Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada.
Telemed J E Health. 2022 Jul;28(7):920-931. doi: 10.1089/tmj.2021.0377. Epub 2021 Nov 29.
The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. virtual care COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on August 10, 2020, and Scopus was searched on August 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. A total of 1,260 full-text articles were reviewed of which 38 articles met the eligibility criteria for inclusion in the review. Seven key barriers and strategies were identified for the implementation of virtual primary care. Of the 38 articles included, the key barriers identified were equitable access to care ( = 20; 53%), lack of funding for virtual care ( = 14; 37%), negative patient and clinician perception ( = 11, 29%), lack of regulatory policies ( = 10, 26%), inadequate clinical workflows ( = 9, 21), lack of virtual care infrastructure ( = 8, 21%), and insufficient virtual care training and education ( = 5, 13%). Strategies included the following: increased funding ( = 15, 39%), improving clinical workflows ( = 13, 34%), appropriate education and training ( = 11, 29%), improving virtual care infrastructure and patient equity ( = 7, 18%), establishing regulatory policies ( = 5, 13%), and improving patient and clinician perceptions ( = 3, 7%). As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.
本范围综述的目的是绘制高收入国家在实施虚拟初级保健服务方面面临的挑战、采取的策略和吸取的经验教训，并以此为决策者提供信息，以便在 COVID-19 大流行期间和之后如何最好地实施虚拟初级保健服务。我们的范围综述结果确定了四重目标各组成部分中的障碍和策略，这可能被证明是在初级保健环境中采用虚拟护理的有效实施策略。2020 年 8 月 10 日在 MEDLINE、EMBASE 和 CINAHL 数据库中检索了“虚拟护理”和“COVID-19”，并于 2020 年 8 月 15 日在 Scopus 数据库中检索了“虚拟护理”和“COVID-19”。数据库检索共返回了 10549 条引文，从符合所有纳入标准的文章的参考文献列表中检索到了另外 766 条引文。共查阅了 1260 篇全文文章，其中 38 篇文章符合纳入综述的标准。为实施虚拟初级保健，确定了 7 个关键障碍和策略。在纳入的 38 篇文章中，确定的关键障碍包括公平获得护理的机会（20 篇，占 53%）、缺乏虚拟护理资金（14 篇，占 37%）、负面的患者和临床医生认知（11 篇，占 29%）、缺乏监管政策（10 篇，占 26%）、临床工作流程不足（9 篇，占 21%）、缺乏虚拟护理基础设施（8 篇，占 21%）和虚拟护理培训和教育不足（5 篇，占 13%）。策略包括以下方面：增加资金（15 篇，占 39%）、改善临床工作流程（13 篇，占 34%）、适当的教育和培训（11 篇，占 29%）、改善虚拟护理基础设施和患者公平性（7 篇，占 18%）、建立监管政策（5 篇，占 13%）和改善患者和临床医生的认知（3 篇，占 7%）。随着许多国家进入 COVID-19 大流行的潜在后续浪潮，吸取早期经验教训以减轻实施障碍，有助于向公平和适当的虚拟初级保健服务过渡。
