Lehoux P, Sicotte C, Denis J L, Berg M, Lacroix A
Interdisciplinary Health Research Group (GRIS), Department of Health Administration, University of Montreal, Branch "Centre-ville", Quebec, Canada.
Soc Sci Med. 2002 Mar;54(6):889-904. doi: 10.1016/s0277-9536(01)00063-6.
Since the early 1990s, telemedicine, or the use of information technology to support the delivery of health care from a distance, has increasingly gained the support of clinicians, administrators and policymakers across industrialised countries. However, the "theory of use" behind telemedicine-its rationale and the manner in which clinicians are expected to use it in their daily activities--has been only marginally investigated. In this paper we present the results of a qualitative study which examines the theory of use behind teleconsultation from the viewpoint of physicians (n = 37) in six specialities, practising in Quebec (Canada) hospitals. We employ Giddens' Structuration Theory (1984) to analyse the views, communications needs and referral strategies of physicians. Two questions are explored: (1) To what extent can teleconsultation be integrated into the routines of diverse medical specialities'? and (2) Why and how might clinicians use this technology? Our research indicates that specialities relying on either thorough physical examinations or specialised investigative techniques are unlikely to restructure their work routines to accommodate teleconsultation, which they view as limited. Specialities that primarily exploit images or numerical data tend to perceive teleconsultation as more useful. The perceived enabling properties of teleconsultation increase as a function of the distance the patient would have to travel to be seen directly by a consultant. The constraining properties are linked to the type of information transmitted, since physicians believe that only objective data can be safely consulted from a distance, whereas relying on the remote physician's interpretation of subjective information is deemed inappropriate. We thus conclude that the development of teleconsultation should be consolidated around applications whose theory of use is compatible with existing clinical routines, or offers opportunities to restructure clinical work according to the needs of providers and remote communities.
自20世纪90年代初以来，远程医疗，即利用信息技术支持远程提供医疗保健服务，越来越受到工业化国家临床医生、管理人员和政策制定者的支持。然而，远程医疗背后的“使用理论”——其基本原理以及临床医生在日常活动中使用它的方式——仅得到了极少的研究。在本文中，我们展示了一项定性研究的结果，该研究从加拿大魁北克省医院六个专业的医生（n = 37）的角度审视了远程会诊背后的使用理论。我们运用吉登斯的结构化理论（1984）来分析医生的观点、沟通需求和转诊策略。探讨了两个问题：（1）远程会诊在多大程度上可以融入不同医学专业的日常工作中？（2）临床医生为什么以及如何使用这项技术？我们的研究表明，依赖全面体格检查或专业检查技术的专业不太可能为了适应远程会诊而重组其工作流程，他们认为远程会诊有局限性。主要利用图像或数值数据的专业往往认为远程会诊更有用。随着患者为得到会诊医生直接诊治而需前往的距离增加，远程会诊所感知到的赋能特性也会增加。限制特性与所传输信息的类型相关，因为医生认为只有客观数据才能从远程安全会诊，而依赖远程医生对主观信息的解读则被认为不合适。因此地，我们得出结论，远程会诊的发展应围绕那些使用理论与现有临床常规兼容，或根据提供者和偏远社区的需求提供重组临床工作机会的应用来巩固进行。
