Lew Eileen, Tan Sean F J, Teo Agnes, Sng Ban L, Lum Elaine P M
Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Anaesthesiology and Perioperative Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.
Telemed Rep. 2023 Jun 26;4(1):156-165. doi: 10.1089/tmr.2023.0023. eCollection 2023.
Studies suggest that preoperative evaluation can be effectively conducted through telehealth. As the COVID-19 pandemic has accelerated digital transformation, we hypothesize that a new telehealth model of care may be feasibly implemented for preoperative evaluation at our institution. This qualitative study seeks to evaluate the attitudes and perception of elective surgery patients and health care providers toward telehealth conducted for preanesthesia evaluation.
At a tertiary women's hospital in Asia, health care providers and elective surgery patients were recruited by convenience and snowball sampling to undergo one-on-one semistructured interviews regarding a new telehealth model of care for preanesthesia evaluation, under-pinned by the Normalization Process Theory. Data were analyzed, coded, and consolidated into themes using the framework analysis method by a team of four researchers from diverse backgrounds.
Twenty-five interviews were conducted among 10 patients and 15 health care participants. Ninety-five codes were identified, consolidated into four themes that connect to guide the implementation of a new telehealth pathway for preoperative care, mapped to the Normalization Process Theory. The themes pertain to advantages of telehealth workflow (coherence), requisites for new telehealth workflow (coherence, collective action), barriers to implementation (cognitive participation, collective action), and enablers of implementation (cognitive participation, collective action). All participants were receptive to telehealth, but health care participants expressed concern about the impact of additional tasks on current clinical workload. Training in videoconferencing was deemed essential by both patients and health care providers.
The study has provided insights into levels of coherence and cognitive participation among patients and health care providers. The telehealth workflow should be redesigned, considering systems' constraints and stakeholders' needs. Greater buy-in is needed to gain health care providers' commitment for collective action. Clinicaltrials.gov identifier: NCT05781789.
研究表明，术前评估可通过远程医疗有效开展。随着新冠疫情加速了数字化转型，我们推测在我们机构可能可行地实施一种新的远程医疗护理模式用于术前评估。本定性研究旨在评估择期手术患者和医疗服务提供者对用于麻醉前评估的远程医疗的态度和看法。
在亚洲一家三级妇产医院，通过便利抽样和滚雪球抽样招募医疗服务提供者和择期手术患者，就一种基于规范化过程理论的用于麻醉前评估的新远程医疗护理模式进行一对一的半结构化访谈。由来自不同背景的四位研究人员组成的团队使用框架分析法对数据进行分析、编码并整合为主题。
对10名患者和15名医疗参与者进行了25次访谈。识别出95个代码，整合为四个主题，这些主题与指导术前护理新远程医疗路径的实施相关，并映射到规范化过程理论。这些主题涉及远程医疗工作流程的优势（连贯性）、新远程医疗工作流程的必要条件（连贯性、集体行动）、实施障碍（认知参与、集体行动）以及实施促进因素（认知参与、集体行动）。所有参与者都接受远程医疗，但医疗参与者对额外任务对当前临床工作量的影响表示担忧。患者和医疗服务提供者都认为视频会议培训至关重要。
该研究深入了解了患者和医疗服务提供者之间的连贯程度和认知参与水平。应重新设计远程医疗工作流程，考虑系统限制和利益相关者的需求。需要更大程度的支持以获得医疗服务提供者对集体行动的承诺。Clinicaltrials.gov标识符：NCT05781789。
