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在澳大利亚实施全科医生到普通医生的电子咨询服务(eConsultant)。

Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia.

机构信息

UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia.

Integrated Care and Innovation Translation, Mater Misericordiae Ltd, Brisbane, Australia.

出版信息

BMC Health Serv Res. 2022 Oct 24;22(1):1278. doi: 10.1186/s12913-022-08663-2.

Abstract

BACKGROUND

In response to lengthy wait times for specialist outpatient appointments, electronic consultation (eConsult) services have developed globally, providing asynchronous, secure and timely communication between general practitioner (GP) and specialist. This study aims to track adoption of a Queensland eConsultant service in two Australian Primary Health Networks (Western Queensland and Brisbane South) to understand key barriers and enablers to adoption and inform modification of the implementation strategy.  METHODS: Our theory-informed mixed-methods evaluation assessed implementation between July 2020 and March 2022. Adoption and implementation activities were prospectively recorded in bespoke tracking spreadsheets with implementation activities coded against the Expert Recommendations for Implementing Change (ERIC) strategies. Semi-structured interviews with GPs and stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) were conducted to understand determinants of implementation.  RESULTS: Of the 40 practices invited to take part in the eConsultant service, 20 (50%) enrolled. Of the 97 GPs who consented, 38 sent at least one Request for Advice (RFA) to the eConsultant with a total of 112 RFA sent. Implementation was predominantly guided by eight strategies. Qualitative interviews were conducted with 11 GPs and 4 stakeholders (12 from rural/remote regions, 11 females and two sole practitioners). Interviewees felt the eConsultant service supported outpatient appointment avoidance and provided efficient, timely access to specialist support for GPs and their patients. Barriers identified to using eConsultant related to digital infrastructure, competing priorities, and keeping the service 'front of mind'. Key enablers identified were the relative advantage of eConsultant over other options, patient benefits and COVD-19 facilitating the use of digital technology.

CONCLUSIONS

This evaluation highlighted service enablers as well as user priorities for broader implementation. A focus on a well-integrated digital system and availability of a variety of eConsultant specialties are seen as key strategies to embedding the eConsultant option in GP advice processes in Australia.

摘要

背景

为缩短专科门诊预约等候时间,全球各地相继开发出电子咨询(eConsult)服务,使全科医生(GP)与专科医生之间实现异步、安全、及时的沟通。本研究旨在跟踪昆士兰电子咨询服务在澳大利亚两个初级保健网络(西昆士兰和布里斯班南部)中的采用情况,以了解采用的主要障碍和促进因素,并为实施策略的修改提供信息。

方法

我们采用理论指导的混合方法评估,于 2020 年 7 月至 2022 年 3 月期间进行实施评估。在专门的跟踪电子表格中前瞻性记录采用和实施活动,并根据实施变化专家建议(ERIC)策略对实施活动进行编码。根据实施研究综合框架(CFIR)对 GP 和利益攸关方进行半结构式访谈,以了解实施的决定因素。

结果

在受邀参与电子咨询服务的 40 家诊所中,有 20 家(50%)参与。在同意参与的 97 名 GP 中,有 38 名向电子咨询员发送了至少一份咨询请求(RFA),共发送了 112 份 RFA。实施主要受八项策略的指导。对 11 名 GP 和 4 名利益攸关方(12 名来自农村/偏远地区,11 名女性,2 名个体从业者)进行了定性访谈。受访者认为电子咨询员服务支持避免门诊预约,并为 GP 及其患者提供了高效、及时的专科支持。使用电子咨询员服务的障碍与数字基础设施、竞争优先级以及保持服务“摆在首位”有关。确定的主要促进因素包括电子咨询员相对于其他选择的相对优势、患者获益以及 COVID-19 促进了数字技术的使用。

结论

本次评估突出了服务的促进因素以及用户对更广泛实施的重点。注重整合良好的数字系统和提供各种电子咨询专业服务,被视为将电子咨询选项嵌入澳大利亚 GP 咨询流程的关键策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ce7/9590149/cb89a12430f3/12913_2022_8663_Fig1_HTML.jpg

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