Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239.
VA Nebraska-Western Iowa Health Care System & University of Nebraska Medical Center, Omaha, NE.
Mil Med. 2020 Dec 30;185(11-12):e2082-e2087. doi: 10.1093/milmed/usaa203.
The Department of Veterans Affairs Veterans Health Administration (VA) Strategic Plan (Fiscal Year 2018-2024) identified four priorities for care including easy access, timely and integrated care, accountability, and modernization, all of which can be directly or indirectly impacted by telemedicine technologies. These strategic goals, coupled with an anticipated rheumatology workforce shortage, has created a need for additional care delivery methods such as clinical video telehealth application to rheumatology (ie, telerheumatology). Rheumatology clinician perceptions of clinical usefulness telerheumatology have received limited attention in the past. The present study aimed to evaluate rheumatologists' perceptions of and experiences with telemedicine, generally, and telerheumatology, specifically, within the VA.
A 38-item survey based on an existing telehealth providers' satisfaction survey was developed by two VA rheumatologists with experience in telemedicine as well as a social scientist experienced in survey development and user experience through an iterative process. Questions probed VA rheumatology clinician satisfaction with training and information technology (IT) supports, as well as barriers to using telemedicine. Additionally, clinician perceptions of the impact and usefulness of and appropriate clinical contexts for telerheumatology were evaluated. The survey was disseminated online via VA REDCap to members of the VA Rheumatology Consortium (VARC) through a LISTSERV. The study protocol was approved by the host institution IRB through expedited review. Survey responses were analyzed using descriptive statistics.
Forty-five anonymous responses (20% response rate) were collected. Of those who responded, 47% were female, 98% were between 35 and 64 years old, 71% reported working at an academic center, and the majority was physician-level practitioners (98%). Respondents generally considered themselves to be tech savvy (58%). Thirty-six percent of the sample reported past experience with telemedicine, and, of those, 29% reported experience with telerheumatology specifically. Clinicians identified the greatest barrier to effective telerheumatology as the inability to perform a physical exam (71%) but agreed that telerheumatology is vital to increasing access to care (59%) and quality of care (40%) in the VA. Overall, regardless of experience with telemedicine, respondents reported that telerheumatology was more helpful for management of rheumatologic conditions rather than initial diagnosis.
While the majority of rheumatology clinicians did not report past experience with telerheumatology, they agreed that it has potential to further the VA mission of improved access and quality of care. Rheumatology clinicians felt the suitability of telerheumatology is dependent on the phase of care. As remote care technologies continue to be rapidly adopted into clinic, clinician perceptions of and experiences with telemedicine will need to be addressed in order to maintain high-quality and clinician- and patient-centric care within VA rheumatology.
退伍军人事务部退伍军人健康管理局（VA）战略计划（2018-2024 财政年度）确定了四项护理重点，包括便捷的获取途径、及时和综合的护理、问责制和现代化，所有这些都可以直接或间接地受到远程医疗技术的影响。这些战略目标，加上预计风湿病劳动力短缺，需要增加其他护理提供方式，如临床视频远程医疗应用于风湿病（即远程风湿病学）。风湿病临床医生对远程风湿病学临床有用性的看法在过去受到的关注有限。本研究旨在评估退伍军人事务部风湿病临床医生对远程医疗的看法和经验，以及对远程风湿病学的看法和经验。
两名在远程医疗方面有经验的退伍军人事务部风湿病学家和一名在调查开发和用户体验方面有经验的社会科学家，通过迭代过程，基于现有的远程医疗提供者满意度调查，制定了一个 38 项的调查问卷。问题探讨了退伍军人事务部风湿病临床医生对培训和信息技术（IT）支持的满意度，以及使用远程医疗的障碍。此外，还评估了临床医生对远程风湿病学的影响、有用性和适当临床环境的看法。该调查通过 VA REDCap 在线分发给退伍军人风湿病学联盟（VARC）的成员，通过 LISTSERV 分发给成员。该研究方案通过快速审查获得所在机构 IRB 的批准。使用描述性统计方法分析调查结果。
共收集到 45 份匿名回复（20%的回复率）。在回复的人中，47%是女性，98%年龄在 35 至 64 岁之间，71%报告在学术中心工作，大多数是医生级别的从业者（98%）。受访者普遍认为自己精通技术（58%）。36%的样本报告了过去远程医疗的经验，其中 29%报告了远程风湿病学的具体经验。临床医生认为有效远程风湿病学的最大障碍是无法进行体检（71%），但他们一致认为远程风湿病学对于增加退伍军人事务部的护理可及性（59%）和护理质量（40%）至关重要。总体而言，无论是否有远程医疗经验，受访者都表示远程风湿病学更有助于管理风湿病，而不是初步诊断。
尽管大多数风湿病临床医生没有报告远程风湿病学的经验，但他们同意远程风湿病学有可能进一步推进退伍军人事务部改善护理可及性和护理质量的使命。风湿病临床医生认为远程风湿病学的适用性取决于护理阶段。随着远程护理技术在诊所中迅速被采用，需要解决临床医生对远程医疗的看法和经验，以维持退伍军人事务部风湿病学中的高质量和以临床医生和患者为中心的护理。
