Pappas Yannis, Vseteckova Jitka, Mastellos Nikolas, Greenfield Geva, Randhawa Gurch
Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, United Kingdom.
Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom.
J Patient Exp. 2019 Dec;6(4):296-304. doi: 10.1177/2374373518803617. Epub 2018 Oct 8.
This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider-patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care-specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decision-making. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients.
本文分析了医疗专业人员和患者在远程医疗会诊中进行诊断和决策时所运用的技能。随着政府工作重点持续强调患者参与疾病管理，准确捕捉临床诊疗过程中医患互动的需求日益增加。本研究借鉴了对英格兰3个国民医疗服务体系机构的10次视频会诊的会话分析，考察了患者、全科医生（GP）、护士和会诊医生在诊断和决策过程中的互动，旨在确定参与者在该过程中使用的技能范围，并捕捉远程医疗会诊诊断和决策阶段的跨专业沟通及患者参与情况。分析表明，远程会诊增强了专业人员之间的协作，使全科医生和护士能够通过为会诊贡献基层医疗的专业知识来提升技能并积极参与诊断和决策。然而，跨专业互动可能导致患者在决策中的参与度有限。本研究结果可用于为远程医疗培训项目提供参考，这些项目侧重于培养专业人员的有效技能以及向患者提供信息。
