Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
Int J Med Inform. 2023 Oct;178:105197. doi: 10.1016/j.ijmedinf.2023.105197. Epub 2023 Aug 19.
Telehealth was rapidly adopted in primary care during COVID-19. However, there is a lack of research assessing how translatable in-person consultations are to telehealth.
To examine insights from in-person GP-Patient consultations for patients with chronic conditions, including 1/frequency, duration, conditions of physical examinations, and when they occur during consultations, 2/types of physical artefacts used, 3/clinical tasks performed, and 4/translatability of clinical tasks to telehealth.
Eligible consultations were extracted from a dataset archive named HaRI, which contains 281 in-person GP consultations in de-identified transcript and video format. 38 consultations were included for analysis meeting eligibility criteria in this study. A multi-method approach (using content analysis, visualisation, video and time analysis) was applied to eligible consultations, extracting clinical tasks that involve physical interactions. Finally, an evidence-based scoring system was used on each clinical task, determining the likelihood of whether each task could be translated into telehealth.
Nine chronic conditions were observed across 38 GP-Patient consultations, predominately diabetes (39 %, 15/38). Out of these 38 consultations, 76 % (29/38) featured physical examinations, where 68 % (26/38) were initiated by GPs (e.g., auscultation), and 26 % (10/38) were initiated by patients (e.g., self-palpation). The average percentage of time spent on physical examination(s) during consultations is low (13.6 %, SD = 9.4 %). A total of 24 clinical tasks were observed across these 38 consultations. Out of these 24 tasks, 92 % (22/24) were supported by physical artefacts. The average score of a task being translatable to Telehealth is 7/10 (where Score 1 = Not amenable to being replicated over telehealth at this stage, scoring 10 = Easily translatable over telehealth with almost no additional equipment being required).
All tasks observed across chronic condition management visits were deemed translatable/potentially translatable to telehealth. However, physical interactions between GPs and patients are still essential. Future research in telehealth should focus on examining ways to support physical examination, reduce uncertainty, promote safety netting, and facilitate patients' safety at home with effective technology and support.
在 COVID-19 期间，远程医疗在初级保健中迅速得到采用。然而，缺乏研究评估面对面咨询在多大程度上可以转化为远程医疗。
检查慢性病患者的门诊医生-患者咨询的见解，包括 1/频率、持续时间、体检条件以及它们在咨询过程中何时发生，2/使用的物理人工制品类型，3/执行的临床任务，以及 4/临床任务向远程医疗的可转换性。
从一个名为 HaRI 的数据集档案中提取符合条件的咨询记录，该档案包含 281 次以匿名方式记录的门诊医生咨询的视频和转录本。38 次咨询符合本研究的纳入标准。对符合条件的咨询记录采用多方法（使用内容分析、可视化、视频和时间分析），提取涉及身体互动的临床任务。最后，对每个临床任务使用基于证据的评分系统，确定每个任务是否可以转化为远程医疗的可能性。
在 38 次 GP-患者咨询中观察到 9 种慢性病，主要是糖尿病（39%，15/38）。在这 38 次咨询中，76%（29/38）进行了体检，其中 68%（26/38）由 GP 发起（例如听诊），26%（10/38）由患者发起（例如自我触诊）。咨询过程中用于体检的时间平均百分比较低（13.6%，SD=9.4%）。在这 38 次咨询中总共观察到 24 个临床任务。在这 24 个任务中，92%（22/24）有物理人工制品支持。任务可转化为远程医疗的平均得分为 7/10（其中 1 分表示现阶段无法通过远程医疗复制，10 分表示几乎无需额外设备即可轻松通过远程医疗转化）。
慢性病管理就诊中观察到的所有任务都被认为可以转化/可能转化为远程医疗。然而，GP 和患者之间的身体互动仍然至关重要。远程医疗的未来研究应侧重于研究支持体检、减少不确定性、促进安全保障以及利用有效的技术和支持在家中为患者提供安全保障的方法。
