面向资源匮乏环境的基于网络的远程医疗系统：转诊医生和专家的见解。
A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists.
机构信息
Synapse Teleneurology Ltd, Belfast, UK; School of Medicine, Queen's University, Belfast, UK;
出版信息
Glob Health Action. 2013 Sep 23;6:21465. doi: 10.3402/gha.v6i0.21465.
BACKGROUND
One way to tackle health inequalities in resource-poor settings is to establish links between doctors and health professionals there and specialists elsewhere using web-based telemedicine. One such system run by the Swinfen Charitable Trust has been in existence for 13 years which is an unusually long time for such systems.
OBJECTIVE
We wanted to gain some insights into whether and how this system might be improved.
METHODS
We carried out a survey by questionnaire of referrers and specialists over a six months period.
RESULTS
During the study period, a total of 111 cases were referred from 35 different practitioners, of whom 24% were not doctors. Survey replies were received concerning 67 cases, a response rate of 61 per cent. Eighty-seven per cent of the responding referrers found the telemedicine advice useful, and 78% were able to follow the advice provided. As a result of the advice received, the diagnosis was changed in 22% of all cases and confirmed in a further 18 per cent. Patient management was changed in 33 per cent. There was no substantial difference between doctors and non-doctors. During the study period, the 111 cases were responded to by 148 specialists, from whom 108 replies to the questionnaire were received, a response rate of 73 per cent. About half of the specialists (47%) felt that their advice had improved the management of the patients. There were 62 cases where it was possible to match up the opinions of the referrer and the consultants about the value of a specific teleconsultation. In 34 cases (55%) the referrers and specialists agreed about the value. However, in 28 cases (45%) they did not: specialists markedly underestimated the value of a consultation compared to referrers. Both referrers and specialist were extremely positive about the system which appears to be working well. Minor changes such as a clearer referral template and an improved web interface for specialists may improve it.
背景
在资源匮乏的环境中解决健康不平等问题的一种方法是通过基于网络的远程医疗在当地医生和卫生专业人员与其他地方的专家之间建立联系。Swinfen 慈善信托基金运营的这样一个系统已经存在了 13 年，对于此类系统来说，这是一个异常长的时间。
目的
我们希望深入了解该系统是否以及如何得到改善。
方法
我们在六个月的时间内通过问卷对转介医生和专家进行了调查。
结果
在研究期间，共有 35 名不同医生的 111 例病例被转介，其中 24%不是医生。收到了 67 例病例的调查回复，回复率为 61%。87%的转介医生认为远程医疗建议有用，78%的医生能够遵循所提供的建议。根据收到的建议，所有病例中有 22%改变了诊断，18%进一步确认了诊断。33%改变了患者管理。医生和非医生之间没有实质性差异。在研究期间，111 例病例由 148 名专家进行了回复，其中 108 名专家回复了问卷，回复率为 73%。大约一半的专家（47%）认为他们的建议改善了患者的管理。有 62 例可以比较转介医生和顾问对特定远程咨询的意见。在 34 例（55%）中，转介医生和专家意见一致。然而，在 28 例（45%）中，他们的意见并不一致：专家明显低估了咨询的价值，与转介医生相比。转介医生和专家对系统都非常满意，系统运行良好。较小的更改，例如更清晰的转介模板和为专家改进的网络界面，可能会有所改善。
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