Ray Kristin N, Demirci Jill R, Bogen Debra L, Mehrotra Ateev, Miller Elizabeth
1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
2 Department of Healthcare Policy and Medicine, Harvard Medical School , Boston, Massachusetts.
Telemed J E Health. 2015 Aug;21(8):622-9. doi: 10.1089/tmj.2014.0186. Epub 2015 Apr 28.
Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies.
Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained.
Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists.
Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing effective telehealth systems.
远程医疗提供了改善农村社区儿童获得专科护理服务的策略。目前尚不清楚农村儿科医生在使用这些远程医疗策略满足儿童专科护理需求方面的经验和偏好。我们了解了农村儿科医生在不同儿科专科远程医疗策略方面的经验和偏好。
对来自美国17个州的农村儿科医生进行了17次半结构化电话访谈。通过电子邮件招募受访者，这些邮件发送给儿科农村健康邮件列表的订阅者以及通过滚雪球抽样确定的农村儿科医生。通过对访谈记录的主题分析确定主题。获得了机构审查委员会的批准。
农村儿科医生确定了几种改善专科护理服务可及性的远程医疗策略，包括医生热线、远程电子病历访问、电子消息系统、实时视频远程医疗和远程医疗分诊系统。农村儿科医生根据他们对不同系统的经验，为优化每种策略的效用提供了建议。农村儿科医生在特定临床环境中更喜欢特定的远程医疗策略，从而形成了一个描述不同远程医疗策略在儿科专科护理中互补作用的框架。最后，农村儿科医生确定了与使用远程医疗策略相关的其他好处，并表示希望远程医疗系统能够加强（而不是取代）农村儿科医生与专科医生之间的个人关系。
农村儿科医生描述了不同专科护理远程医疗策略的互补作用。此外，农村儿科医生为优化个体远程医疗策略提供了建议。农村儿科医生的意见对于优化特定远程医疗策略和设计有效的远程医疗系统至关重要。
