1 Centre for Online Health, The 1974 University of Queensland , Australia.
2 Department of Orthopaedics, Princess Alexandra Hospital, Australia.
J Telemed Telecare. 2017 Dec;23(10):835-841. doi: 10.1177/1357633X17732800. Epub 2017 Sep 26.
Health services in the United States and Europe have reported that tele-orthopaedics saves significant patient travel time, reduces time off work, increases satisfaction with care and in some scenarios reduces the cost of care. Less is known about the role of tele-orthopaedics in Australia. The aim of this study was to explore Australian-based tele-orthopaedic services, and to identify the barriers and enablers associated with these services. We used a qualitative case study methodology where specific services were identified from multiple sources and invited to participate in a structured interview. Nine tele-orthopaedic services contributed to the study. Telehealth activity in each service ranged from one to 75 patients per week, and service maturity ranged from three months to 10 years. Services were used predominantly for fracture clinics and peri-operative consultations. The majority (78%) of services used videoconferencing. Two services used asynchronous methods to review radiographs without direct patient involvement. Tele-orthopaedics was found to be disruptive as it required the redesign of many care processes. However, all services found the redesign feasible. Staff resistance was a commonly cited barrier. Further, imaging repositories from multiple imaging providers complicated access to information. Key enablers included clinical champions, picture archiving and communication systems, and the perceived benefit to patients who would avoid the need for travel. Whilst it appears that tele-orthopaedics is not widely utilised in Australia, recognition of the barriers and enablers is important for the development of similar services.
美国和欧洲的医疗服务机构报告称，远程矫形术可显著节省患者的旅行时间，减少误工时间，提高患者对治疗的满意度，在某些情况下还降低了治疗成本。而关于远程矫形术在澳大利亚的应用，我们了解得较少。本研究旨在探讨澳大利亚的远程矫形术服务，并确定与这些服务相关的障碍和促进因素。我们采用了定性案例研究方法，从多个来源确定了特定的服务，并邀请它们参与结构化访谈。共有 9 个远程矫形术服务参与了这项研究。每个服务的远程医疗活动每周从 1 名到 75 名患者不等，服务的成熟度从 3 个月到 10 年不等。这些服务主要用于骨折门诊和围手术期咨询。大多数（78%）的服务使用视频会议。有两个服务使用异步方法查看放射影像，而无需直接与患者联系。远程矫形术具有颠覆性，因为它需要重新设计许多护理流程。然而，所有服务都认为重新设计是可行的。员工抵制是一个常见的障碍。此外，来自多个影像供应商的影像存储库使得获取信息变得复杂。关键的促进因素包括临床拥护者、影像归档和通信系统，以及患者避免旅行的需求所带来的好处。虽然远程矫形术在澳大利亚似乎尚未得到广泛应用，但认识到这些障碍和促进因素对于类似服务的发展非常重要。
