Dobke Marek K, Bhavsar Dhaval, Gosman Amanda, De Neve Joan, De Neve Brian
Division of Plastic Surgery, Department of Surgery, University of California San Diego, 200 West Arbor Drive, MC-8890 San Diego, CA 92103-8890, USA.
Telemed J E Health. 2008 Apr;14(3):245-9. doi: 10.1089/tmj.2007.0038.
The study goal was to evaluate the impact of the telemedicine consult on patients with chronic wounds. Thirty patients from long-term care skilled nursing facilities, referred to the ambulatory wound care program for wound assessment and preparation of management plans, were the subject of this prospective, randomized trial. To facilitate communication with a surgical wound care specialist, telemedicine feedback was provided prior to face-to-face consultation to 15 patients. The telemedicine consult included (1) wound assessment, (2) rationale for the suggested wound management with emphasis on wound risk projections, and (3) prevention and benefits of surgical intervention. This was communicated to the patient by the field wound care nurse. The telemedicine impact was measured by assessing the duration of the subsequent face-to-face consultation and patient satisfaction with further care decisions as well as by validation of a decisional conflict scale. The average duration of the face-to-face consultation was 50 +/- 12 minutes versus 35 +/- 6 (p < 0.01) minutes for patients subjected to the telemedicine feedback preceding the direct contact with the specialist. The telemedicine consult was found to be a useful aid in increasing the satisfaction rate from care decisions ultimately made during the direct consult (acceptance rate 93% vs. 47% in those subjected to treatment without the intermediate telemedicine consult, p < 0.01). The decisional conflict as a state of uncertainty about the course of action to take was reduced in patients subjected to telemedicine decision aid. The average Decisional Conflict Scale score was 14 +/- 1.73 in patients subjected to telemedicine feedback as opposed to 35 +/- 4.26 (p < 0.001) in no-telemedicine contact. The telemedicine consult preceding face-to-face evaluation improved patient satisfaction and understanding of their care as well as increased the perception of shared decision making regarding the wound care.
本研究的目的是评估远程医疗会诊对慢性伤口患者的影响。本前瞻性随机试验的对象是30名来自长期护理专业护理机构的患者，他们被转介到门诊伤口护理项目进行伤口评估并制定管理计划。为便于与外科伤口护理专家沟通，在面对面会诊前，向15名患者提供了远程医疗反馈。远程医疗会诊包括：（1）伤口评估；（2）建议伤口管理的依据，重点是伤口风险预测；（3）手术干预的预防措施和益处。现场伤口护理护士将这些信息传达给患者。通过评估后续面对面会诊的时长、患者对进一步护理决策的满意度以及决策冲突量表的有效性来衡量远程医疗的影响。接受远程医疗反馈的患者在与专家直接接触前进行面对面会诊的平均时长为50±12分钟，而未接受远程医疗反馈的患者为35±6分钟（p<0.01）。结果发现，远程医疗会诊有助于提高直接会诊期间最终护理决策的满意度（接受率为93%，而未进行中间远程医疗会诊的患者为47%，p<0.01）。接受远程医疗决策辅助的患者中，作为对采取行动过程不确定性状态的决策冲突有所减少。接受远程医疗反馈的患者决策冲突量表平均得分为14±1.73，而未进行远程医疗接触的患者为35±4.26（p<0.001）。面对面评估前的远程医疗会诊提高了患者对护理的满意度和理解，也增强了他们对伤口护理共同决策的认知。
