Otago Medical School, University of Otago, Dunedin, Otago, New Zealand.
Bioethics Centre, University of Otago, 71 Frederick Street, Dunedin 9016, New Zealand.
J Prim Health Care. 2024 Sep;16(3):288-294. doi: 10.1071/HC24027.
Introduction The use of telephone and video consultations has vastly increased since the onset of the COVID-19 pandemic. Health care providers in traditional clinical practices have embraced these virtual consultations as an alternative to face-to-face consultations, but there has also been a simultaneous increase in services offered directly to consumers via commercial entities. One of the main challenges in telemedicine (and the broader field of digital health) is how to conduct a meaningful ethical assessment of such services. Aim This article presents a novel framework for practical ethical analysis of direct-to-consumer virtual general practitioner consultation services in Aotearoa New Zealand. Methods First, a scoping review of academic and policy documents identified the core ethical challenges arising from virtual consultations. Second, a qualitative analysis was conducted to translate the main ethical themes and subthemes into practical questions to assess virtual general practice services. Results A total of 49 relevant documents were selected for review. The six key ethical themes related to telemedicine were: privacy, security, and confidentiality; equity; autonomy and informed consent; quality and standards of care; patient empowerment; and continuity of care. A practical ethical checklist consisting of 25 questions was developed from these themes and their subthemes. Discussion The checklist provides an accessible way of incorporating ethics into technology assessment and can be used by all relevant stakeholders, including patients, health care providers, and developers. Application of the framework contributes to improving the quality of virtual consultation services with a specific focus on ethics.
简介
自 COVID-19 大流行以来，电话和视频咨询的使用大大增加。传统临床实践中的医疗保健提供者已经接受了这些虚拟咨询作为面对面咨询的替代方法，但通过商业实体直接向消费者提供的服务也同时增加。远程医疗（以及更广泛的数字健康领域）的主要挑战之一是如何对这些服务进行有意义的伦理评估。
目的
本文提出了一种新的框架，用于对新西兰直接面向消费者的虚拟全科医生咨询服务进行实际的伦理分析。
方法
首先，对学术和政策文件进行范围审查，确定了虚拟咨询产生的核心伦理挑战。其次，进行了定性分析，将主要的伦理主题和子主题转化为评估虚拟全科医疗服务的实际问题。
结果
共选择了 49 份相关文件进行审查。与远程医疗相关的六个关键伦理主题是：隐私、安全和保密性；公平；自主权和知情同意；护理质量和标准；患者赋权；以及护理连续性。从这些主题及其子主题中制定了一份由 25 个问题组成的实用伦理检查表。
讨论
该检查表提供了一种将伦理纳入技术评估的便捷方式，可以由所有相关利益相关者使用，包括患者、医疗保健提供者和开发者。该框架的应用有助于提高虚拟咨询服务的质量，特别关注伦理问题。
