Maria Ana Rita J, Serra Helena, Castro Maria G, Heleno Bruno
Regional Health Administration of Lisbon and Tagus Valley, Comprehensive Health Research Centre (CHRC), Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal.
Interdisciplinary Centre of Social Sciences (CICS. NOVA), NOVA School of Social Sciences and Humanities | Faculdade de Ciências Sociais e Humanas, Universidade NOVA de Lisboa, Lisbon, Portugal.
Digit Health. 2022 Nov 28;8:20552076221133698. doi: 10.1177/20552076221133698. eCollection 2022 Jan-Dec.
Previous qualitative research on teleconsultations has focused on synchronous communication between a patient and a clinician. This study aims to explore physicians' and patients' perceptions of the interaction on the interface between primary care and the Cardiology service of a referral hospital through teleconsultations.
This qualitative study was embedded in an organizational case study concerning the introduction and rollout of a new service model that took place at the point of care. The patients and physicians were recruited for semi-structured interviews until thematic saturation was achieved, between September 2019 - January 2020. The interviews were audiorecorded and anonymized. The transcribed interviews were stored, coded, and analyzed in MAXQDA, following the steps for conventional content analysis.
A total of 29 participants were interviewed. Patients and physicians presented clear views about the role of the GP and the cardiologist and their function in overall structure of healthcare. GPs felt their role was to bring expertise in the patient which could supplement the cardiologists' expertise on the condition. However, GPs had to renegotiate roles in the teleconsultations when they saw themselves in a new situation, together with another physician and the patient.
Our findings suggest that joint teleconsultations can promote continuity of care for patients in the primary/secondary care interface. Active coordination between physicians with delineation of roles throughout primary-secondary care interface is needed to manage selected patients who may benefit the most from shared care.
先前关于远程会诊的定性研究主要集中在患者与临床医生之间的同步沟通。本研究旨在通过远程会诊，探讨基层医疗服务机构与一家转诊医院的心脏病科服务部门之间的界面上，医生和患者对互动的看法。
本定性研究嵌入了一项关于新服务模式引入和推广的组织案例研究，该研究在医疗服务点进行。在2019年9月至2020年1月期间，招募患者和医生进行半结构化访谈，直至达到主题饱和。访谈进行了录音并匿名处理。转录后的访谈内容在MAXQDA中存储、编码并分析，遵循传统内容分析的步骤。
共采访了29名参与者。患者和医生对全科医生（GP）和心脏病专家的角色及其在整体医疗结构中的作用提出了明确的看法。全科医生认为他们的角色是提供患者的专业信息，以补充心脏病专家对病情的专业知识。然而，当全科医生在远程会诊中与另一名医生和患者处于新的情境时，他们不得不重新协商自己的角色。
我们的研究结果表明，联合远程会诊可以促进基层/二级医疗界面患者的连续护理。在整个基层-二级医疗界面中，需要医生之间进行积极协调并明确角色，以管理那些可能从共享护理中获益最大的特定患者。
