慢性阻塞性肺疾病（COPD）早期患者对远程医疗支持与专科护理干预的认知比较：一项定性研究
Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study.
作者信息
Fitzsimmons Deborah A, Thompson Jill, Bentley Claire L, Mountain Gail A
机构信息
School of Health Studies, Western University, Arthur and Sonia Labatt Health Sciences Building, London, Ontario, N6A 3B4, Canada.
School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
出版信息
BMC Health Serv Res. 2016 Aug 22;16(1):420. doi: 10.1186/s12913-016-1623-z.
BACKGROUND
The increasing prevalence and associated cost of treating Chronic Obstructive Pulmonary Disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients' vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a qualitative study embedded within a feasibility and pilot Randomised Controlled Trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. The aim of the study was to qualitatively explore the experiences of patients with COPD who had received either a Telehealth-supported or a specialist nursing intervention following their discharge from hospital after an admission for a COPD exacerbation.
METHODS
Patients were invited to either participate in semi-structured interviews or to complete a semi-structured self-administered questionnaire on completion of the intervention. Nine patients were interviewed (67 % female) and seventeen patients completed the questionnaires. In addition, three clinicians responsible for the delivery of both interventions were interviewed to obtain their perspectives on the new services.
RESULTS
Seven underlying themes emerged from the patient interviews and were further explored in the questionnaires: (1) patient demographics; (2) information received by the participants; (3) installation of the Telehealth technology; (4) Telehealth service functionality; (5) visits; (6) service withdrawal; and (7) service perceptions. Recipients of both services reported feelings of safety derived from the delivery of an integrated, community-based service.
CONCLUSIONS
Although recipients of the Telehealth service received 50 % fewer home visits from the clinicians than recipients of a more traditional community-based nursing intervention, the patients were enthusiastic about the service, with some describing it as the best service they had ever received. This suggests that a Telehealth intervention is an acceptable alternative to a more traditional home nursing visit model for monitoring community-based patients with COPD following their discharge from hospital.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN68856013.
背景
慢性阻塞性肺疾病（COPD）的患病率不断上升，治疗相关费用难以持续承受，因此需要关注自我管理和预防住院。对患者生命体征进行远程医疗监测可使临床医生合理安排工作负荷，并让患者对自身健康承担更多责任。本文报告了一项定性研究的结果，该研究嵌入了一项可行性和试点随机对照试验（RCT），该试验在基于社区的慢性阻塞性肺疾病支持出院服务中采用远程医疗支持护理。该研究的目的是定性探索慢性阻塞性肺疾病患者在因慢性阻塞性肺疾病急性加重入院后出院时接受远程医疗支持或专科护理干预的体验。
方法
邀请患者在干预结束时参加半结构化访谈或完成半结构化自填问卷。对9名患者进行了访谈（67%为女性），17名患者完成了问卷。此外，对负责实施这两种干预措施的3名临床医生进行了访谈，以获取他们对新服务的看法。
结果
从患者访谈中出现了7个潜在主题，并在问卷中进一步探讨：（1）患者人口统计学；（2）参与者收到的信息；（3）远程医疗技术的安装；（4）远程医疗服务功能；（5）就诊；（6）服务退出；（7）服务认知。两种服务的接受者都报告说，基于社区的综合服务让他们感到安全。
结论
尽管接受远程医疗服务的患者接受临床医生家访的次数比接受更传统的社区护理干预的患者少50%，但患者对该服务很热情，一些人将其描述为他们接受过的最好的服务。这表明，对于监测出院后的社区慢性阻塞性肺疾病患者，远程医疗干预是一种比传统家庭护理访视模式更可接受的替代方案。
试验注册
当前对照试验ISRCTN68856013。
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