Assessing Telemedicine Demand and Viability in Indonesian Geriatric Clinics: A Comprehensive HOT FIT and Sociotechnical Analysis.

INTRODUCTION: The growing elderly population in Indonesia presents challenges for the healthcare system, prompting the exploration of telemedicine as a solution. However, its effective implementation in Indonesia faces obstacles. METHOD: This research aimed to develop a comprehensive geriatric telemedicine framework in Padang City by studying multiple stakeholders. We employed qualitative methods, including in- -depth interviews, across two hospitals, a Health Office, and a Community Health Center, involving 18 elderly participants. RESULT: The study identified ten key dimensions for geriatric telemedicine services: technology, Human-Computer Interface (HCI), infrastructure, system workflow, clinical content, people (diverse roles), organization (ecosystem, service workflow, internal and external regulations), and financing (social security agency on health and independent). We used the Human-Organization- Technology Fit and Sociotechnical System approaches for analysis. CONCLUSION: The study suggests implications for future implementation and advocates for broader participant involvement, information technology (IT) studies for system development, and longitudinal evaluations to assess the impact on elderly health outcomes.

Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia.

AIM: To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals. METHODS: Hospital based prospective study at 12 centers of 9 countries. RESULTS: 12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non-significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P < 0.001). Vaginal delivery also had higher rates of severe asphyxia and palsy than elective cesarean section. CONCLUSION: Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.