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麻醉远程会诊:术前评估的质量、医学经济学利益和患者满意度——一项前瞻性观察研究。

Anesthesia Teleconsultation: Quality, Medicoeconomic Interest, and Patient Satisfaction of Preoperative Assessment-A Prospective Observational Study.

机构信息

Groupe Hospitalier La Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.

Department of Anesthesiology, Clinique Drouot Sport, Paris, France.

出版信息

Telemed J E Health. 2024 Feb;30(2):457-463. doi: 10.1089/tmj.2023.0054. Epub 2023 Jul 26.

Abstract

Telemedicine can be defined as the use of telecommunication technology for performing medical acts remotely by health professionals. Currently in anesthesia, teleconsultation (TC) is becoming widespread, although the benefit and quality have not been well evaluated. The objective of this study was to assess the quality, the patient satisfaction, as well as the ecological and medicoeconomic impacts of the preanesthesia TC. This prospective observational multicentric study was approved by the Société Française d'Anesthésie-Réanimation ethics committee. The study took place from October 2020 to March 2021, in eight French health care institutions. Every adult patient requiring TC before elective surgery could be included. Unavailability of videoconferencing for the patient was the main exclusion criteria. Five hundred three () patients, scheduled for surgery, were included. Their files were analyzed for quality, 375 were successfully interviewed for the second part of the study evaluating satisfaction and medicoeconomic impact. The study's evaluation criteria were the quality of the TeleMed-Cs, the satisfaction and comprehension for the patient, and the medicoeconomic impact of a remote evaluation compared with the face-to-face consultation with the surgeon. Of the 503 files, 478 (95%) were reviewed and met all the high authority of health quality criteria. The electronic format of records was associated with higher completion rate. The median satisfaction was 10.0 (IQR 8.25-10.0). The cost of a TC in anesthesia was significantly lower than that of a face-to-face surgical consultation with a median cost of 1.49€ (IQR 0.8-1.99) versus 34.81€ (IQR 14.01-91.7) < 0.001. TC in anesthesia seems to be a good alternative in terms of quality, patient satisfaction, and medicoeconomic gain for our patients. By facilitating access to preoperative evaluation, it could be adopted worldwide and thus reduce surgery-related morbidity and mortality in our patients.

摘要

远程医疗可以被定义为通过卫生专业人员使用远程通信技术来进行医疗行为。目前,在麻醉学中,远程咨询(TC)越来越普及,尽管其益处和质量尚未得到很好的评估。本研究的目的是评估麻醉前 TC 的质量、患者满意度以及生态和医疗经济影响。这项前瞻性观察性多中心研究得到了法国麻醉与复苏学会伦理委员会的批准。该研究于 2020 年 10 月至 2021 年 3 月在法国的 8 家医疗机构进行。每一位需要 TC 的择期手术成年患者都可以纳入研究。患者无法进行视频会议是主要的排除标准。共纳入了 503 名()患者,他们计划接受手术。分析了他们的病历以评估质量,其中 375 名患者成功接受了第二部分研究的采访,评估了满意度和医疗经济影响。该研究的评估标准是 TeleMed-Cs 的质量、患者的满意度和理解程度,以及与与外科医生面对面咨询相比,远程评估的医疗经济影响。在 503 份病历中,有 478 份(95%)被审查,均符合所有高卫生质量标准。电子病历格式与更高的完成率相关。中位数满意度为 10.0(IQR 8.25-10.0)。麻醉中的 TC 成本明显低于面对面的外科咨询,中位数成本为 1.49 欧元(IQR 0.8-1.99)与 34.81 欧元(IQR 14.01-91.7)相比,差异具有统计学意义(P < 0.001)。在质量、患者满意度和医疗经济收益方面,麻醉中的 TC 似乎是一种较好的替代方案。通过促进术前评估的可及性,它可以在全球范围内得到采用,从而降低我们患者的手术相关发病率和死亡率。

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