1 School of Medicine, State University of New York Downstate, USA.
2 Department of Family Medicine, University of California, USA.
J Telemed Telecare. 2018 Aug;24(7):465-472. doi: 10.1177/1357633X17711822. Epub 2017 Jun 14.
Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse practitioners, physician assistants, trainee physicians and less-experienced primary care providers report the greatest clinical educational benefit, particularly for conditions involving lab-based diagnosis and management.
背景
电子咨询系统允许初级保健提供者通过迭代电子通信及时获得专业知识。此类系统在美国的使用正在扩大,用户满意度有很好的记录。我们描述了一个长期存在的综合电子咨询和转诊系统对初级保健提供者的教育影响。
方法
使用五点李克特量表通过电子调查,检查初级保健提供者对电子咨询系统通信固有的教育价值的看法,以及对他们管理常见专业临床情况和问题的能力的影响。总体上和按初级保健提供者的专业、提供者类型和工作年限检查初级保健提供者看法的差异。
结果
在 221 名初级保健提供者参与者(35%的回复率)中,83.9%的人同意或强烈同意集成电子咨询和转诊系统具有教育价值。提供者类型(主治医生、中级提供者或受训医生)、初级保健提供者的专业或工作年限对教育价值的报告没有显著差异。电子咨询和转诊系统在临床管理方面的益处对于基于实验室的情况(例如亚临床甲状腺功能减退症)比更弥散的情况(例如腹痛)似乎更强。与主治医生相比,护士从业者/医师助理和受训医生在使用电子咨询和/或转诊系统时更有可能报告其管理特定临床情况的能力得到提高,而经验≤10 年的初级保健提供者比经验>20 年的初级保健提供者更有可能报告管理特定临床情况的能力得到提高。
结论
初级保健提供者对综合电子咨询和转诊系统的教育价值给予压倒性的积极评价。护士从业者、医师助理、受训医生和经验较少的初级保健提供者报告了最大的临床教育益处,特别是对于涉及实验室诊断和管理的情况。