Silsand Line, Severinsen Gro-Hilde, Berntsen Gro
Norwegian Centre for E-health Research, Tromsø, Norway.
Institute of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
JMIR Form Res. 2021 Mar 5;5(3):e25220. doi: 10.2196/25220.
The Patient-Centered Team (PACT) focuses on the transitional phase between hospital and primary care for older patients in Northern Norway with complex and long-term needs. PACT emphasizes a person-centered care approach whereby the sharing of power and the patient's response to "What matters to you?" drive care decisions. However, during the COVID-19 pandemic, videoconferencing was the only option for assessing, planning, coordinating, and performing treatment and care.
The aim of this study is to report the experience of the PACT multidisciplinary health care team in shifting rapidly from face-to-face care to using videoconferencing for clinical and collaborative services during the initial phase of the COVID-19 pandemic. This study explores how PACT managed to maintain person-centered care under these conditions.
This case study takes a qualitative approach based on four semistructured focus group interviews carried out in May and June 2020 with 19 PACT members and leaders.
The case study illustrates that videoconferencing is a good solution for many persons with complex and long-term needs and generates new opportunities for interaction between patients and health care personnel. Persons with complex and long-term needs are a heterogeneous group, and for many patients with reduced cognitive capacity or hearing and vision impairment, the use of videoconferencing was challenging and required support from relatives or health care personnel. The study shows that using videoconferencing offered an opportunity to use health care personnel more efficiently, reduce travelling time for patients, and improve the information exchange between health care levels. This suggests that the integration of videoconferencing contributed to the preservation of the person-centered focus on care during the COVID-19 pandemic. There was an overall agreement in PACT that face-to-face care needed to be at the core of the person-centered care approach; the main use of videoconferencing was to support follow-up and coordination.
The COVID-19 pandemic and the rapid adoption of digital care have generated a unique opportunity to continue developing a health service to both preserve and improve the person-centered care approach for persons with complex and long-term needs. This creates demand for overall agreements, including guidelines and procedures for how and when to use videoconferencing to supplement face-to-face treatment and care. Implementing videoconferencing in clinical practice generates a need for systematic training and familiarization with the equipment and technology as well as for an extensive support organization. Videoconferencing can then contribute to better preparing health care services for future scenarios.
以患者为中心的团队（PACT）专注于挪威北部有复杂和长期需求的老年患者在医院和初级保健之间的过渡阶段。PACT强调以人为主导的护理方法，即权力共享以及患者对“对你来说什么最重要？”这一问题的回答驱动护理决策。然而，在新冠疫情期间，视频会议是进行评估、规划、协调以及实施治疗和护理的唯一选择。
本研究的目的是报告PACT多学科医疗团队在新冠疫情初期迅速从面对面护理转向使用视频会议进行临床和协作服务的经验。本研究探讨了PACT在这些条件下如何设法维持以人为主导的护理。
本案例研究采用定性方法，基于2020年5月和6月对19名PACT成员和负责人进行的四次半结构化焦点小组访谈。
该案例研究表明，视频会议对于许多有复杂和长期需求的人来说是一个很好的解决方案，并为患者与医护人员之间的互动创造了新机会。有复杂和长期需求的人群是一个异质性群体，对于许多认知能力下降或有听力和视力障碍的患者来说，使用视频会议具有挑战性，需要亲属或医护人员的支持。该研究表明，使用视频会议提供了一个更高效利用医护人员、减少患者出行时间以及改善不同医疗层级之间信息交流的机会。这表明视频会议的整合有助于在新冠疫情期间维持以人为主导的护理重点。PACT总体上一致认为面对面护理需要成为以人为主导的护理方法的核心；视频会议的主要用途是支持后续跟进和协调。
新冠疫情以及数字护理的迅速采用创造了一个独特的机会，可继续发展一项医疗服务，以维护和改进针对有复杂和长期需求者的以人为主导的护理方法。这就需要达成全面共识，包括关于如何以及何时使用视频会议来补充面对面治疗和护理的指导方针和程序。在临床实践中实施视频会议需要对设备和技术进行系统培训和熟悉，以及建立一个广泛的支持机构。这样视频会议就能有助于为未来情况更好地准备医疗服务。
