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外科医生对 COVID-19 大流行期间远程医疗访问的看法:有待改进。

Surgery Provider Perceptions on Telehealth Visits During the COVID-19 Pandemic: Room for Improvement.

机构信息

Department of Surgery, University of Michigan, Ann Arbor, Michigan.

University of Michigan Medical School, Ann Arbor, Michigan.

出版信息

J Surg Res. 2021 Apr;260:300-306. doi: 10.1016/j.jss.2020.11.034. Epub 2020 Nov 13.

Abstract

BACKGROUND

COVID-19 has mandated rapid adoption of telehealth for surgical care. However, many surgical providers may be unfamiliar with telehealth. This study evaluates the perspectives of surgical providers practicing telehealth care during COVID-19 to help identify targets for surgical telehealth optimization.

MATERIALS AND METHODS

At a single tertiary care center with telehealth capabilities, all department of surgery providers (attending surgeons, residents, fellows, and advanced practice providers) were emailed a voluntary survey focused on telehealth during the pandemic. Descriptive statistics and Mann-Whitney U analyses were performed as appropriate on responses. Text responses were thematically coded to identify key concepts.

RESULTS

The completion rate was 41.3% (145/351). Providers reported increased telehealth usage relative to the pandemic (P < 0.001). Of respondents, 80% (116/145) had no formal telehealth training. Providers estimated that new patient video visits required less time than traditional visits (P = 0.001). Satisfaction was high for several aspects of video visits. Comparatively lower satisfaction scores were reported for the ability to perform physical exams (sensitive and nonsensitive) and to break bad news. The largest barriers to effective video visits were limited physical exams (55.6%; 45/81) and lack of provider or patient internet access/equipment/connection (34.6%; 28/81). Other barriers included ineffective communication and difficulty with fostering rapport. Concerns regarding video-to-telephone visit conversion were loss of physical exam/visual cues (34.3%; 24/70), less personal interactions (18.6%; 13/70), and reduced efficiency (18.6%; 13/70).

CONCLUSIONS

Telehealth remains a new experience for surgical providers despite its expansion. Optimization strategies should target technology barriers and include specialized virtual exam and communication training.

摘要

背景

COVID-19 要求快速采用远程医疗进行外科护理。然而,许多外科医生可能不熟悉远程医疗。本研究评估了在 COVID-19 期间进行远程医疗护理的外科医生的观点,以帮助确定外科远程医疗优化的目标。

材料与方法

在一家具有远程医疗能力的三级保健中心,所有外科部门的医生(主治医生、住院医师、研究员和高级执业医师)都收到了一封关于大流行期间远程医疗的自愿调查电子邮件。对回复进行了适当的描述性统计和曼-惠特尼 U 分析。对文本回复进行了主题编码以确定关键概念。

结果

完成率为 41.3%(145/351)。与大流行相比,医生报告远程医疗使用增加(P<0.001)。在回答问题的医生中,80%(116/145)没有接受过正式的远程医疗培训。医生估计新患者的视频就诊比传统就诊需要的时间更少(P=0.001)。视频就诊的几个方面满意度很高。报告的对进行体格检查(敏感和非敏感)和传达坏消息的能力的满意度较低。有效视频就诊的最大障碍是体格检查受限(55.6%;45/81)和缺乏医生或患者的互联网接入/设备/连接(34.6%;28/81)。其他障碍包括沟通不畅和难以建立融洽关系。对视频到电话就诊转换的担忧包括丧失体格检查/视觉线索(34.3%;24/70)、个人互动减少(18.6%;13/70)和效率降低(18.6%;13/70)。

结论

尽管远程医疗有所扩展,但它仍然是外科医生的新体验。优化策略应针对技术障碍,并包括专门的虚拟检查和沟通培训。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cdf/7664345/673ae5cf897d/gr1_lrg.jpg

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