Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, 10000 Troyes, France.
LIST3N/Tech-CICO, Troyes University of Technology, CEDEX, 10300 Troyes, France.
Int J Environ Res Public Health. 2021 Oct 23;18(21):11148. doi: 10.3390/ijerph182111148.
Evaluating the use and impact of telemedicine in nursing homes is necessary to promote improvements in the quality of this practice. Even though challenges and opportunities of telemedicine are increasingly becoming well documented for geriatrics (such as improving access to healthcare, patient management, and education while reducing costs), there is still limited knowledge on how to better implement it in an inter-organizational context, especially when considering nursing homes. In this regard, this study aimed first to describe the telemedicine activity of nursing homes when cooperating with a general hospital; and then understand the behavioral differences amongst nursing homes while identifying critical factors when implementing a telemedicine project. We conducted a sequential, explanatory mixed-method study using quantitative then qualitative methods to better understand the results. Three years of teleconsultation data of twenty-six nursing homes (15 rural and 11 urban) conducting teleconsultations with a general hospital (Troyes Hospital, France) were included for the quantitative analysis, and eleven telemedicine project managers for the qualitative analysis. Between April 2018 and April 2021, 590 teleconsultations were conducted: 45% ( = 265) were conducted for general practice, 29% ( = 172) for wound care, 11% ( = 62) for diabetes management, 8% ( = 47) with gerontologist and 6% ( = 38) for dermatology. Rural nursing homes conducted more teleconsultations overall than urban ones (RR: 2.484; 95% CI: 1.083 to 5.518; = 0.03) and included more teleconsultations for general practice (RR: 16.305; 95% CI: 3.505 to 73.523; = 0.001). Our qualitative study showed that three critical factors are required for the implementation of a telemedicine project in nursing homes: (1) the motivation to perform teleconsultations (in other words, improving access to care and cooperation between professionals); (2) building a relevant telemedicine medical offer based on patients' and treating physicians' needs; and (3) it's specific organization in terms of time and space. Our study showed different uses of teleconsultations according to the rural or urban localization of nursing homes and that telemedicine projects should be designed to consider this aspect. Triggered by the COVID-19 pandemic, telemedicine projects in nursing homes are increasing, and observing the three critical factors presented above could be necessary to limit the failure of such projects.
评估养老院中远程医疗的使用情况和影响对于提高这种实践的质量是必要的。尽管远程医疗在老年医学方面的挑战和机遇（例如，改善医疗保健的可及性、患者管理和教育，同时降低成本）越来越受到关注，但对于如何在组织间更好地实施远程医疗，尤其是在养老院中，仍然知之甚少。在这方面，本研究首先旨在描述养老院与综合医院合作时的远程医疗活动；然后了解养老院在实施远程医疗项目时的行为差异，并确定关键因素。我们采用了定量和定性的顺序、解释性混合方法研究，以更好地理解结果。我们对 26 家养老院（15 家农村和 11 家城市）的三年远程咨询数据进行了研究，这些数据是与一家综合医院（法国特鲁瓦医院）进行远程咨询的，共进行了 590 次远程咨询：其中 45%（=265）用于一般实践，29%（=172）用于伤口护理，11%（=62）用于糖尿病管理，8%（=47）用于老年病学，6%（=38）用于皮肤病学。农村养老院的远程咨询总数高于城市养老院（RR：2.484；95%CI：1.083 至 5.518；=0.03），包括更多的一般实践远程咨询（RR：16.305；95%CI：3.505 至 73.523；=0.001）。我们的定性研究表明，在养老院实施远程医疗项目需要三个关键因素：（1）进行远程咨询的动机（换句话说，改善护理的可及性和专业人员之间的合作）；（2）根据患者和治疗医生的需求，建立相关的远程医疗医疗服务；（3）在时间和空间方面进行具体的组织。我们的研究表明，根据养老院的农村或城市定位，远程咨询的使用情况有所不同，因此，应该设计远程医疗项目来考虑这一方面。远程医疗项目在养老院中正在增加，而新冠疫情则触发了这种增长，观察以上三个关键因素可能对于限制此类项目的失败是必要的。
