School of Health Sciences, University of Nottingham, Nottingham, UK
School of Health Sciences, University of Nottingham, Nottingham, UK.
BMJ Open. 2024 Nov 1;14(10):e079153. doi: 10.1136/bmjopen-2023-079153.
The COVID-19 pandemic has led to increased use of digital clinical consultations (phone or video calls) within UK maternity services. This project aimed to review the evidence on digital clinical consultations in maternity systems to illuminate how, for whom and in what contexts, they can be used to support safe, personalised and equitable care.
A realist synthesis, drawing on diverse sources of evidence (2010-present) from OECD countries, alongside insights from knowledge user groups (representing healthcare providers and service users).
The review used three analytical processes (induction, abduction and retroduction) within three iterative stages (development of initial programme theories; evidence retrieval and synthesis; validation and refinement of the programme theories).
Ninety-three evidence sources were included in the final synthesis. Fifteen programme theories were developed showing that digital clinical consultations involve different mechanisms operating across five key contexts: the organisation, healthcare providers, the clinical relationship, the reason for consultation and women. The review suggests that digital clinical consultations can be effective and acceptable to stakeholders if there is access to appropriate infrastructure/digital resources and if implementation is able to ensure personalisation, informed choice, professional autonomy and relationship-focused connections. The review found relatively less evidence in relation to safety and equity.
Due to the complexity of maternity systems, there can be 'no one-size fits all' approach to digital clinical consultations. Nonetheless, the review distills four 'CORE' implementation principles: C-creating the right environment, infrastructure and support for staff; O-optimising consultations to be responsive, flexible and personalised to different needs and preferences; R-recognising the importance of access and inclusion; and E-enabling quality and safety through relationship-focused connections. Service innovation and research are needed to operationalise, explore and evaluate these principles, particularly in relation to safety and equity.
CRD42021288702.
新冠疫情大流行导致英国产科学领域增加了对数字临床咨询（电话或视频咨询）的使用。本项目旨在综述产科学数字临床咨询的证据，以阐明其如何、为谁以及在何种情况下可用于支持安全、个性化和公平的护理。
真实主义综合研究，利用来自经合组织国家的 2010 年至今的各种来源的证据（包括医疗保健提供者和服务使用者的知识用户群体的见解）。
该综述使用了三个分析过程（归纳、溯因和推论）和三个迭代阶段（初始方案理论的发展；证据检索和综合；方案理论的验证和完善）。
最终综合分析纳入了 93 个证据来源。共提出了 15 个方案理论，表明数字临床咨询涉及不同的机制，在五个关键背景下运作：组织、医疗保健提供者、临床关系、咨询原因和妇女。综述表明，如果能够获得适当的基础设施/数字资源，并且实施能够确保个性化、知情选择、专业自主权和以关系为中心的联系，那么数字临床咨询对利益相关者来说是有效且可接受的。综述发现与安全性和公平性相关的证据相对较少。
由于产科学系统的复杂性，数字临床咨询不可能有“一刀切”的方法。尽管如此，该综述总结了四个“核心”实施原则：C-为员工创造合适的环境、基础设施和支持；O-优化咨询，以响应、灵活和个性化满足不同的需求和偏好；R-认识到获得和包容的重要性；E-通过以关系为中心的联系实现质量和安全。需要进行服务创新和研究，以实施、探索和评估这些原则，特别是在安全性和公平性方面。
CRD42021288702。
