Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Eur Spine J. 2021 Aug;30(8):2109-2123. doi: 10.1007/s00586-020-06653-8. Epub 2020 Nov 22.
To utilize data from a global spine surgeon survey to elucidate (1) overall confidence in the telemedicine evaluation and (2) determinants of provider confidence.
Members of AO Spine International were sent a survey encompassing participant's experience with, perception of, and comparison of telemedicine to in-person visits. The survey was designed through a Delphi approach, with four rounds of question review by the multi-disciplinary authors. Data were stratified by provider age, experience, telemedicine platform, trust in telemedicine, and specialty.
Four hundred and eighty-five surgeons participated in the survey. The global effort included respondents from Africa (19.9%), Asia Pacific (19.7%), Europe (24.3%), North America (9.4%), and South America (26.6%). Providers felt that physical exam-based tasks (e.g., provocative testing, assessing neurologic deficits/myelopathy, etc.) were inferior to in-person exams, while communication-based aspects (e.g., history taking, imaging review, etc.) were equivalent. Participants who performed greater than 50 visits were more likely to believe telemedicine was at least equivalent to in-person visits in the ability to make an accurate diagnosis (OR 2.37, 95% C.I. 1.03-5.43). Compared to in-person encounters, video (versus phone only) visits were associated with increased confidence in the ability of telemedicine to formulate and communicate a treatment plan (OR 3.88, 95% C.I. 1.71-8.84).
Spine surgeons are confident in the ability of telemedicine to communicate with patients, but are concerned about its capacity to accurately make physical exam-based diagnoses. Future research should concentrate on standardizing the remote examination and the development of appropriate use criteria in order to increase provider confidence in telemedicine technology.
利用全球脊柱外科医生调查的数据，阐明（1）对远程医疗评估的整体信心，以及（2）提供者信心的决定因素。
AO 脊柱国际的成员被发送了一份调查，涵盖了参与者对远程医疗的体验、看法以及与面对面访问的比较。该调查是通过德尔菲法设计的，由多学科作者进行了四轮问题审查。数据按提供者年龄、经验、远程医疗平台、对远程医疗的信任度和专业领域进行分层。
485 名外科医生参与了调查。全球范围内的调查包括来自非洲（19.9%）、亚太地区（19.7%）、欧洲（24.3%）、北美（9.4%）和南美（26.6%）的受访者。提供者认为基于体检的任务（例如，激发测试、评估神经功能缺陷/脊髓病等）不如面对面检查，而基于沟通的方面（例如，病史采集、影像审查等）则是等同的。进行超过 50 次访问的参与者更有可能认为远程医疗在做出准确诊断的能力方面至少与面对面访问相当（OR 2.37，95%CI 1.03-5.43）。与面对面就诊相比，视频（与仅电话相比）就诊与对远程医疗制定和传达治疗计划的能力的信心增加相关（OR 3.88，95%CI 1.71-8.84）。
脊柱外科医生对远程医疗与患者沟通的能力有信心，但对其准确进行基于体检的诊断的能力表示担忧。未来的研究应集中在标准化远程检查和制定适当的使用标准上，以提高提供者对远程医疗技术的信心。
