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Am J Manag Care. 2024 May;30(6 Spec No.):SP437-SP444. doi: 10.37765/ajmc.2024.89550.
Challenges in implementing telemedicine disproportionately affect patients served in safety-net settings. Few studies have elucidated pragmatic, team-based strategies for successful telemedicine implementation in primary care, especially with a safety-net population.
We conducted in-depth, semistructured qualitative interviews with primary care clinicians and staff in a large urban safety-net health care system on the facilitators, challenges, and impact of implementing team workflows for synchronous telemedicine video and audio-only visits.
Interviews were analyzed using modified grounded theory with multistage coding. Common themes were identified and reviewed to describe within-group and between-group variations. We used the Practical, Robust Implementation Sustainability Model framework to organize the final themes with an implementation science lens.
Four themes emerged from 11 interviews: (1) having a dedicated individual preparing patients for video visits is a prerequisite for the successful introduction of video visits to patients with limited digital literacy; (2) health care maintenance during video and audio-only visits benefits from standardized workflows and communication; (3) the increased flexibility and accessibility of telemedicine visits were perceived benefits to patient care, despite barriers for subsets of patients; and (4) telemedicine visits generally have a positive impact on work experience for clinicians and staff due to increased efficiency, despite audio-only visits feeling less engaging.
Understanding how to strategically use team-based workflows to expand video visit access while ensuring care quality of all telemedicine visits will allow primary care practices to maximize telemedicine's benefits to patients in the safety-net setting.
远程医疗实施面临的挑战对在保障型医疗环境中服务的患者造成了不成比例的影响。很少有研究阐明了在初级保健中成功实施远程医疗的实用、基于团队的策略，尤其是针对保障性人群。
我们对一家大型城市保障性医疗保健系统中的初级保健临床医生和工作人员进行了深入的半结构化定性访谈，内容涉及同步远程医疗视频和音频访问团队工作流程实施的促进因素、挑战和影响。
使用改良的扎根理论和多阶段编码对访谈进行分析。确定了常见主题，并对其进行了审查，以描述组内和组间的差异。我们使用实用、稳健的实施可持续性模型框架，从实施科学的角度组织最终主题。
从 11 次访谈中得出了四个主题：（1）为视频访问准备患者的专门人员是向数字素养有限的患者成功引入视频访问的前提条件；（2）视频和音频访问期间的医疗保健维护得益于标准化的工作流程和沟通；（3）远程医疗访问的灵活性和可及性增加被认为是患者护理的好处，但对部分患者存在障碍；（4）由于效率提高，远程医疗访问通常对临床医生和工作人员的工作体验产生积极影响，尽管音频访问感觉不那么吸引人。
了解如何战略性地使用基于团队的工作流程来扩大视频访问的机会，同时确保所有远程医疗访问的护理质量，将使初级保健实践能够最大限度地发挥远程医疗对保障性环境中患者的益处。
