美国初级保健实践中的远程医疗体验：实践领导者的观点。
The Telemedicine Experience in Primary Care Practices in the United States: Insights From Practice Leaders.
机构信息
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
出版信息
Ann Fam Med. 2023 May-Jun;21(3):207-212. doi: 10.1370/afm.2967.
PURPOSE
The need to rapidly implement telemedicine in primary care during the coronavirus disease 2019 (COVID-19) pandemic was addressed differently by various practices. Using qualitative data from semistructured interviews with primary care practice leaders, we aimed to report commonly shared experiences and unique perspectives regarding telemedicine implementation and evolution/maturation since March 2020.
METHODS
We administered a semistructured, 25-minute, virtual interview with 25 primary care practice leaders from 2 health systems in 2 states (New York and Florida) included in PCORnet, the Patient-Centered Outcomes Research Institute clinical research network. Questions were guided by 3 frameworks (health information technology evaluation, access to care, and health information technology life cycle) and involved practice leaders' perspectives on the process of telemedicine implementation in their practice, with a specific focus on the process of maturation and facilitators/barriers. Two researchers conducted inductive coding of qualitative data open-ended questions to identify common themes. Transcripts were electronically generated by virtual platform software.
RESULTS
Twenty-five interviews were administered for practice leaders representing 87 primary care practices in 2 states. We identified the following 4 major themes: (1) the ease of telemedicine adoption depended on both patients' and clinicians' prior experience using virtual health platforms, (2) regulation of telemedicine varied across states and differentially affected the rollout processes, (3) visit triage rules were unclear, and (4) there were positive and negative effects of telemedicine on clinicians and patients.
CONCLUSIONS
Practice leaders identified several challenges to telemedicine implementation and highlighted 2 areas, including telemedicine visit triage guidelines and telemedicine-specific staffing and scheduling protocols, for improvement.
目的
在 2019 年冠状病毒病（COVID-19）大流行期间，需要迅速在初级保健中实施远程医疗，不同的实践方式对此有不同的应对。本研究使用来自初级保健实践负责人半结构化访谈的定性数据，旨在报告自 2020 年 3 月以来，与远程医疗实施和演变/成熟相关的共同经验和独特观点。
方法
我们对来自 2 个州（纽约州和佛罗里达州）2 个卫生系统的 25 名初级保健实践负责人进行了 25 分钟的虚拟半结构化访谈，这些负责人都参与了 PCORnet，即患者为中心的成果研究所临床研究网络。问题的提出遵循了 3 个框架（卫生信息技术评估、获得医疗服务的机会和卫生信息技术生命周期），并涉及实践负责人对其实践中远程医疗实施过程的看法，特别关注成熟过程和促进因素/障碍。2 位研究人员对定性数据的开放性问题进行了归纳编码，以确定共同主题。采访记录由虚拟平台软件自动生成。
结果
针对来自 2 个州的 87 个初级保健实践的 25 名实践负责人进行了 25 次访谈。我们确定了以下 4 个主要主题：（1）远程医疗的采用难易程度取决于患者和临床医生先前使用虚拟健康平台的经验；（2）各州的远程医疗监管各不相同，这对实施过程产生了不同的影响；（3）就诊分诊规则不明确；（4）远程医疗对临床医生和患者都有积极和消极的影响。
结论
实践负责人确定了远程医疗实施中存在的一些挑战，并强调了需要改进的 2 个方面，包括远程医疗就诊分诊指南和远程医疗特定的人员配备和调度协议。
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