A survey on occupational medicine residency programs across european countries.

Primary healthcare centers (PHCs), which are health units providing comprehensive packages of services at nominal fees to vulnerable Lebanese, migrants, and displaced populations, are struggling to maintain safe and accessible operations. Financial challenges are at an all-time high, with analysts claiming that Lebanon is currently facing its worst economic crisis since the end of its civil war in 1990. Unsurprisingly, the Lebanese healthcare system has been severely impacted by this crisis, and PHCs are no exception []. In fact, between August 2020 and November 2021, PHC consultations increased by 10 to 17% monthly, signaling an increased dependence from vulnerable individuals on PHCs []. However, access to healthcare services in Lebanon is hindered by the centralization of services in and around Beirut [], limited patient awareness and health literacy, widespread societal stigma around essential services like mental and reproductive health services [], and prohibitive service costs. In recent years, the healthcare system has been grappling with multiple intersecting crises: an influx of refugees, COVID-19, the August 4 Beirut Blast, and the ongoing economic collapse. These factors pushed an already overwhelmed healthcare system to its limits, especially in tandem with the brain drain of professionals, prioritization of more pressing responses, limited resources, as well as other challenges []. Therefore, it is crucial to vitalize primary care services by scaling up integrated community-based services. One potential solution to respond to the aforementioned challenges is the adoption of telehealth (TH) – a modality of remote healthcare services provision relying on the use of information and communication technologies (ICT). PHCs are ideal for TH integration in Lebanon because they have the minimally required ICT, and their catchment areas cover rural governorates, which typically host underserved populations []. For instance, many PHCs in Lebanon are usually equipped with the tablets and computers, internet connection, and the IT personnel needed for the TH implementation []. For patients in rural settings, TH implementation offers them improved access to high-quality services, reduced wait time, work absenteeism, and transportation cost, and positive perception of clinician competency. It also protects from the disruption of care delivery in the event of nationwide events that can impede access to care. [] In contrast, for PHCs and medical professionals, TH helps them overcome the issue of limited resources and improves the sharing of medical information between PHCs and physicians, hence reducing unnecessary referrals. [] Moreover, TH eliminates the practitioners’ need to commute, allowing them to treat patients living in otherwise unreachable areas []. However, the implementation of TH in PHCs is not seamless. Issues such as potential regulatory concerns, infrastructural limitations including unreliable internet connection and outdated hardware, limited digital literacy among PHC staff and patients, associated resistance, and others may pose a challenge for the integration of TH []. Surprisingly, even though 80% of the Lebanese population owns a smartphone and 76% has access to the internet, TH use has been limited before the COVID-19 pandemic. [] However, following COVID-19, the Lebanese Order of Physicians encouraged physicians to provide healthcare services remotely when deemed possible. [] In 2020, Helou et al. explored how physicians adapted to the sudden need for TH and found a significant shift in their perceptions, indicating greater openness and willingness to adopt this model. [] In 2022, a cross-sectional study by Shaarani et al. investigated the utilization of TH by Lebanese physicians during the COVID-19 pandemic and found that 75.8% used TH during the pandemic, and 40% started doing so because of the pandemic. [].