Pôle Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France.
Troyes University of Technology, ICD, Tech-CICO, Troyes, France.
Telemed J E Health. 2021 Nov;27(11):1299-1304. doi: 10.1089/tmj.2020.0524. Epub 2021 Jan 27.
Teleconsultations have been an indispensable part of the public health armamentarium during the COVID-19 crisis. Many physicians replaced face-to-face consultations with teleconsultations for the very first time. This study aimed to understand telemedicine uses by physicians during the lockdown period and explain the changes in their teleconsultation practices after the reopening of an outpatient department. A mixed-method analysis was used. First, a quantitative study was conducted with a retrospective analysis of the ratio of all teleconsultations and physical consultations between January 1 and July 31, 2020. Second, semidirective interviews were undertaken with physicians to better understand the dynamics of teleconsultation use. In total, 28 physicians practiced 603 teleconsultations over the study period. The rate of teleconsultations was 0.2% before the lockdown (January 1 to March 15, 2020), reaching 19.5% during the lockdown (April 2020), and decreasing to 8.4% at the reopening of the physical outpatient facilities. Based on the dynamics of their teleconsultation uses, four medical departments were selected for the qualitative study component (neurology, urology, pneumology, and anesthesiology). From the semistructured interviews, the main uses of telemedicine were for patients living with "chronic but under control" conditions that received follow-ups. Physicians also identified practices to improve patient empowerment and nurse autonomy. The results of the anesthesiology department showed that teleconsultations must be more codified to meet the same standards of quality as face-to-face consultations. The COVID-19 outbreak and lockdown period triggered a wider use of teleconsultations and have allowed physicians to think about new uses and opportunities.
远程会诊在 COVID-19 危机期间已成为公共卫生武器库中不可或缺的一部分。许多医生首次将面对面的会诊改为远程会诊。本研究旨在了解封锁期间医生使用远程医疗的情况，并解释在门诊部重新开放后他们的远程会诊实践的变化。本研究采用混合方法分析。首先，对 2020 年 1 月 1 日至 7 月 31 日所有远程会诊和物理会诊的比例进行了回顾性分析，开展了一项定量研究。其次，对医生进行了半直接访谈，以更好地了解远程会诊使用的动态。在研究期间，共有 28 名医生进行了 603 次远程会诊。封锁前（2020 年 1 月 1 日至 3 月 15 日）远程会诊的比例为 0.2%，封锁期间达到 19.5%，在实体门诊设施重新开放时降至 8.4%。根据远程会诊使用的动态，选择了四个医疗部门进行定性研究部分（神经病学、泌尿科、肺病学和麻醉学）。从半结构化访谈中，远程医疗的主要用途是为患有“慢性但得到控制”的患者提供随访。医生还确定了增强患者权能和护士自主权的做法。麻醉学部门的结果表明，远程会诊必须更加规范，以达到与面对面会诊相同的质量标准。COVID-19 爆发和封锁期促使远程会诊的使用范围更广，并使医生能够思考新的用途和机会。
