Aminoff Hedvig, Meijer Sebastiaan, Arnelo Urban, Frennert Susanne
Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
JMIR Form Res. 2021 Jan 11;5(1):e20692. doi: 10.2196/20692.
Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption.
Our objective was to gain a deeper understanding of ERCP practitioners' attitudes toward teleguidance. These findings could inform the implementation process and future evaluations.
We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons' beliefs about teleguidance's contribution to performance and factors that might interact with implementation.
Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard "Ease of Use" items for "Compatibility and Implementation Climate." In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (9/14) among experts and 75% (7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [9/14], novices 69% [6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05).
Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes.
远程医疗创新很少被应用于常规医疗保健中，其原因尚不清楚。远程指导是一种在内镜逆行胰胆管造影术（ERCP）期间进行远程手术指导的有前景的服务，本应扩大规模，但有人担心用户态度可能会影响其采用。
我们的目的是更深入地了解ERCP从业者对远程指导的态度。这些发现可为实施过程和未来评估提供信息。
我们对ERCP工作人员进行了半结构化访谈，了解工作中的挑战以及对远程指导的看法。技术接受模型（TAM）的理论构建指导了主题分析。我们的研究结果成为一份16项问卷的输入内容，该问卷调查外科医生对远程指导对手术表现的贡献以及可能与实施相互作用的因素的看法。
对来自5家医院的ERCP工作人员进行的20次访谈结果被用于调整TAM问卷，将标准的“易用性”项目替换为“兼容性和实施氛围”。共有来自15个ERCP诊所的23名ERCP专家回复了问卷：9名新手（<500例ERCP手术）和14名专家（>500例ERCP手术）。专家对有用性项目的平均认同率为64%（约9/14），新手为75%（约7/9）。对兼容性项目的平均认同率略低（专家64%[约9/14]，新手69%[约6/9]）。这些平均值是根据几个项目的总和计算得出的，因此，它们只是近似实际值。14名专家中有11名（79%）和9名新手中的8名（89%）同意远程指导可以提高ERCP手术期间的整体质量和患者安全，但14名专家中只有8名（57%）和9名新手中的6名（67%）同意远程指导不会带来新的患者安全风险。14名专家中只有5名（36%）和9名新手中的3名（33%）确信视频和图像传输能正常运行。同样，14名专家中只有6名（43%）和9名新手中的6名（67%）同意管理工作会顺利进行。在这16个项目中的任何一项上，专家和新手之间均无统计学显著差异（P<0.05）。
ERCP手术的新手和专家都担心远程指导可能会扰乱现有的工作流程。然而，新手总体上比专家对远程指导更积极，特别是在发展技术技能和工作流程方面。虽然新培训的专家是远程指导的主要目标对象，但专家也是预期用户。由于专家更有可能是关键决策者，他们的态度可能对采用产生更大的相对影响。我们提出了解决这些问题的建议。我们得出结论，将TAM用作概念框架可以通过将定性研究结果与知名分析主题相联系，支持以用户为中心的远程医疗设计和实施探究。
