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COVID-19大流行期间远程儿科医疗服务的数字方法:现有证据及进一步研究的呼吁。

Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research.

作者信息

Badawy Sherif M, Radovic Ana

机构信息

Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.

出版信息

JMIR Pediatr Parent. 2020 Jun 25;3(1):e20049. doi: 10.2196/20049.


DOI:10.2196/20049
PMID:32540841
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7318926/
Abstract

The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)-secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts.

摘要

冠状病毒病(COVID-19)疫情的全球蔓延构成了公共卫生威胁,并以前所未有的各种方式在个人和职业方面影响了全世界的人们。毫无疑问,当前的全球COVID-19危机比以往任何时候都更凸显了在这场大流行时代利用数字方法优化儿科医疗服务的重要性。在这篇观点文章中,我们重点介绍了一些现有的数字方法,这些方法已经并可以继续用于简化COVID-19大流行时代的远程儿科患者护理,包括但不限于远程医疗。JMIR Pediatrics and Parenting目前正在出版一期COVID-19特别主题专刊,研究人员可以在其中分享他们与不同环境下远程儿科医疗服务的数字方法相关的中期和最终研究数据。COVID-19大流行迅速改变了全球医疗系统,在适应方面有显著的差异和创新。在医疗服务提供中对数字方法的利用和优化迅速扩展,特别是综合远程医疗和虚拟健康。数字方法已经并将继续发挥重要作用,作为宝贵且可靠的资源,以克服COVID-19大流行期间所带来的限制和挑战,并为更多患者和家庭增加获得有效、可及且方便用户的医疗服务的机会。然而,仍有一些挑战有待解决,并需要进一步的研究。优化医疗服务提供的数字方法并将其纳入公共卫生应对措施将是当前COVID-19疫情期间以及未来其他可能的大流行期间持续进行的过程。监管变革对于支持这些方法的安全和广泛采用至关重要。让所有相关利益攸关方参与应对当前和未来的挑战以及后勤、技术和财务障碍将是成功的关键。未来的研究应考虑评估以下与远程医疗和其他数字方法相关的研究领域:成本效益和投资回报率;对医疗质量的影响;在急性疾病和慢性健康状况管理中使用的平衡以及所需就诊次数;在其他环境(如住院服务、专科会诊和农村地区)进一步采用的系统准备情况;持续的以用户为中心的评估,包括患者、家庭和医疗服务提供者的反馈;优化健康公平以及解决与种族和族裔、社会经济地位、移民身份和农村社区相关的医疗服务获取差异的策略;对于受《健康保险流通与责任法案》(HIPAA)保护的项目中受保护健康信息的隐私和安全问题;针对某些特定人群(特别是青少年和需要心理健康服务的人群)的保密问题;暴力暴露和儿童忽视的早期检测;以及将培训纳入本科和研究生医学教育及专科 fellowship。解决这些研究领域对于理解远程医疗和其他数字方法作为现代医疗服务提供关键部分的益处、可持续性、安全性和优化策略至关重要。这些努力将为通过扩大传播和实施工作长期采用这些方法提供信息。

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