Dixon Ronald F, Rao Latha
1 Massachusetts General Hospital-Beacon Hill Primary Care , Boston, Massachusetts.
Telemed J E Health. 2014 Jul;20(7):669-72. doi: 10.1089/tmj.2013.0211. Epub 2014 May 2.
Both primary care and specialty care in many areas face access constraints. Tools to evaluate and engage patients with chronic disease, without having them present to the clinic, are needed. Asynchronous virtual care has been explored as one of the ways to deliver care more efficiently, yet this has not been integrated into a busy practice environment. This pilot study aims to assess the utility of a Web platform that allows patients with chronic disease to be evaluated for follow-up care, thereby avoiding an office visit.
Patients with 10 common chronic conditions were recruited into the study at a busy primary care clinic. Instead of booking an in-office follow-up visit, they were directed online to complete a questionnaire pertaining to their condition 7-28 days after their office visit. Their physician would review their responses and make treatment decisions, informing the patient online. Patient and physician satisfaction was measured using a validated Likert scale after each visit.
Patients were satisfied with the Web site and process as a way to receive their follow-up care. Clinicians were satisfied in making clinical decisions with the information received via the Web site. The clinician time spent for the overall encounter was significantly shorter than for an in-person follow-up visit.
Clinicians and patients are interested in tools that improve patient health, are convenient, and save time for both parties. Targeting patients with chronic illness and leveraging available technology to deliver the care are very satisfactory to both clinicians and patients. Asynchronous virtual visits for patients with chronic medical conditions are an effective way to evaluate and manage patients, while providing physicians significant time savings. These visits have the potential to reduce in-office follow-up visits across primary care, potentially improving access and reducing costs.
许多地区的初级保健和专科护理都面临着就诊限制。需要一些工具来评估慢性病患者并让他们无需到诊所就诊就能接受治疗。异步虚拟护理已被探索为一种更高效提供护理的方式,但尚未融入繁忙的医疗实践环境。这项试点研究旨在评估一个网络平台的效用,该平台允许对慢性病患者进行随访评估,从而避免门诊就诊。
在一家繁忙的初级保健诊所招募了患有10种常见慢性病的患者。他们不是预约门诊随访,而是在门诊就诊7至28天后被引导到网上完成一份与病情相关的问卷。他们的医生会查看他们的回答并做出治疗决定,然后在线告知患者。每次就诊后使用经过验证的李克特量表测量患者和医生的满意度。
患者对通过该网站和流程接受随访护理感到满意。临床医生对通过网站收到的信息做出临床决策感到满意。整个诊疗过程中临床医生花费的时间明显短于面对面随访就诊。
临床医生和患者都对能够改善患者健康、方便且能为双方节省时间的工具感兴趣。针对慢性病患者并利用现有技术提供护理,对临床医生和患者来说都非常令人满意。对患有慢性疾病的患者进行异步虚拟就诊是评估和管理患者的有效方式,同时为医生节省大量时间。这些就诊有可能减少初级保健中的门诊随访就诊,从而有可能改善就诊机会并降低成本。