الفهرس 
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Abstract
Telehealth is delivering healthcare services remote from healthcare facilities using telecommunications and virtual technology. Telehealth is considered the most basic part of e-health, which depends on far wider range of information and communication technologies.
The main components for implementing telehealth are:
Leadership and governance are to ensure the involvement of stakeholders. Strategy and investment by making sure that the plan meets acceptance from consumers. Legislation, policy and compliance are of the main points essential for telehealth. Infrastructure would be presented in providing updated equipment compatible with the required services, designing software compatible with the needs of the service as well as proper training of healthcare providers to be ready to provide high quality service. Workforce regular evaluation, workshops and training should be provided on regular bases to make sure of proper evaluation and meeting the needed progress and evolution of the program. Preparing management teams and proper structure to assure sustainability and progress of different telehealth programs.
Telehealth in family practice can render promising effects in connecting, sharing and processing information and data leading to improving quality of healthcare delivered on personal and community basis as well as reducing costs of health services. This can happen through initiation of a strategy for using technology in primary care settings and allow family physicians to be leading the implementation and development of technology in a manner that suits primary care services and patient centered approach.
Telehealth is crucial to help doctors in rural areas to access specialists services, besides providing medical students education over distance. It is shown that the assistance of telehealth for primary care providers in continuous education and acquiring knowledge through peer communication and reducing isolation as well as teleconsultation through which they could benefit from consulting specialists located in another area Self-monitoring of pregnancy with smart devices preference in some countries like Germany, through telemedicine, is increasing Telemedicine is more important in pediatrics for those living at far distances compared to closer ones . The increase in the prevalence of chronic diseases urges adapting a method for continuous following up and care, the use of telehealth will play a role in home healthcare of these patients in addition to remote monitoring .Telemedicine has a strong impact in reducing frequency of re-hospitalization by long term management of chronic conditions. The benefits of Telehealth include increasing access to expertise in difficultly reached geographical areas with no available medical teams, and may be used as a means to deliver fast first aid. Additionally, it may minimize costs of hospitals as patients can be monitored remotely even from home.
Egypt is deploying technology in all its services in different socio-economic applications. As an example, for these applications are e-government, e-businesses and e-learning. Minor steps have been taken in telehealth, but not yet enough Egypt is aiming to reach Universal Health Coverage, this increases the demand of telehealth in routine health services
So, this study was designed to inform the health decision makers by information concerning the knowledge and attitude of healthcare workers and patients attending primary healthcare centers about telehealth.
This study aimed to measure the awareness of telehealth among attendees and workers of primary healthcare units and to evaluate and identify change of attitude of healthcare workers towards telehealth implementation after orientation. The study was conducted in two phases. Phase one is Cross sectional study for both healthcare workers and patients. The second Phase was Interventional study for healthcare workers (HCWs). The study was conducted in primary healthcare (PHC) centers in East region of Cairo. It was completed in 9 months.
The study included all the PHC workers who were present at the units and agreed to participate and had a role in referring and following up of patients. The selected healthcare worker should fulfill one inclusion criteria that s/he should spend at least 6 months in PHC units to be familiar with the work nature in such units. A convenient sample of patients who attended the healthcare units for themselves or accompanied dependents (children, geriatrics or handicapped) as their caregivers were selected. A sample of 162 Patients was calculated using Epi-Info 7 program.
An adjusted valid self-administered five-point Likert-scale questionnaire was admitted to healthcare workers. The questionnaire included different domains of awareness, advantages, disadvantages, necessity, ease and importance of security of telehealth. A total of 109 questionnaires were collected in this phase from healthcare workers who were present and agreed to participate. The scoring of questionnaire questions was done by five points, as 5 is the highest point and 1 is the lowest. A score was given for each domain then a total score was given for the whole questionnaire.
The healthcare workers were submitted to an Orientation program: The program was designed of one session, which was held after filling the questionnaires. In this phase a total of 104 questionnaires were re-collected, after 2 weeks of the orientation program, giving a response rate = 95.4%. The DROP rate was contributed to the reason that healthcare workers were on vacation so couldn’t reach them
An adjusted valid interview questionnaire previously used in other studies, the questionnaire was translated to Arabic and modified according to the Egyptian culture and validation of translation was done by expert opinion. The questionnaire was admitted to the patients. The questions focused mainly on their knowledge and willing to use telemedicine and their network infrastructure, in addition to their socioeconomic status. The causes of acceptance and refusal of telehealth application. The number of collected questionnaires was 170
Ethical issues were considered
The results showed the total score of healthcare workers before the program was 130.36±23.53 and it was 156.49±18.45 and this difference was statistically significant as P˂.05. Awareness percentage among healthcare workers with master’s degree was 66.7% while awareness percentage and healthcare workers with bachelor degree was 55.6%. The highest awareness percentage was recorded among physicians (64.3%) followed by the pharmacists (62.5%) while the lowest percentage was among nurses (29.6%).
The percentage of patients aware of telehealth was 64.7%, 30.9% of them gave full definitions. The sources of knowledge were recorded to be television, net then healthcare workers. The percentage of patients willing to use telehealth was 78.2%.
It was concluded that the applied program played an important role in improving the knowledge and attitudes scores of healthcare workers towards telehealth. The percentage of telehealth awareness among patients and that of willing to use telehealth were higher among high economic status patients and were lower among inhabitants of slum areas.
The percentage of telehealth awareness and that of willing to use telehealth were higher among patients willing to receive electronic video, messages or SMS.
It is recommended to design an orientation program of telehealth to be delivered to all healthcare workers especially to nurses in primary healthcare centers and another program of telehealth to be broadcasted and delivered to all primary health centers attendee specially those of low socioeconomic status.