Center for Excellence in Primary Care, Department of Family & Community Medicine, University of California, San Francisco, CA, 94110.
University of California, Berkeley, Berkeley, CA.
Health Serv Res. 2018 Aug;53(4):2483-2502. doi: 10.1111/1475-6773.12776. Epub 2017 Sep 20.
To understand patient, primary care clinician (PCC), and subspecialist perspectives on potential, unexplored roles for patients in electronic consultation and referral (eCR) systems.
Primary focus group and survey data collected April-November 2015. Zuckerberg San Francisco General Hospital (ZSFG) is part of an integrated public health delivery system. Its mature eCR system was first implemented in 2005.
This mixed-methods study synthesizes patient, subspecialist, and PCC perspectives through two patient focus groups in English, Spanish, and Cantonese (n = 6); subspecialist focus groups (n = 2); and an electronic survey of all PCCs (n = 222/634, 35 percent response).
DATA COLLECTION/EXTRACTION METHODS: Focus groups were audio-recorded and transcribed. Two researchers coded the transcripts to identify recurrent themes. Survey data were analyzed using summary and bivariate statistics.
Patients expressed minimal desire to directly engage in eCR, instead of emphasizing their PCC's role in advocating, informing, and finding health solutions. Subspecialists requested more consistent communication to patients about the electronic consultation process. Most PCCs (52 percent) supported patient engagement in the eCR process, particularly patient ability to track consult status and securely message with subspecialists.
Results suggest a continuum of opportunities for patients and their caregivers to engage in eCR systems.
了解患者、初级保健临床医生（PCC）和专家对患者在电子咨询和转介（eCR）系统中潜在的、未被探索的角色的看法。
2015 年 4 月至 11 月期间收集的主要焦点小组和调查数据。Zuckerberg 旧金山总医院（ZSFG）是一个综合公共卫生服务系统的一部分。其成熟的 eCR 系统于 2005 年首次实施。
这项混合方法研究通过在英语、西班牙语和粤语中进行的两次患者焦点小组（n=6）、专家焦点小组（n=2）以及对所有 PCC 的电子调查（n=222/634，35%的回应），综合了患者、专家和 PCC 的观点。
资料收集/提取方法：焦点小组进行了录音和转录。两位研究人员对这些抄本进行了编码，以确定反复出现的主题。使用总结和双变量统计对调查数据进行了分析。
患者表示对直接参与 eCR 的意愿极小，而不是强调他们的 PCC 在倡导、告知和寻找健康解决方案方面的作用。专家要求与患者就电子咨询过程进行更一致的沟通。大多数 PCC（52%）支持患者参与 eCR 过程，特别是患者能够跟踪咨询状态并与专家安全地交流。
结果表明患者及其照顾者在 eCR 系统中有一系列参与的机会。
