Serina Peter T, Davoodi Natalie M, Guthrie Kate M, Merchant Roland C, Goldberg Elizabeth M
Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
J Patient Exp. 2023 Mar 14;10:23743735231160418. doi: 10.1177/23743735231160418. eCollection 2023.
This study's objective was to determine how frontline physicians perceived telehealth for older adults with sensory impairments, cognitive impairments, mobility challenges, or those receiving end-of-life care. We conducted a multiple-methods study of US emergency, geriatric, and primary care physicians. Phase 1 involved semi-structured interviews with 48 physicians on their experiences using telehealth with older adults. In phase 2, we used those qualitative findings to generate a web-based survey administered to 74 physicians. In phase 3, we reintegrated qualitative data to enrich survey results. We identified 3 key findings: (1) 50% of emergency physicians, 33% of geriatricians, and 18% of primary care physicians considered telehealth to be a poor substitute for providing end-of-life care ( = .68); (2) for hearing, vision, and cognitive impairments, 61%, 58%, and 54%, respectively, saw telehealth as a good or fair substitute for providing care ( = .14); and (3) 98% indicated that telehealth was a good or fair substitute for in-person care for those with mobility impairment ( < .001). Preferences and comfort using telehealth with older adults vary by clinical context, patient population, and physician specialty, requiring tailored adaptations.
本研究的目的是确定一线医生如何看待针对有感官障碍、认知障碍、行动不便或接受临终关怀的老年人的远程医疗。我们对美国的急诊、老年病和初级保健医生进行了一项多方法研究。第一阶段包括对48名医生进行半结构化访谈，了解他们使用远程医疗服务老年人的经历。在第二阶段，我们利用这些定性研究结果生成了一项针对74名医生的网络调查。在第三阶段，我们重新整合定性数据以丰富调查结果。我们确定了3个关键发现：（1）50%的急诊医生、33%的老年病医生和18%的初级保健医生认为远程医疗是提供临终关怀的糟糕替代方式（P = 0.68）；（2）对于听力、视力和认知障碍，分别有61%、58%和54%的人认为远程医疗是提供护理的良好或尚可替代方式（P = 0.14）；（3）98%的人表示，对于行动不便的人，远程医疗是面对面护理的良好或尚可替代方式（P < 0.001）。在使用远程医疗服务老年人方面的偏好和舒适度因临床背景、患者群体和医生专业而异，需要进行量身定制的调整。
