Jordan D Nicki, Jessen Cornelia M, Ferucci Elizabeth D
University of Washington School of Medicine, Alaska WWAMI Program, Seattle, Washington, USA.
Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA.
Telemed J E Health. 2021 Jan;27(1):82-89. doi: 10.1089/tmj.2019.0284. Epub 2020 Apr 13.
Chronic diseases disproportionately affect minority and rural populations. Specialist access improves health outcomes in many chronic diseases but access to specialist care may be limited. Video telemedicine can expand access to specialists in rural locations. The objective of this study was to understand patient and provider perspectives on the benefits, barriers, and best uses of video telemedicine in chronic disease specialty care in the setting of a well-established store-and-forward telehealth network with recent expansion of video telemedicine. Patients and providers were recruited from specialty clinics at the Alaska Native Medical Center. Semi-structured interviews were conducted after a brief survey. Interview questions focused on perceived benefits and barriers to use of video telemedicine for chronic disease specialty care, as well as the best uses of telemedicine and factors that improve the ease of use. Participants considered the major benefit of telemedicine to be a reduction in travel and related costs. Telemedicine was considered by most participants as less appropriate for new conditions or for new patients. Limitations included the need to perform a physical examination or needing tests, procedures, or medications that cannot be performed in rural clinics. This study describes the views of patients and providers who have experience with telemedicine. It did not evaluate the cost-effectiveness or impact on health outcomes, although further studies are planned. Patients and providers view video telemedicine as a reasonable addition to in-person visits for the management of chronic disease, although there are limitations.
慢性病对少数族裔和农村人口的影响尤为严重。获得专科医疗服务可改善多种慢性病的健康结局，但获得专科护理的机会可能有限。视频远程医疗可以扩大农村地区患者获得专科医生服务的机会。本研究的目的是，在一个成熟的存储转发远程医疗网络且近期扩展了视频远程医疗的背景下，了解患者和医疗服务提供者对于视频远程医疗在慢性病专科护理中的益处、障碍及最佳应用的看法。患者和医疗服务提供者是从阿拉斯加原住民医疗中心的专科诊所招募的。在进行简短调查后开展了半结构化访谈。访谈问题聚焦于视频远程医疗用于慢性病专科护理的感知益处和障碍，以及远程医疗的最佳应用和提高易用性的因素。参与者认为远程医疗的主要益处是减少了出行及相关费用。大多数参与者认为远程医疗不太适合用于新病症或新患者。局限性包括需要进行体格检查，或需要在农村诊所无法进行的检查、操作或用药。本研究描述了有远程医疗经验的患者和医疗服务提供者的观点。尽管计划开展进一步研究，但本研究未评估成本效益或对健康结局的影响。患者和医疗服务提供者认为，视频远程医疗是慢性病管理中面对面就诊的合理补充，尽管存在局限性。
