使用在线视频电话与患者家属进行医疗咨询的用途和局限性：一项前瞻性队列研究。
Usage and limitations of medical consultation with patients' families using online video calls: a prospective cohort study.
机构信息
Division of Clinical Epidemiology, NHO Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
出版信息
BMC Med Inform Decis Mak. 2024 May 27;24(1):139. doi: 10.1186/s12911-024-02542-y.
BACKGROUND
Few studies have been conducted on the usage of telehealth focusing on consultations between patients' families and physicians. This study aimed to identify the usage and limitations of online medical consultations with patients' families compared to the traditional in-person consultations.
METHODS
We conducted a prospective cohort study from April 1, 2020, to September 30, 2021, at an educational acute-care hospital in Japan. The study included hospitalized patients aged 20 years or older and their family members for whom an online or in-person medical consultation between the family member and physician was conducted during the hospitalization period. The primary endpoints assessed were three topics pertaining to medical consultation: medical conditions and treatment plans, policies for life-threatening events, and post-discharge support. The secondary endpoint was the number of consultations required.
RESULTS
Online consultations and traditional in-person consultations were provided to 58 and 53 patients' families, respectively. Of the patients in the online consultation group who underwent multiple consultations, 46 (79%) also underwent in-person consultations. Regarding the topics, all the patients' families in both consultation groups had consultations on medical conditions and treatment plans; regarding the policy for life-threatening events, 47% of patient families in the online consultation group were consulted compared to 53% of those in the in-person group. Regarding post-discharge support, 59% of patient families in the online group were consulted compared to 40% in the in-person group. In the online consultation group of 58 patients' families, 188 consultations were conducted, including 95 online and 93 in-person consultations. Consultations on policy for life-threatening events were significantly more frequent in in-person consultations than in online consultations (p < 0.05). Regarding post-discharge support, online consultations were significantly more frequent than in-person consultations (p < 0.05). The number of family members who attended online consultations was significantly higher than those who attended in-person consultations (p < 0.05).
CONCLUSIONS
Online consultation between the physician and patient's family may be an alternative to in-person consultation for explaining medical conditions and treatment plans. However, in-person consultation still plays an important role in sensitive topics, such as policy consultation for life-threatening events.
背景
很少有研究关注患者家属与医生之间的远程医疗使用情况。本研究旨在确定与传统的面对面咨询相比，在线医疗咨询在患者家属中的使用情况和局限性。
方法
我们在日本一家教学急症医院进行了一项前瞻性队列研究，时间为 2020 年 4 月 1 日至 2021 年 9 月 30 日。研究纳入了年龄在 20 岁及以上的住院患者及其家属，这些患者在住院期间接受了家庭成员与医生之间的在线或面对面的医疗咨询。主要终点评估了三个与医疗咨询相关的主题：医疗状况和治疗计划、危及生命事件的政策以及出院后的支持。次要终点是所需咨询的次数。
结果
在线咨询和传统的面对面咨询分别提供给 58 个和 53 个患者家属。在接受多次咨询的在线咨询组患者中，有 46 人（79%）也接受了面对面咨询。在咨询主题方面，两组咨询患者家属均进行了医疗状况和治疗计划的咨询；在危及生命事件的政策方面，在线咨询组有 47%的患者家属进行了咨询，而面对面咨询组有 53%的患者家属进行了咨询。关于出院后的支持，在线组有 59%的患者家属进行了咨询，而面对面组只有 40%的患者家属进行了咨询。在 58 个患者家属的在线咨询组中，共进行了 188 次咨询，包括 95 次在线咨询和 93 次面对面咨询。危及生命事件政策咨询在线咨询明显多于面对面咨询（p<0.05）。关于出院后的支持，在线咨询明显多于面对面咨询（p<0.05）。在线咨询的家属人数明显多于面对面咨询（p<0.05）。
结论
医生与患者家属之间的在线咨询可能是解释医疗状况和治疗计划的替代面对面咨询的方式。然而，在危及生命事件的政策咨询等敏感话题方面，面对面咨询仍发挥着重要作用。
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