The Queen's Medical Center, Honolulu, HI (ALET, KBG, AM, PAC, MAK).
Richmond VA Medical Center, Richmond, VA (SC).
Hawaii J Health Soc Welf. 2024 Sep;83(9):250-256. doi: 10.62547/VZQV6670.
The research team assessed community acceptability of prehospital stroke telemedicine services in rural O'ahu communities. Tools were developed to evaluate patient-centered goals about implementing ambulance-based telemedicine which aimed to retain appropriate patients in community hospitals and improve thrombolytic treatment times. Using a mixed methods approach, the team surveyed well-appearing adults (ie, able to complete survey and interview) at O'ahu community events. Participants were asked to complete a short Likert-scale questionnaire (n=263) followed by a semi-structured interview (n=29). Data were summarized by descriptive and inferential statistics. Comparisons between rural and urban groups were made by chi-square analysis and Wilcoxon rank-sum 2-tailed test. Interviews were transcribed, coded, and analyzed using inductive and deductive methods. The findings suggest that use of prehospital telemedicine for specialty care is viewed favorably by both rural and urban respondents. Additionally, most respondents felt comfortable staying at their local hospital if they had access to a specialist by telemedicine. However, mistrust in rural hospitals may be a potential barrier to implementation. Compared to urban respondents, rural respondents were less confident in their local hospital's resources and capabilities for stroke care. The findings identified a potential misalignment of the project's goal with some patients' goal to use emergency medical services (EMS) to bypass rural hospitals for stroke care. Future community outreach efforts are needed to encourage activation of EMS and highlight the advantages of utilizing prehospital telemedicine for accessing specialty care thereby improving treatment times.
研究团队评估了夏威夷欧胡岛农村社区对院前中风远程医疗服务的接受程度。研究团队开发了一些工具来评估基于救护车的远程医疗实施的以患者为中心的目标，旨在将合适的患者留在社区医院并缩短溶栓治疗时间。该团队采用混合方法，在夏威夷欧胡岛社区活动中调查了外表正常的成年人（即能够完成调查和访谈的人）。要求参与者完成一份简短的李克特量表问卷（n=263），然后进行半结构化访谈（n=29）。使用描述性和推断性统计方法对数据进行总结。通过卡方分析和 Wilcoxon 秩和检验对农村和城市组进行了比较。对访谈进行了转录、编码和分析，使用了归纳和演绎方法。研究结果表明，农村和城市受访者都对使用院前远程医疗进行专科护理持积极态度。此外，如果他们可以通过远程医疗获得专家的帮助，大多数受访者都愿意留在当地医院。然而，对农村医院的不信任可能是实施的潜在障碍。与城市受访者相比，农村受访者对当地医院治疗中风的资源和能力缺乏信心。研究结果发现，该项目的目标与一些患者的目标之间可能存在错位，这些患者希望通过紧急医疗服务（EMS）绕过农村医院进行中风治疗。需要开展未来的社区外展工作，以鼓励激活 EMS，并强调利用院前远程医疗获取专科护理的优势，从而缩短治疗时间。
