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利用基于学校的远程咨询服务,使巴基斯坦半农村地区能够获得社区卫生服务:顺序解释性混合方法研究。

Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study.

机构信息

School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan.

Aga Khan University Hospital, Karachi, Pakistan.

出版信息

JMIR Form Res. 2024 Nov 12;8:e48664. doi: 10.2196/48664.

Abstract

BACKGROUND

In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities.

OBJECTIVE

This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan.

METHODS

This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis.

RESULTS

A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care.

CONCLUSIONS

This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue.

摘要

背景

在巴基斯坦偏远地区,优质医疗保健和经验丰富的专业人员都很匮乏。远程医疗可以通过提供远程咨询等创新服务来弥合这一差距。学校可以作为引入这些服务的有效平台,极大地改善半农村社区的卫生服务获取途径。

目的

本研究旨在探讨在巴基斯坦卡拉奇的半农村地区,通过引入以学校为基础的远程咨询服务(TCS)来加强社区卫生的可行性。

方法

本研究采用混合方法设计。共有 393 名学生参与了定量部分,35 名家长、教师和社区利益相关者参与了定性部分(焦点小组讨论)。定量数据使用 SPSS(版本 24;IBM 公司)进行比例计算,而定性数据则进行主题分析。

结果

在 28 个月的时间里,为 393 名学生提供了总共 1046 次成功的远程咨询。人口统计学数据显示,接受 TCS 的学生的平均年龄为 9.24(SD 3.25)岁,其中大多数是男性(59.3%,233/393)。只有 1.24%(13/1046)的病例需要转诊。定性分析产生了三个主题:(1)医疗体验的转变,(2)远程咨询需求的增加,(3)护理的心理方面。

结论

本研究证明了在卡拉奇的半城市学校中整合 TCS 以解决医疗保健可及性差距的有效性。通过学校平台实施 TCS 提高了在校儿童的整体健康状况,同时减少了学校缺勤和家庭经济负担。该研究强调了 TCS 的成本效益、时间效率和质量,社区支持 24/7 可用性、向成年人扩展以及报销模式。由学校保健护士主导的 TCS 为解决医疗保健挑战提供了一种可扩展的解决方案,可改善巴基斯坦乃至全球在校儿童的健康结果,特别是在获取途径是主要问题的低收入和中等收入国家。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5cb/11599883/8785082d3c58/formative_v8i1e48664_fig1.jpg

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