Li Yiwen, Pope Charlene, Damonte Jennifer, Spates Tanika, Maa April, Chen Suephy, Yeung Howa
Department of Dermatology, Emory University School of Medicine, Atlanta, GA, United States.
Charleston Veterans Affairs Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, United States.
JMIR Dermatol. 2024 Feb 7;7:e50352. doi: 10.2196/50352.
Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members' engagement in telespecialty care.
This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services).
In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion.
In total, 3 themes were identified from participants' experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward.
This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans.
退伍军人事务部医疗保健系统一直是异步远程医疗的早期采用者，以便为居住在农村地区的退伍军人在基层医疗环境中提供及时和高质量的专科护理服务。很少有研究探讨如何提高基层医疗团队成员参与远程专科护理的程度。
这项定性研究旨在探讨使用异步远程专科护理（远程皮肤病学和远程眼科护理服务）的实施过程中的障碍和促进因素。
总共采访了30名参与者，包括来自2个社区门诊诊所的基层医疗服务提供者、护士、远程医疗临床技术人员、医疗和项目支持助理以及管理人员。使用访谈指南进行半结构化访谈，进行数字录音并转录。访谈记录采用定性内容分析总结方法进行分析。两名编码员独立审查记录。通过共识讨论解决差异。
从参与者的经历中总共确定了3个主题：对远程专科护理的积极看法、实施中的担忧和挑战以及服务改进建议。参与者表示，远程医疗就诊节省了通勤和等待时间，为农村地区的退伍军人提供了更多获得及时医疗护理的机会。提到的担忧包括技术挑战和设备故障、人员短缺无法满足面对面和远程医疗就诊需求、预约过多导致转诊延迟、需要更标准化的操作协议，以及在支持人员中进行更多带有形成性反馈的实践培训。参与者还面临预约取消的挑战，并努力寻找有效管理远程医疗和面对面就诊以简化患者流程的方法。尽管如此，大多数参与者对未来实施远程专科护理感到有动力和信心。
这项研究为远程专科护理实施中的积极看法和持续挑战提供了重要见解。需要基层医疗团队的反馈来改善为农村退伍军人提供的远程专科护理服务。
