密苏里州东南部医院采用远程医疗传染病咨询的感知障碍和促进因素。
Perceived barriers and facilitators to the adoption of telemedicine infectious diseases consultations in southeastern Missouri hospitals.
机构信息
Brown School, Washington University in Saint Louis, St. Louis, MO, USA.
Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
出版信息
J Telemed Telecare. 2024 Oct;30(9):1462-1474. doi: 10.1177/1357633X221149461. Epub 2023 Jan 19.
INTRODUCTION
Telemedicine infectious diseases consultations (tele-ID consults) improves access to healthcare for underserved/resource-limited communities. However, factors promoting or hindering implementation of tele-ID consults in low-resource settings are understudied. This study sought to fill this gap by describing perceived barriers and facilitators tele-ID consults at three rural hospitals in southeastern Missouri.
METHODS
Twelve in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders from three rural, southeastern Missouri hospitals with partial or no on-site availability of ID physicians. Our literature-informed interview guide elicited participants' knowledge and experience with tele-ID consults, perceptions on ID consultation needs, and perceived barriers to and facilitators of tele-ID consults. Interview transcripts were coded using an iterative process of inductive analysis to identify core themes related to barriers and facilitators.
RESULTS
Perceived barriers to adopting and implementing tele-ID consults included logistical challenges, technology and devices, negative emotional responses, patient-related factors, concerns about reduced quality of care when using telemedicine, lack of acceptance or buy-in from physicians or staff, and legal concerns. Key facilitators included perceived need, perceived benefits to patients and physicians, flexibility and openness to change among staff members and patients, telemedicine champions, prior experiences, and enthusiasm.
DISCUSSION
Our findings demonstrate that rural hospitals need tele-ID consults and have the capacity to implement tele-ID consults, but operational and technical feasibility challenges remain. Adoption and implementation of tele-ID consults may reduce ID-physician shortage-related service gaps by permitting ID physician's greater geographic reach.
简介
远程医疗传染病咨询（远程 ID 咨询）改善了服务不足/资源有限社区获得医疗保健的机会。然而，在资源匮乏的环境中，促进或阻碍远程 ID 咨询实施的因素尚未得到充分研究。本研究旨在通过描述密苏里州东南部的三家农村医院对远程 ID 咨询的感知障碍和促进因素来填补这一空白。
方法
对来自密苏里州东南部三家农村医院的信息丰富的医院利益相关者进行了 12 次深入的半结构化访谈，这些医院部分或完全没有 ID 医生的现场服务。我们的文献启发式访谈指南引出了参与者对远程 ID 咨询的知识和经验、对 ID 咨询需求的看法以及对远程 ID 咨询的障碍和促进因素的看法。使用迭代的归纳分析过程对访谈记录进行编码，以确定与障碍和促进因素相关的核心主题。
结果
采用和实施远程 ID 咨询的感知障碍包括后勤挑战、技术和设备、负面情绪反应、患者相关因素、对使用远程医疗时降低护理质量的担忧、医生或员工的接受度或投入度低，以及法律问题。主要的促进因素包括感知到的需求、对患者和医生的感知益处、员工和患者的灵活性和对变革的开放性、远程医疗拥护者、以往经验和热情。
讨论
我们的研究结果表明，农村医院需要远程 ID 咨询并且有能力实施远程 ID 咨询，但仍存在运营和技术可行性挑战。远程 ID 咨询的采用和实施可以通过允许 ID 医生更大的地理覆盖范围来减少与 ID 医生短缺相关的服务差距。
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