《医生、患者与症状自查 App：德国全科医生的定性访谈研究》
The Doctors, Their Patients, and the Symptom Checker App: Qualitative Interview Study With General Practitioners in Germany.
机构信息
Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany.
Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany.
出版信息
JMIR Hum Factors. 2024 Nov 18;11:e57360. doi: 10.2196/57360.
BACKGROUND
Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action.
OBJECTIVE
We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands?
METHODS
We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization.
RESULTS
Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the "unorganized stage" of patients' searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients' decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient's next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data.
CONCLUSIONS
GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients' anxiety, was too risk-averse, or made patients more insistent on their own opinions.
背景
症状检查器专为非专业人士设计，承诺提供初步诊断、紧迫感和建议的行动方案。
目的
我们以国际症状检查器应用程序（SCA）Ada App 为例，回答以下问题：全科医生（GP）如何在他们日常工作的宏观、中观和微观层面体验 SCA，以及这如何与工作相关的心理社会资源和需求相互作用？
方法
我们于 2020 年 12 月至 2022 年 2 月在德国对 8 名全科医生进行了半结构化访谈。我们使用综合基础方法，即解释性重构方法，对数据进行分析，以确定核心主题和主题化模式。
结果
尽管本研究中的大多数全科医生对医疗保健数字化和他们的实践持开放态度，但只有一名医生熟悉 SCA。全科医生认为 SCA 是患者了解自身病情的“无组织阶段”的一部分。一些人更喜欢它而不是流行的搜索引擎。一旦 SCA 会影响患者就医的决定，他们就认为 SCA 与他们的工作相关。一些人希望提前看到 SCA 的结果，以便决定患者的下一步行动。全科医生描述诊断过程是由共同决策指导的，医生主导，患者决策。他们认为诊断是对数据进行解释的行为，而 SCA 尽管数据量巨大，但无法做到这一点。
结论
全科医生对 SCA 持技术实用主义观点。他们在一个稀缺性日益增加的医疗保健系统中运作。他们认为，如果 SCA 有助于减少行政任务和不必要的患者接触，那么它将是一种潜在的与工作相关的资源。如果 SCA 增加工作量，例如，如果它增加患者的焦虑、过于规避风险或使患者更坚持自己的意见，那么它将被视为一种潜在的与工作相关的需求。
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