佛罗里达一号+临床研究网络中远程医疗对COVID-19的实施响应：临床医生和卫生系统领导者的观点
Telehealth Implementation Response to COVID-19 in the OneFlorida+ Clinical Research Network: Perspectives of Clinicians and Health Systems Leaders.
作者信息
Theis Ryan P, Dorbu Joshua I, Mavrodieva Maria E, Guerrero Richard A, Wright Stacy E, Donahoo William T, Modave François, Carrasquillo Olveen, Shenkman Elizabeth A
机构信息
Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA.
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida, Gainesville, Florida, USA.
出版信息
Telemed J E Health. 2024 Jan;30(1):268-277. doi: 10.1089/tmj.2023.0029. Epub 2023 Jun 26.
Introduction:The COVID-19 pandemic forced health systems worldwide to make rapid adjustments to patient care. Nationwide stay-at-home mandates and public health concerns increased demand for telehealth to maintain patients' continuity of care. These circumstances permitted observation of telehealth implementation in real-world settings at a large scale. This study aimed to understand clinician and health system leader (HSL) experiences in expanding, implementing, and sustaining telehealth during COVID-19 in the OneFlorida+ clinical research network.
Methods:We conducted semistructured videoconference interviews with 5 primary care providers, 7 specialist providers, and 12 HSLs across 7 OneFlorida+ health systems and settings. Interviews were audiorecorded, transcribed, and summarized using deductive team-based template coding. We then used matrix analysis to organize the qualitative data and identify inductive themes.
Results:Rapid telehealth implementation occurred even among sites with low readiness, facilitated by responsive planning, shifts in resource allocation, and training. Common hurdles in routine telehealth use, including technical and reimbursement issues, were also barriers to telehealth implementation. Acceptability of telehealth was influenced by benefits such as the providers' ability to view a patient's home environment and the availability of tools to enhance patient education. Lower acceptability stemmed from the inability to conduct physical examinations during the shutdown.
Conclusions:This study identified a broad range of barriers, facilitators, and strategies for implementing telehealth within large clinical research networks. The findings can contribute to optimizing the effectiveness of telehealth implementation in similar settings, and point toward promising directions for telehealth provider training to improve acceptability and promote sustainability.
引言
新冠疫情迫使全球医疗系统迅速调整患者护理方式。全国范围内的居家令和公共卫生问题增加了对远程医疗的需求，以维持患者的连续护理。这些情况使得能够大规模观察远程医疗在现实环境中的实施情况。本研究旨在了解在“OneFlorida+”临床研究网络中，临床医生和卫生系统领导者（HSL）在新冠疫情期间扩展、实施和维持远程医疗方面的经验。
方法
我们对“OneFlorida+”7个卫生系统和机构中的5名初级保健提供者、7名专科提供者和12名HSL进行了半结构化视频会议访谈。访谈进行了录音、转录，并使用基于团队的演绎式模板编码进行总结。然后，我们使用矩阵分析来组织定性数据并确定归纳主题。
结果
即使在准备不足的站点，通过响应式规划、资源分配的转变和培训，远程医疗也得以迅速实施。常规远程医疗使用中的常见障碍，包括技术和报销问题，也是远程医疗实施的障碍。远程医疗的可接受性受到一些益处的影响，比如提供者能够查看患者的家庭环境以及加强患者教育工具的可用性。可接受性较低源于在关闭期间无法进行体格检查。
结论
本研究确定了在大型临床研究网络中实施远程医疗的广泛障碍、促进因素和策略。这些发现有助于在类似环境中优化远程医疗实施的有效性，并为远程医疗提供者培训指明有前景的方向，以提高可接受性并促进可持续性。
Zotero 插件