Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia.
J Oncol Pract. 2018 Jul;14(7):e429-e437. doi: 10.1200/JOP.18.00110.
The Queensland Remote Chemotherapy Supervision (QReCS) model enables rural nurses to administer chemotherapy in smaller rural towns under supervision by health professionals from larger centers using telehealth. Its implementation began in North Queensland, Australia (population, 650,000), in 2014 between two regional cancer centers (Townsville and Cairns as primary sites) and six rural sites (125 to 1,000 kilometers from primary sites). Our study examined the implementation processes, feasibility, and safety of this model.
Details of implementation and patients' clinical details for the period of 2014 to 2016 for descriptive analysis were extracted from telechemotherapy project notes and oncology information systems of North Queensland, respectively.
After a successful pilot study in Townsville Cancer Centre, statewide rural and cancer networks of Queensland Health, in collaboration with clinicians and managers across the state of Queensland, developed the QReCS model and a guide for operationalizing it. QReCS was implemented at six sites from 2014 to 2016. Main enablers across North Queensland included collaboration among clinicians and managers, availability of common electronic medical records, funding from Queensland Health, and installation of telehealth infrastructure by statewide telehealth services. Main barriers included turnover of senior management and nursing staff at two rural towns. Sixty-two patients received 327 cycles of low- to medium-risk chemotherapy agents. Rates of treatment delays, adverse events, and hospital admissions were similar to those in face-to-face care.
Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.
昆士兰远程化疗监管（QReCS）模式使农村护士能够在较小的农村城镇中根据医疗专业人员从较大中心使用远程医疗提供的监督下管理化疗。该模式于 2014 年在澳大利亚昆士兰州北部（人口 65 万）实施，在两个区域癌症中心（汤斯维尔和凯恩斯为主要地点）和六个农村地点（距主要地点 125 至 1000 公里）之间展开。我们的研究检查了该模式的实施过程、可行性和安全性。
分别从北昆士兰的远程化疗项目记录和肿瘤信息系统中提取了 2014 年至 2016 年期间实施情况和患者临床细节的详细信息，用于描述性分析。
在汤斯维尔癌症中心成功进行试点研究后，昆士兰州健康州立农村和癌症网络与全州的临床医生和管理人员合作，制定了 QReCS 模式及其运营指南。2014 年至 2016 年期间，QReCS 在六个地点实施。整个北昆士兰的主要推动因素包括临床医生和管理人员之间的合作、共同电子病历的可用性、昆士兰州健康的资金投入以及全州远程医疗服务机构安装远程医疗基础设施。主要障碍包括两个农村城镇的高级管理人员和护理人员的更替。62 名患者接受了 327 个低至中风险化疗药物周期的治疗。治疗延迟、不良事件和住院率与面对面护理相似。
在较大地理区域内实施 QReCS 模式是可行的，且具有可接受的安全性。临床医生和管理人员的领导力和合作、资源充足性和共同治理是关键推动因素。
