Department of Pathology, Faculty of Medicine, University of La Laguna, Canary Islands, Spain.
Telemed J E Health. 2010 Mar;16(2):233-43. doi: 10.1089/tmj.2009.0107.
Referrals from rural health centers to urban hospitals join waiting lists as outpatients for hospital admission and hospital treatment. This influences quality of life (QoL) of the rural population and retired people who require medical attention without traveling, provided no risks are involved. For this reason, a rural region of Spain has adopted a strategy to deliver telemedicine (TM) specialized care (Extremadura model) as a political decision.
The present study aimed at objectively assessing QoL on aspects of health and well-being for citizens benefiting from this system.
We performed a randomized study of 800 primary care patients referred for specialized care: 420 regular face-to-face hospital referrals and 380 referred to a hospital specialist at a distance by TM. The study used two questionnaires: a modified version of the classical SF-12v2 short form questionnaire for health and well-being and a specific author-elaborated questionnaire. The latter focused on major patient concerns such as (1) discomfort and pain relief, (2) swift diagnosis, (3) swift treatment, (4) swift decision on hospital admission or not, (5) avoidance of traveling, (6) avoidance of red tape, and (7) personal attention. QoL was assessed twice: before referral to a hospital specialist and 6 months after referral to the same. The results were statistically compared.
Both groups showed comparable health status with added advantages for TM referrals such as (1) less traveling (p = 0.0001) and (2) faster diagnosis, health examination, and treatment (p = 0.0001).
Telemedicine care by a hospital specialist through videoconferencing was comparable to hospital referral for face-to-face medicine. Teleconsultations managed by nurses had a positive impact on the QoL of rural patients. They did not have to travel and thus diagnoses and examinations to start treatment were initiated faster.
农村卫生中心将患者转诊到城市医院，这些患者需要在门诊排队等待住院和治疗。这会影响到农村地区居民和需要就医但又不愿长途跋涉的退休人员的生活质量（QoL），除非不存在任何风险。出于这个原因，西班牙的一个农村地区采取了一项策略，通过远程医疗（TM）提供专门的医疗服务（埃斯特雷马杜拉模式），这是一项政治决策。
本研究旨在客观评估从该系统中受益的公民的健康和幸福感方面的生活质量。
我们对 800 名接受专科医疗的初级保健患者进行了一项随机研究：420 名患者常规面对面转诊至医院，380 名患者通过 TM 远程转诊至医院专家。该研究使用了两个问卷：一个经过修改的经典 SF-12v2 短式健康调查问卷，用于评估健康和幸福感，以及一个由作者专门设计的问卷。后者重点关注患者的主要关注点，例如（1）缓解不适和疼痛，（2）快速诊断，（3）快速治疗，（4）快速决定是否住院，（5）避免旅行，（6）避免繁文缛节，（7）个人关注。生活质量在两次就诊时进行评估：转诊至医院专家之前和转诊后 6 个月。对结果进行了统计学比较。
两组患者的健康状况相当，但 TM 转诊组有一些额外的优势，例如（1）减少旅行（p = 0.0001）和（2）更快的诊断、健康检查和治疗（p = 0.0001）。
通过视频会议由医院专家提供的远程医疗服务与面对面医疗的转诊相当。由护士管理的远程咨询对农村患者的生活质量产生了积极影响。他们无需旅行，因此更快地开始了诊断和检查以启动治疗。
