University of Kansas Medical Center, Kansas City, KS, USA.
Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force Base, NE, USA.
Am Fam Physician. 2021 Feb 1;103(3):147-154.
Telemedicine can provide patients with cost-effective, quality care. The coronavirus disease 2019 pandemic has highlighted the need for alternative methods of delivering health care. Family physicians can benefit from using a standardized approach to evaluate and diagnose musculoskeletal issues via telemedicine visits. Previsit planning establishes appropriate use of telemedicine and ensures that the patient and physician have functional telehealth equipment. Specific instructions to patients regarding ideal setting, camera angles, body positioning, and attire enhance virtual visits. Physicians can obtain a thorough history and perform a structured musculoskeletal examination via telemedicine. The use of common household items allows physicians to replicate in-person clinical examination maneuvers. Home care instructions and online rehabilitation resources are available for initial management. Patients should be scheduled for an in-person visit when the diagnosis or management plan is in question. Patients with a possible deformity or neurovascular compromise should be referred for urgent evaluation. Follow-up can be done virtually if the patient's condition is improving as expected. If the condition is worsening or not improving, the patient should have an in-office assessment, with consideration for referral to formal physical therapy or specialty services when appropriate.
远程医疗可以为患者提供具有成本效益的高质量医疗服务。2019 年冠状病毒病大流行凸显了需要替代医疗保健方法。家庭医生可以从使用标准化方法通过远程医疗访问评估和诊断肌肉骨骼问题中受益。预访计划确定远程医疗的适当用途,并确保患者和医生拥有功能齐全的远程医疗设备。向患者提供有关理想设置、摄像头角度、身体姿势和着装的具体说明,可增强虚拟访问效果。医生可以通过远程医疗获得详细的病史并进行结构化的肌肉骨骼检查。使用常见的家用物品可以使医生复制亲自进行的临床检查操作。可以提供家庭护理说明和在线康复资源以进行初步管理。当诊断或管理计划有疑问时,应安排患者进行亲自就诊。如果患者可能存在畸形或神经血管损伤,应转至紧急评估。如果患者的病情如预期的那样有所改善,可以进行虚拟随访。如果病情恶化或没有改善,则患者应进行门诊评估,并在适当情况下考虑转至正式的物理治疗或专科服务。
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