Department of Otolaryngology-Head and Neck Surgery.
The Ohio State University College of Medicine.
Laryngoscope. 2018 May;128(5):1068-1074. doi: 10.1002/lary.26929. Epub 2017 Oct 27.
To evaluate diagnostic concordance of a synchronous telemedicine otolaryngology clinic with use of currently available technology.
Prospective.
Patients in a rural otolaryngology clinic were enrolled in a pilot telemedicine clinic. To assess system fidelity, an on-site and remote (consulting) otolaryngologist conducted simultaneous patient evaluations using streaming telecommunication technology for all aspects of the clinical encounter, including high-definition examination and endoscopic images. Both physicians and patients were blinded and diagnoses recorded. Post-encounter physician surveys and an original patient-centered TeleENT Satisfaction Questionnaire (TESQ) were used to assess overall satisfaction.
Twenty-one patients were enrolled consecutively. Visual technology was found acceptable in all cases, and audio technology was acceptable in 20 of 21 encounters. Patient satisfaction was 96%, and patients felt comfortable using a telemedicine system in the future. Encounters were not significantly longer than traditional encounters. Physician diagnostic agreement was found in 95% of cases, and the consulting physician indicated that all encounters provided sufficient history, examination, and high-quality images to generate an accurate diagnosis, order additional workup, and/or make an appropriate referral.
A synchronous otolaryngology telemedicine clinic is comparable to a standard clinic in terms of diagnostic concordance and patient satisfaction when using streaming technology and high-definition images. Using telemedical technology may be a viable way to increase otolaryngology access in remote or underserved areas. With system validity now established, future studies will assess the feasibility of using trained on-site physician extenders (nurse practitioners or physician assistants) to conduct in-person patient encounters with remote otolaryngologist support.
2c. Laryngoscope, 128:1068-1074, 2018.
评估使用现有技术的同步远程医疗耳鼻喉科诊所的诊断一致性。
前瞻性。
农村耳鼻喉科诊所的患者被纳入试点远程医疗诊所。为了评估系统的保真度，现场和远程（咨询）耳鼻喉科医生使用流媒体通信技术同时进行患者评估，包括高清检查和内窥镜图像。医生和患者均为盲法，记录诊断结果。在就诊后，医生会进行调查，并使用原始的以患者为中心的远程耳鼻喉科满意度问卷（TESQ）评估整体满意度。
连续纳入 21 例患者。所有病例均发现视觉技术可接受，21 次就诊中有 20 次音频技术可接受。患者满意度为 96%，患者表示将来愿意使用远程医疗系统。就诊时间并未明显长于传统就诊。95%的病例中，医生的诊断结果一致，咨询医生表示所有就诊均提供了足够的病史、检查和高质量的图像，足以做出准确的诊断、安排进一步检查和/或进行适当转诊。
当使用流媒体技术和高清图像时，同步耳鼻喉远程医疗诊所与标准诊所在诊断一致性和患者满意度方面相当。使用远程医疗技术可能是增加偏远或服务不足地区耳鼻喉科就诊机会的可行方法。随着系统有效性的建立，未来的研究将评估使用经过培训的现场医生助手（护士或医师助理）与远程耳鼻喉科医生支持进行现场患者就诊的可行性。
2c。喉镜，128：1068-1074，2018。
