Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts.
Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts.
JAMA Netw Open. 2021 Dec 1;4(12):e2137193. doi: 10.1001/jamanetworkopen.2021.37193.
Telehealth has been posited as a cost-effective means for improving access to care for persons with chronic conditions, including kidney disease. Perceptions of telehealth among older patients with chronic illness, their care partners, and clinicians are largely unknown but are critical to successful telehealth use and expansion efforts.
To identify patient, care partner, and nephrologists' perceptions of the patient-centeredness, benefits, drawbacks of telehealth compared to in-person visits.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used semistructured interviews conducted from August to December 2020 with purposively sampled patients (aged 70 years or older, chronic kidney disease stages 4 to 5), care partners, and clinicians in Boston, Massachusetts; Chicago, Illinois; Portland, Maine; and San Diego, California.
Participants described telehealth experiences, including factors contributing to and impeding engagement, satisfaction, and quality of care. Thematic analysis was used to analyze data.
Of 60 interviews, 19 (32%) were with clinicians, 30 (50%) with patients, and 11 (18%) with care partners; 16 clinicians (84%) were nephrologists; 17 patient participants (43%) were non-Hispanic Black, and 38 (67%) were women. Four overarching themes characterized telehealth's benefits and drawbacks for patient-centered care among older, chronically ill adults: inconsistent quality of care, patient experience and engagement, loss of connection and mistrust (eg, challenges discussing bad news), and disparities with accessing telehealth. Although telehealth improved convenience and care partner engagement, participants expressed concerns about clinical effectiveness and limitations of virtual physical examinations and potentially widening disparities in access. Many participants shared concerns about harms to the patient-clinician relationship, limited ability to comfort patients in virtual settings, and reduced patient trust.
Older patients, care partners, and kidney clinicians (ie, nephrologists and physician assistants) shared divergent views of patient-centered telehealth care, especially its clinical effectiveness, patient experience, access to care, and clinician-patient relationship. Understanding older patients' and kidney clinicians' perceptions of telehealth elucidate barriers that should be addressed to promote high-quality care and telehealth use.
远程医疗被认为是改善慢性疾病患者（包括肾病患者）获得医疗服务的一种具有成本效益的手段。然而，人们对老年慢性病患者、其护理人员和临床医生对远程医疗的看法知之甚少，但这些看法对于成功开展远程医疗服务和扩大远程医疗服务规模至关重要。
确定患者、护理人员和肾病医生对远程医疗与面对面就诊相比的以患者为中心、获益和弊端的看法。
设计、地点和参与者：这项定性研究于 2020 年 8 月至 12 月在马萨诸塞州波士顿、伊利诺伊州芝加哥、缅因州波特兰和加利福尼亚州圣地亚哥进行，使用半结构式访谈，对有目的抽样的患者（年龄 70 岁或以上，慢性肾脏病 4 至 5 期）、护理人员和临床医生进行了访谈。
参与者描述了远程医疗体验，包括参与、满意度和护理质量的促进和阻碍因素。采用主题分析法对数据进行分析。
在 60 次访谈中，19 次（32%）是与临床医生进行的，30 次（50%）是与患者进行的，11 次（18%）是与护理人员进行的；16 名临床医生（84%）是肾病医生；17 名患者参与者（43%）是非西班牙裔黑人，38 名（67%）是女性。4 个主要主题描述了远程医疗在为老年慢性病患者提供以患者为中心的护理方面的优势和劣势：护理质量不一致、患者体验和参与、丧失联系和信任（例如，讨论坏消息的挑战）以及获取远程医疗的差距。尽管远程医疗提高了便利性和护理人员的参与度，但参与者对临床疗效以及虚拟体检的局限性表示担忧，并对获取远程医疗的机会表示担忧。许多参与者对远程医疗对医患关系的危害、在虚拟环境中安慰患者的能力有限以及患者信任度降低表示担忧。
老年患者、护理人员和肾脏临床医生（即肾病医生和医师助理）对以患者为中心的远程医疗护理有不同的看法，尤其是其临床疗效、患者体验、获得医疗服务的机会以及医患关系。了解老年患者和肾脏临床医生对远程医疗的看法，阐明了促进高质量护理和远程医疗使用应解决的障碍。
