远程医疗在初始门诊专科会诊中的应用：对普通儿科医生和儿科专家的全国性调查。
Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists.
机构信息
Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA, 15213, USA.
Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA, 15213, USA.
出版信息
Healthc (Amst). 2022 Mar;10(1):100600. doi: 10.1016/j.hjdsi.2021.100600. Epub 2021 Dec 4.
BACKGROUND
Evidence-based strategies are needed to support appropriate use of telemedicine for initial outpatient subspecialty consultative visits. To inform such strategies we performed a survey of general pediatricians and pediatric subspecialists about use of telemedicine for patients newly referred for pediatric subspecialty care.
METHODS
We developed and fielded an e-mail and postal survey of a national sample of 840 general pediatricians and 840 pediatric subspecialists in May and June 2020.
RESULTS
Of 266 completed surveys (17% response rate), 204 (76%) thought telemedicine should be offered for some and 29 (11%) thought telemedicine should be offered for all initial subspecialist visits. Most respondents who indicated telemedicine should be offered for some initial consultations believed this decision should be made by subspecialty attendings (176/204, 86%). Respondents prioritized several data elements to inform this decision, including clinical information and family-based contextual information (e.g., barriers to in-person care, interest in telemedicine, potential communication barriers). Factors perceived to reduce appropriateness of telemedicine for subspecialty consultation included need for interpreter services and prior history of frequent no-shows. Responses from generalists and subspecialists rarely differed significantly.
CONCLUSIONS
Survey results suggest potential opportunities to support the appropriate use of telemedicine for initial outpatient pediatric subspecialty visits through structured transfer of specific clinical and contextual information at the time of referral and through strategies to mitigate perceived communication or engagement barriers.
IMPLICATION
Pediatric physician beliefs about telemedicine for initial outpatient subspecialty consultative visits may inform future interventions to support appropriate telemedicine use.
LEVEL OF EVIDENCE
Survey of a national sample of clinicians.
背景
需要循证策略来支持远程医疗在初始门诊专科会诊中的合理使用。为了提供这种策略，我们对普通儿科医生和儿科专家进行了一项调查，了解他们对新转介至儿科专科护理的患者使用远程医疗的情况。
方法
我们于 2020 年 5 月和 6 月开发并通过电子邮件和邮寄方式向全国范围内的 840 名普通儿科医生和 840 名儿科专家进行了调查。
结果
在 266 份完成的调查中（17%的回复率），204 份（76%）认为应该为某些初始专科就诊提供远程医疗，29 份（11%）认为应该为所有初始专科就诊提供远程医疗。大多数表示应该为某些初始咨询提供远程医疗的受访者认为这一决定应由专科主治医生做出（176/204，86%）。受访者优先考虑了一些数据要素来做出这一决定，包括临床信息和以家庭为基础的背景信息（例如，面对面护理的障碍、对远程医疗的兴趣、潜在的沟通障碍）。被认为会降低远程医疗用于专科会诊的适宜性的因素包括需要翻译服务和先前频繁失约的病史。普通科医生和专家的回答很少有显著差异。
结论
调查结果表明，通过在转诊时有针对性地传递特定的临床和背景信息，以及通过减轻感知到的沟通或参与障碍的策略，为初始门诊儿科专科就诊提供远程医疗有潜在的机会。
意义
儿科医生对初始门诊专科会诊远程医疗的看法可能为支持远程医疗合理使用的未来干预措施提供信息。
证据水平
对全国临床医生样本进行的调查。
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