Dai Zhaoli
College of Medicine and Public Health, Flinders University, Sturt Road, Room 2.13 Health Sciences Building, Bedford Park, SA 5042 Australia.
School of Population Health, University of New South Wales, Sydney, NSW Australia.
BMC Digit Health. 2023;1(1):2. doi: 10.1186/s44247-022-00003-y. Epub 2023 Jan 24.
Telehealth and telecare are particularly important and beneficial to long-term care facilities due to care demands, workforce, and the unique environment. Stemming from the recent findings on telehealth utilisation in residential aged-care facilities in Australia, this commentary seeks to identify lessons and perspectives learned during the Covid-19 pandemic from multiple users, including patients, physicians, nurses, and healthcare workers in long-term care (LTC) settings.
From patients' perspectives, older adults residing in LTC settings often opt not to use virtual care, with the majority preferring in-person visits. This is despite residents expressing their willingness to use telehealth, and virtual care has advantages in LTC settings or in remote areas. Additionally, hearing, vision, or cognitive impairment can limit residents' ability to use information technology to access care, so their preferences for phone or video consultations depend on the health conditions or care requirement. From physicians' perspectives, most healthcare practitioners have a positive attitude toward using telehealth. However, telephone consultations tended to be the dominant mode during the early period of the Covid-19 pandemic. Physicians also raised several major concerns, including technical and equipment-related issues, expanded roles, or additional workloads of LTC staff that could negatively affect clinical decision-making and unequal access in rural, older, and cognitively impaired patients. Most nurses and healthcare workers perceived telehealth positively as a way to enhance patients' care access. However, the majority had concerns about acquiring appropriate knowledge of using the technology for themselves and their patients. In remote areas, nurses expressed higher efficiency and higher care quality when utilising telehealth in caring for older patients than in the regular in-person care mode.
Since the beginning of the Covid-19 pandemic, telehealth has continued as an alternative platform in clinical services. However, as a healthcare platform that offers flexibilities of time, location, and improved efficiency, changing the traditional mindset is essential to shift the paradigm to use telehealth when appropriate. Importantly, telehealth needs substantial support in rural or remote long-term care facilities. Doing so will contribute to the reduction of healthcare inequity in long-term care facilities in remote settings and those with social disparities.
由于护理需求、劳动力以及独特的环境，远程医疗和远程护理对长期护理机构尤为重要且有益。基于澳大利亚老年护理机构中远程医疗使用情况的最新研究结果，本评论旨在确定在新冠疫情期间从包括患者、医生、护士以及长期护理（LTC）机构医护人员在内的多个用户身上吸取的经验教训和观点。
从患者的角度来看，居住在长期护理机构中的老年人通常不愿使用虚拟护理，大多数人更喜欢面对面就诊。尽管居民表示愿意使用远程医疗，且虚拟护理在长期护理机构或偏远地区具有优势。此外，听力、视力或认知障碍可能会限制居民使用信息技术获取护理的能力，因此他们对电话或视频咨询的偏好取决于健康状况或护理需求。从医生的角度来看，大多数医疗从业者对使用远程医疗持积极态度。然而，在新冠疫情初期，电话咨询往往是主要方式。医生还提出了几个主要问题，包括技术和设备相关问题、角色扩大或长期护理机构工作人员额外的工作量，这些可能会对临床决策产生负面影响，以及农村、老年和认知障碍患者获得服务不平等的问题。大多数护士和医护人员对远程医疗持积极看法，认为这是增加患者获得护理机会的一种方式。然而，大多数人担心自己和患者获取使用该技术的适当知识。在偏远地区，护士表示在照顾老年患者时，使用远程医疗比常规面对面护理模式效率更高、护理质量更好。
自新冠疫情开始以来，远程医疗一直是临床服务中的一个替代平台。然而，作为一个提供时间、地点灵活性并提高效率的医疗平台，改变传统观念对于在适当的时候转变为使用远程医疗的模式至关重要。重要的是，远程医疗在农村或偏远的长期护理机构中需要大量支持。这样做将有助于减少偏远地区以及存在社会差异的长期护理机构中的医疗不平等现象。
