Moloczij N, Mosley I, Moss K M, Bagot K L, Bladin C F, Cadilhac D A
Medical and Cognitive Research Unit, Austin Health, Heidelberg, Victoria, Australia.
National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia.
Intern Med J. 2015 Sep;45(9):957-64. doi: 10.1111/imj.12793.
Fast diagnosis and delivery of treatment to patients experiencing acute stroke can reduce subsequent disability. While telemedicine can improve rural community access to specialists and facilitate timely diagnosis and treatment decisions, it is not widely used for stroke in Australia.
Identifying the barriers and facilitators to clinician engagement with, and utilisation of, telemedicine consultations could expedite implementation in rural and remote locations.
Purposive sampling was used to identify and recruit medical and nursing staff varying in telemedicine experience across one hospital department. Twenty-four in-depth, face-to-face interviews were conducted examining aspects surrounding stroke telemedicine uptake. Inductive qualitative thematic analysis was undertaken, and two further researchers verified coding.
The main barriers identified were contrasting opinions about the utility of thrombolysis for treating acute stroke, lack of confidence in the telemedicine system, perceived limited need for specialist advice and concerns about receiving advice from an unfamiliar doctor. Facilitators included assistance with diagnosis and treatment, the need for a user-friendly system and access to specialists for complex cases.
Acceptability of telemedicine for acute stroke was multifaceted and closely aligned with regional clinician beliefs about the value of thrombolysis for stroke, highlighting an important area for education. Addressing beliefs about treatment efficacy and other perceived barriers is important for establishing a stroke telemedicine programme.
对急性中风患者进行快速诊断和治疗可减少后续残疾情况。虽然远程医疗可以改善农村社区患者获得专科医生服务的机会，并促进及时的诊断和治疗决策，但在澳大利亚，它并未广泛应用于中风治疗。
确定临床医生参与和利用远程医疗咨询的障碍及促进因素，这可能会加快其在农村和偏远地区的实施。
采用目的抽样法，在一个医院科室中识别并招募具有不同远程医疗经验的医护人员。进行了24次深入的面对面访谈，考察围绕中风远程医疗应用的各个方面。进行归纳性定性主题分析，另外两名研究人员对编码进行了验证。
确定的主要障碍包括对溶栓治疗急性中风效用的不同看法、对远程医疗系统缺乏信心、认为对专科医生建议的需求有限以及对从不熟悉的医生那里获得建议的担忧。促进因素包括诊断和治疗方面的协助、对用户友好系统的需求以及复杂病例可获得专科医生服务。
急性中风远程医疗的可接受性是多方面的，并且与地区临床医生对中风溶栓价值的信念密切相关，凸显了一个重要的教育领域。解决对治疗效果的信念及其他感知到的障碍对于建立中风远程医疗项目很重要。
