无程序激励或要求的临床间电子咨询：对初级保健提供者观点的定性研究。

Inter-clinician eConsults without programmatic incentives or requirements: a qualitative study of primary care provider perspectives.

机构信息

Cambridge Health Alliance, Cambridge, MA, USA.

Institute for Community Health, Malden, MA, USA.

出版信息

Fam Pract. 2020 Sep 5;37(4):525-529. doi: 10.1093/fampra/cmaa016.

DOI:10.1093/fampra/cmaa016

PMID:32112080

Abstract

BACKGROUND

Inter-clinician electronic consultation (eConsult) programmes are becoming more widespread in the USA as health care systems seek innovative ways of improving specialty access. Existing studies examine models with programmatic incentives or requirements for primary care providers (PCPs) to participate.

OBJECTIVE

We aimed to examine PCP perspectives on eConsults in a system with no programmatic incentive or requirement for PCPs to use eConsults.

METHODS

We conducted seven focus groups with 41 PCPs at a safety-net community teaching health care system in Eastern Massachusetts, USA.

RESULTS

Focus groups revealed that eConsults improved PCP experience by enabling patient-centred care and enhanced PCP education. However, increased workload and variations in communication patterns added challenges for PCPs. Patients were perceived as receiving timelier and more convenient care. Timelier care combined with direct documentation in the patient record was perceived as improving patient safety. Although cost implications were less clear, PCPs perceived costs as being lowered through fewer unnecessary visits and laboratories.

CONCLUSIONS

Our findings suggest that eConsult systems with no programmatic incentives or requirements for PCPs have the potential to improve care.

摘要

背景

随着医疗保健系统寻求创新方法来改善专业服务的可及性，美国的临床医生间电子咨询（eConsult）计划越来越普及。现有研究考察了针对参与的初级保健提供者（PCP）有计划激励或要求的模式。

目的

我们旨在研究在没有针对 PCP 使用 eConsult 的计划激励或要求的系统中，PCP 对 eConsult 的看法。

方法

我们在美国马萨诸塞州东部的一个安全网社区教学医疗保健系统中进行了七次焦点小组讨论，共有 41 名 PCP 参加。

结果

焦点小组揭示了 eConsult 通过实现以患者为中心的护理和增强 PCP 教育，改善了 PCP 的体验。然而，工作量的增加和沟通模式的变化给 PCP 带来了挑战。患者被认为得到了更及时和更方便的护理。及时的护理加上在患者记录中的直接记录被认为提高了患者的安全性。虽然成本影响不太清楚，但 PCP 认为通过减少不必要的就诊和实验室检查，降低了成本。