Rego Nazaré, Pereira Helena Silva, Crispim José
Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.
Institute for Systems and Computer Engineering, Technology, and Science (INESC TEC), Porto, Portugal.
JMIR Hum Factors. 2021 Nov 23;8(4):e27873. doi: 10.2196/27873.
Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians' or patients' perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important.
The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations.
Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis.
Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians' willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians' answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient's health and patient management, National Health System costs reduction, and reciprocity relative to patients' willingness to engage in teleconsultations.
To promote the use of home teleconsultations for DM, decision makers should improve patients' health literacy so the physician-patient communication is more effective; explore information and communication technology developments to reduce current limitations of non-face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians.
糖尿病（DM）是21世纪最具挑战性的疾病之一，也是第六大死因。远程医疗在糖尿病患者的护理中应用越来越广泛。尽管在家进行远程会诊已被证明在降低糖化血红蛋白方面比其他远程医疗方式更有效，但在2019冠状病毒病危机之前，其应用一直滞后。关于医生或患者对远程医疗看法的研究相互独立进行，很少有研究关注远程会诊。在卫生系统面临巨大压力、很大一部分医疗保健必须在远程提供的时期，从直接参与医疗互动的利益相关者那里了解在家进行远程会诊的情况尤为重要。
研究患者和医生对使用家庭同步远程会诊进行糖尿病护理的意图，以确定涉及家庭远程会诊的项目所固有的驱动因素和障碍。
开发了两份相同的问卷，将技术接受模型和技术接受与使用统一理论结合起来，并评估患者和医生对信息通信技术使用的信心。使用典型相关分析对75名患者和68名医生的回答进行分析。
预测变量结构（绩效、努力、社会影响、便利条件和态度）与使用意图之间的关联产生了显著函数，医生的典型相关系数R为0.95，患者为0.98。确定的患者使用意图的主要障碍是解释医疗问题所需的预期努力以及隐私和保密问题。主要驱动因素是便于与医生联系，这有利于患者疾病管理和治疗、节省时间以及医生愿意进行远程会诊的互惠性。医生的回答显示使用意图与家庭远程会诊的预期绩效之间存在关联。医生回答中表达的使用意图的主要障碍是对患者检查质量的怀疑。主要驱动因素是节省时间、提高生产力、改善患者健康和患者管理、降低国家卫生系统成本以及患者愿意参与远程会诊的互惠性。
为促进家庭远程会诊在糖尿病护理中的应用，决策者应提高患者的健康素养，以便医患沟通更有效；探索信息通信技术发展以减少当前非面对面检查的局限性；确保患者隐私和数据保密；并向医生展示家庭远程会诊的能力。
