Bradford Natalie K, Caffery Liam J, Smith Anthony C
The University of Queensland, Centre for Online Health, Princess Alexandra Hospital, Telehealth Centre, Woollongabba, Queensland, Australia.
Rural Remote Health. 2016 Oct-Dec;16(4):3808. Epub 2016 Oct 17.
With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge. Telehealth services can efficiently and effectively improve access to healthcare for people living in rural and remote areas of Australia. However, telehealth services are not mainstream or routinely available in many rural and remote locations. The barriers to integration of telehealth into mainstream practice have been well described, but not the factors that may influence the success and sustainability of a service. Our aim was to collate, review and synthesise the available literature regarding telehealth services in rural and remote locations of Australia, and to identify the factors associated with their sustained success.
A systematic literature review of peer-reviewed and grey literature was undertaken. Electronic databases were searched for potentially relevant articles. Reference lists of retrieved articles and the grey literature were also searched. Searches identified 970 potentially eligible articles published between 1988 and 2015. Studies and manuscripts of any type were included if they described telehealth services (store-and-forward or real-time videoconferencing) to provide clinical service or education and training related to health care in rural or remote locations of Australia. Data were extracted according to pre-defined criteria and checked for completeness and accuracy by a second reviewer. Any disagreements were resolved with discussion with a third researcher. All articles were appraised for quality and levels of evidence. Data were collated and grouped into categories including clinical speciality, disciplines involved, geographical location and the role of the service. Data relating to the success or sustainability of services were grouped thematically.
Inclusion criteria were met by 116 articles that described 72 discrete telehealth services. Telehealth services in rural and remote Australia are described and we have identified six key factors associated with the success and sustainability of services: vision, ownership, adaptability, economics, efficiency and equipment.
Telehealth has the potential to address many of the key challenges to providing health in Australia, with its substantial land area and widely dispersed population. This review collates information regarding the telehealth services in Australia and describes models of care and characteristics of successful and sustainable services. We identified a wide variety of telehealth services being provided in rural and remote areas of Australia. There is great potential to increase this number by scaling up and replicating successful services. This review provides information for policy makers, governments and public and private health services that wish to integrate telehealth into routine practice and for telehealth providers to enhance the sustainability of their service.
随着医疗保健成本的不断攀升、农村地区医疗从业者招聘和留用问题以及规模经济不佳，是将人送到服务机构还是将服务送到人身边，这一问题令世界各地的卫生当局陷入两难境地。与城市居民相比，农村地区居民的健康状况更差，如何在农村地区提供医疗保健和服务仍是一项持续存在的挑战。远程医疗服务能够高效且有效地改善澳大利亚农村和偏远地区居民获得医疗保健的机会。然而，在许多农村和偏远地区，远程医疗服务并非主流服务，也无法常规获取。远程医疗融入主流医疗实践的障碍已得到充分描述，但影响服务成功及可持续性的因素却鲜有人提及。我们的目标是整理、回顾并综合有关澳大利亚农村和偏远地区远程医疗服务的现有文献，确定与服务持续成功相关的因素。
对同行评审文献和灰色文献进行了系统的文献综述。在电子数据库中搜索潜在相关文章。还搜索了检索文章的参考文献列表和灰色文献。搜索共识别出1988年至2015年间发表的970篇潜在符合条件的文章。如果研究和手稿描述了为澳大利亚农村或偏远地区提供临床服务或与医疗保健相关的教育和培训的远程医疗服务（存储转发或实时视频会议），则纳入任何类型的研究和手稿。数据按照预先定义的标准提取，并由第二位评审人员检查其完整性和准确性。任何分歧都通过与第三位研究人员讨论来解决。对所有文章进行质量和证据水平评估。数据进行整理并归类为临床专科、涉及学科、地理位置和服务角色等类别。与服务成功或可持续性相关的数据按主题进行分组。
116篇文章符合纳入标准，这些文章描述了72项独立的远程医疗服务。介绍了澳大利亚农村和偏远地区的远程医疗服务，我们确定了与服务成功和可持续性相关的六个关键因素：愿景、所有权、适应性、经济性、效率和设备。
鉴于澳大利亚幅员辽阔、人口分布广泛，远程医疗有潜力应对提供医疗保健方面的许多关键挑战。本综述整理了有关澳大利亚远程医疗服务的信息，描述了护理模式以及成功和可持续服务的特征。我们发现澳大利亚农村和偏远地区正在提供各种各样的远程医疗服务。通过扩大规模和复制成功服务，增加此类服务数量的潜力巨大。本综述为希望将远程医疗纳入常规实践的政策制定者、政府以及公共和私人医疗服务机构提供了信息，也为远程医疗服务提供者提高其服务的可持续性提供了参考。
