseases, such as diabetes, hypertension and cardiovascular disease, require ongoing care and careful management (Ofman et al. 2004). These patients face the reality that obtaining medical appointments has become a complicated task, further exacerbating their situation (Kuo et al. 2020). Problems of access to medical care mean that patients cannot be constantly monitored by health professionals, which, as has been reported before, leads to worsening of their illnesses and increased costs for the health care system (Allegrante et al. 2019).

While access to health services is a public health problem, different services have been offered to solve the difficulty of patient care; in this context, telemedicine has emerged as a key component in the digital revolution that is transforming the delivery of health services (Battineni et al. 2021). This modality takes advantage of information and communications technology to offer medical care at a distance, providing a series of significant benefits for both patients and health professionals. One of the most notable benefits of telemedicine is improved access to healthcare (Barbosa et al. 2021), especially in rural or remote areas where the availability of healthcare services may be limited. However, many patients in the city, but living in remote urban areas, would also benefit from telemedicine because it allows patients to connect with health professionals without the need to travel long distances (Imberti et al. 2021), resulting in more timely and efficient care. In addition, this approach also facilitates care for people with reduced mobility or disabilities, improving their quality of life (Petretto et al. 2023; Tamura et al. 2023).

On the other hand, telemedicine contributes to reducing costs for patients and health systems in general (Etges et al. 2022; Sharifi Kia et al. 2023). By eliminating the need to travel, the costs associated with transportation are significantly reduced. Additionally, virtual consultations are often more affordable than in-person visits, benefiting those without health insurance or with limited coverage. For health systems, implementing telemedicine can lead to improved efficiency in resource utilization and a decrease in emergency room visits (Zeltzer et al. 2023). Telemedicine facilitates greater continuity in medical care. Patients can maintain a constant connection with their care providers, making it easier to track chronic conditions, adjust treatments, and regularly monitor health. This is especially beneficial for those with chronic illnesses that require constant management and for those who need frequent adjustments to their medication (Kesavadev and Mohan 2023; Omboni 2024).

Telepharmacy is a key extension of telemedicine that seeks to optimize medication use (Keeys et al. 2014; Livet et al. 2021). Through telepharmacy, patients can receive pharmaceutical advice remotely, including reviewing their medications and ensuring that these are being taken as directed to achieve the therapeutic goal (Cigolle and Phillips 2023; Emadi et al. 2022). This approach helps improve adherence to treatments and minimizes medication-related errors; Likewise, it allows the detection and reporting of adverse reactions as a contribution to pharmacovigilance (Edrees et al. 2022; Sungsana et al. 2023). Telepharmacy plays a fundamental role in improving adherence to treatments. Pharmacists can offer personalized reminders about taking medications, as well as provide additional information about the importance of following the treatment plan. This is especially valuable for patients with chronic diseases who require long-term medications, as non-adherence can have significant health consequences.

Particularly relevant in the context of pandemics or outbreaks of communicable diseases, telemedicine helps reduce the spread of infections by minimizing the need for in-person visits to medical facilities. Patients can receive necessary care and medications from the safety of their homes, decreasing exposure to potential pathogens (Alhmoud et al. 2022; Harindhanavudhi et al. 2022). Telemedicine makes it easier to collect and manage health data more efficiently. Patients can access their medical records electronically, allowing them to easily share relevant information with their care providers. This contributes to more personalized and evidence- based care, as healthcare professionals have access to a more complete set of information (Record et al. 2021).

Before the pandemic, telemedicine was limited and focused on certain small groups of patients. During the pandemic, many patients had no other option than to be treated through telemedicine, in order to have their illnesses taken care of. Despite this, the question arises as to whether patients want telemedicine after the pandemic or if the preference for in-person medical appointments remains and, likewise, to know what factors explain this intention to use telemedicine. The current research was carried out in Peru. The study aims to analyze the effect of influence of social influence, resistance to use, perceived ease of use, perceived usefulness, and facilitating conditions in the intention to use telemedicine in Peru.

In the last decade and more during the COVID-19 pandemic, in the various health systems the implementation of telemedicine was gaining space, benefiting the control of different diseases such as dyslipidemia (Bingham et al. 2020), cardiovascular disease (Kuan et al. 2022), Alzheimer’s disease (Angelopoulou et al. 2022), inflammatory bowel disease (Pang et al. 2022), HIV (El-Nahal et al. 2022), diabetes (Onishi et al. 2022), Parkinson’s disease (Podlewska and van Wamelen 2022), epilepsy (Kikuchi et al. 2022) and other diseases (Chua et al. 2022; Ma et al. 2022).

Telemedicine is a valuable option for patients who may have limited access to healthcare services, while also helping to decongest hospitals and improve the quality of care. However, some patients may perceive telemedicine as impersonal and lacking in warmth. For others, physical contact with their healthcare provider, direct eye contact, and an in-person smile are essential components of their care. Telemedicine interventions have seen web-based consultations (Musa Mamman et al. 2022; Shibata and Hoshide 2023), telemonitoring (Fountoulakis et al. 2015; Lee et al. 2020; Ayoub et al. 2022), remote consultations (Shea et al. 2006; Sood et al. 2017; Lo et al. 2023), and Internet-based consultations (Lu et al. 2020; Cunha et al. 2023). Among the professionals involved in telemedicine physicians (Shea et al. 2006; Fountoulakis et al. 2015; Lee et al. 2020; Garavand et al. 2022), nurses (Shea et al. 2006; Isidori et al. 2022; Plunger et al. 2022), pharmacists (Lu et al. 2020; Howard et al. 2022; Li et al. 2022) and multidisciplinary teams (Sood et al. 2017; Caponnetto et al. 2021) are all mentioned. Different barriers have been reported for the implementation of telemedicine (Bakshi and Tandon 2022; Furlepa et al. 2022; Kruse and Heinemann 2022). A more detailed analysis of what has been published on telemedicine is presented below.

To obtain the documents corresponding to this analysis, a search was carried out in December 28^th, 2023 on the Scopus website (https://www.scopus.com/), and the algorithm was used: TITLE-ABS-KEY (telemedicine) AND PUBYEAR > 2019 AND PUBYEAR < 2024 AND (EXCLUDE (PUBSTAGE, “aip”)) AND (LIMIT-TO (DOCTYPE, “ar”)) AND (LIMIT-TO (SUBJAREA, “DENT”) OR LIMIT-TO (SUBJAREA, “IMMU”) OR LIMIT- TO (SUBJAREA, “PHAR”) OR LIMIT-TO (SUBJAREA, “PSYC”) OR LIMIT-TO (SUBJAREA, “MEDI”) OR LIMIT-TO (SUBJAREA, “HEAL”) OR LIMIT-TO (SUBJAREA, “NURS”)). Fig. 1 shows the process and steps of article selection.

Figure 1. 

Process of article selection.

A total of 32 711 papers were found, of which 32 018 papers were published and 693 in press. In addition, 20 318 articles, 4 962 reviews, 1 820 letters, 1 563 conference papers, 1 446 editorials, 1 437 notes, 732 book chapters, 202 short surveys, 73 erratum, 69 review conferences, 63 books, 25 retractions, and 1 data paper were found.

The areas analyzed for this publication were medicine (27 174), health professions (2 779), nursing (2 325), psychology (1 162), pharmacology, toxicology and pharmaceutics (542), immunology and microbiology (491), and dentistry (183). Only article-type documents were selected; thus 19 738 documents were selected. Considering the areas with business topics and the highest number of publications, we considered selecting: medicine, health professions, nursing, psychology, pharmacology, toxicology and pharmaceutics, immunology and microbiology, and dentistry. Including these limitations, 17 848 articles were considered for the review, which showed that 160 countries participated in publications. Table 1 details the top ten countries, mentioning the number of articles.

Table 2 shows the top 10 institutions with the most published articles, representing 23.97%. The United States, Canada, Italy and UK were the top countries with publications of articles on telemedicine.

Table 3 details the journals with more articles published about telemedicine. From 2000 to 2023, 4361 documents were published in the top 10 journals, representing 24.43% of the articles. Telemedicine and E Health was the journal with the most articles (879), accounting for 4.92% of the total number of publications; it was followed by Journal of Medical Internet Research and International Journal of Environmental Research and Public Health with 850 and 542 publications, respectively. The Journal of Telemedicine and Telecare was the journal with the highest CiteScore 2022 (12.1) and SJE 2022 (1.992). Then, Journal of Medical Internet Research has the highest Impact Factor (7.4). Finally, Plos One was the journal with the highest H-index (404).

Finally, Table 4 presents the more relevant authors of publications on telemedicine, showing their filiations, countries, and total H-index.

Every time there are changes in technology, users tend to reject it, citing various reasons for continuing to use the previous technology as much as possible. For this reason, it is necessary to know what factors have an effect on the acceptance of services based on telemedicine and that allow the necessary corrections and incentives to be made in order to obtain the greatest benefit from these types of health programs. The implementation of telemedicine requires a significant investment of resources, so if you can know what factors interact to increase acceptance, it will be easier to plan the implementation.

Hypothesis 6: PEUS through PUSE has a positive and significant effect on IUTM

Research model

Fig. 2 shows the research model to analyze the effects among of variables.

Figure 2. 

Research model.

Current research uses a prospective, non-experimental, cross and correlational design. The objective is to analyze the effects among the variables of the model to explain the intention to use the telemedicine programs.

The purpose of this study was to identify the factors that influence people’s intention to use telemedicine. The results showed that the respondents believed that telemedicine would improve the quality of medical care, which is an important factor for the continuity of use. This may be due to the fact that telemedicine allows for more accessible medical appointments, making it easier for people to receive medical attention, especially in developing countries where this can be a challenge (Kadir 2020; Suzuki et al. 2020; Yousef et al. 2021). Additionally, telemedicine is perceived as a way to improve access to health services without disrupting people’s daily lives, as is often the case with long waiting times in public health services (Latifi et al. 2019; Palozzi et al. 2020; Barbosa et al. 2021). Furthermore, respondents found learning to use telemedicine to be easy, as current telemedicine systems are user-friendly and intuitive for patients. The study also highlighted the importance of the new form of communication and trust-building that can be established between patients and health professionals through telemedicine. While traditional in-person consultations allow for physical examination and emotional bonding, telemedicine offers a unique opportunity for patients to build trust with their healthcare providers through virtual consultations.

Social networks have become an integral part of people’s lives, with the opinions of others having a significant impact on their lives. This need for validation of actions has resulted in people sharing many aspects of their lives, including personal and sensitive information like health problems or deep thoughts. Often, people use social media to express their frustration towards political or sports actors. The experiences of other people can influence one’s opinion, which can be requested through a chat message or posted voluntarily to thank or complain about the services received (Al-Dmour et al. 2020; Elia et al. 2020; Suarez-Lledo and Alvarez-Galvez 2021). Negative comments on social media can quickly spread, leading people to question the quality of the service. It is difficult to verify the authenticity of such comments, but people tend to believe them, and even if they have doubts, they assume that there must be some truth to it. This difficulty in verifying information is the biggest problem with social media. Endurance Items has capitalized on people’s fears of abandoning traditional medical appointments due to depersonalization. However, it is important to remember that several communication tools have been incorporated to help people overcome their resistance to change, as seen in the widespread use of mobile phones. This resistance is usually lower in younger people compared to adults and the elderly.

Although the number of participants in the study was limited, PLS-SEM allowed for the analysis of data. Due to the pandemic, patients in healthcare facilities were not available, and therefore, the participants were citizens. Future research should focus on evaluating the acceptance of different modes of telemedicine provision, such as video call, chatbot, synchronous chat, telephone, and other methods. It is essential to differentiate between the intention to use these technologies and evaluate their effectiveness in patients with specific diseases, such as diabetes and hypertension, as well as in patients from urban and rural areas. Additionally, it is necessary to assess the perception of the cost of telemedicine services. For example, should patients pay the same amount for virtual and face-to-face medical appointments? Finally, future research should explore which health professionals are most needed to offer telemedicine services and whether patients are interested in blended services, that is, partial and face-to-face appointments alternately.

In developing countries, telemedicine services have been used to provide medical care to patients with other diseases that need to be monitored. These patients often lack access to medical facilities and receive remote care through telemedicine. However, to plan for medical services in the post-pandemic period, it is necessary to understand the potential users of telemedicine services, their preferences, and specific requirements for medical care. Telemedicine services are not suitable for all patients, and thus, it is necessary to prioritize the types of patients who can benefit the most from this service. Gradually, health services in developing countries are implementing telemedicine services to improve healthcare access for patients.