Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC (KN Ray), Pittsburgh, Pa.
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health (JM Kahn), Pittsburgh, Pa; Department of Critical Care Medicine, CRISMA Center, University of Pittsburgh School of Medicine (JM Kahn), Pittsburgh, Pa.
Acad Pediatr. 2020 Jan-Feb;20(1):16-22. doi: 10.1016/j.acap.2019.08.002. Epub 2019 Aug 9.
Nearly a quarter of families of children with need of subspecialty care report difficulty accessing that care. Telehealth is a method to overcome barriers to subspecialty care. However, improving access to subspecialty care through telehealth requires granular identification of specific subspecialty barriers and recognition of the strengths and limitations of each telehealth strategy for addressing identified barriers. Focusing on each sequential step in subspecialty referrals and potential associated barriers, we summarize specific telehealth and technology-enabled strategies to improve access to subspecialty care, including electronic consultations, live interactive telemedicine, store-and-forward telemedicine, tele-mentoring, patient portals, and remote patient monitoring. Intentionally selecting telehealth strategies to target specific subspecialty referral barriers may avoid risks from misapplication of telehealth, may more clearly elevate equitable access as an essential goal within telehealth initiatives, and may also lead to synergistic use of strategies that overcome sequential barriers.
近四分之一有专科医疗需求儿童的家庭报告称，他们在获得专科医疗服务方面存在困难。远程医疗是克服专科医疗障碍的一种方法。然而，要通过远程医疗改善专科医疗服务的可及性，需要精细识别具体的专科障碍，并认识到每种远程医疗策略在解决已确定障碍方面的优势和局限性。我们专注于专科转诊的每一个连续步骤和潜在的相关障碍，总结了改善专科医疗服务可及性的具体远程医疗和技术支持策略，包括电子咨询、实时互动远程医疗、存储转发远程医疗、远程指导、患者门户和远程患者监测。有针对性地选择远程医疗策略来针对特定的专科转诊障碍，可能有助于避免远程医疗应用不当的风险，更明确地将公平获取作为远程医疗计划的一个基本目标，并且还可能导致克服连续障碍的策略的协同使用。
