Qin Rosie, Dzombak Rachel, Amin Roma, Mehta Khanjan
The Pennsylvania State University, University Park, PA 16802, USA.
J Prim Care Community Health. 2013 Jul 1;4(3):177-81. doi: 10.1177/2150131912461797. Epub 2012 Oct 3.
Access to health care in rural areas of developing nations is hindered by both the lack of physicians and the preference of many physicians to practice in urban settings. As a result, rural patients often choose not to sacrifice wages or time to visit distant health care providers. A telemedicine system, Mashavu: Networked Health Solutions, designed to increase access to preprimary health care in rural areas, was field-tested in rural Kenya. This study aims to examine the reliability of the system compared to the traditional face-to-face method of health care delivery.
Reliability of the telemedicine system was tested using a modified intraobserver concordance study. Community health workers operated the system in various remote locations. Patient health information including chief complaint, medical history, and vital statistics were sent via Internet to a consulting nurse. After patients completed the telemedicine consultation, they also met in-person with the same nurse. Subsequently, the nurse's advice during the in-person session was compared with his feedback provided through the telemedicine consultation.
When comparing the nurse's advice given through the telemedicine system with the advice given through more traditional face-to-face, in-person consultation, the nurse provided consistent medical feedback in 78.4% of the cases (n = 102). The nurse's advice regarding patient action (eg, clinical referrals or no further care necessary) was the same in 89.2% of the cases (n = 91).
The study found that this telemedicine system was able to provide patients with approximately the same quality of care and advice as if the patient had physically travelled to a clinic to see a nurse. In rural areas of developing nations where there are high logistical and economical barriers to accessing health care, this telemedicine system successfully increased the ease and lowered the cost of connecting rural patients with nurses to provide preprimary care.
发展中国家农村地区获得医疗服务受到两方面阻碍，一是医生短缺，二是许多医生倾向于在城市执业。因此，农村患者常常不愿为了看病而牺牲工资或时间去拜访距离较远的医疗服务提供者。一个旨在增加农村地区初级卫生保健可及性的远程医疗系统——马沙武：网络健康解决方案，在肯尼亚农村地区进行了实地测试。本研究旨在检验该系统与传统面对面医疗服务提供方式相比的可靠性。
使用改良的观察者内一致性研究来测试远程医疗系统的可靠性。社区卫生工作者在不同偏远地点操作该系统。患者的健康信息，包括主要症状、病史和生命体征，通过互联网发送给一名咨询护士。患者完成远程医疗咨询后，还与同一名护士进行面对面会诊。随后，将护士在面对面会诊期间给出的建议与通过远程医疗咨询提供的反馈进行比较。
将通过远程医疗系统给出的护士建议与通过更传统的面对面会诊给出的建议进行比较时，护士在78.4%的病例（n = 102）中提供了一致的医疗反馈。护士关于患者行动（例如，临床转诊或无需进一步治疗）的建议在89.2%的病例（n = 91）中是相同的。
该研究发现，这个远程医疗系统能够为患者提供与患者亲自前往诊所看护士时大致相同质量的护理和建议。在发展中国家农村地区，获得医疗服务存在较高后勤和经济障碍，这个远程医疗系统成功提高了便利性，并降低了农村患者与护士联系以提供初级护理的成本。
