Lurtz Josefine, C Sauter Thomas, Jacob Christine
FHNW - University of Applied Sciences Northwestern Switzerland, Riggenbachstrasse 16, Olten, 4600, Switzerland.
University of Oxford, Oxford, United Kingdom.
JMIR Hum Factors. 2024 Dec 4;11:e59073. doi: 10.2196/59073.
Pain and its adequate treatment are an issue in hospitals and emergency departments (EDs). A virtual reality (VR) tool to manage pain could act as a valuable complement to common pharmaceutical analgesics. While efficacy could be shown in previous studies, this does not assure clinical adoption in EDs.
The main aim of this study was to investigate which factors affect the adoption and potential reimbursement of a VR tool for pain management in the ED of a Swiss university hospital.
Key informant interviews were conducted using in-depth semistructured interviews with 11 participants reflecting the perspectives of all the relevant stakeholder groups, including physicians, nurses, patients, health technology providers, and health insurance and reimbursement experts. The interviews were recorded and transcribed, and the extracted data were systematically analyzed using a thematic analysis and narrative synthesis of emergent themes. A consolidated framework for eHealth adoption was used to enable a systematic investigation of the topic and help determine which adoption factors are considered as facilitators or barriers or as not particularly relevant for the tool subject of this study.
According to the participants, the three key facilitators are (1) organizational environment; (2) tension for change, ease of use, and demonstrability; and (3) employee engagement. Further, the three key barriers to adoption are (1) workload, (2) changes in clinical workflow and habit, and (3) reimbursement.
This study concludes that the adoption of a VR tool for pain management in the ED of the hospital subject of this study, although benefiting from a high tension for change in pain and workload management, is highly dependent on the respective organizational environment, engagement of the clinical staff, and reimbursement considerations. While tailored incentive structures and ambassador roles could benefit initial adoption, a change in the reimbursement landscape and further investigation of the positive effects on workflow effectiveness are required to drive long-term adoption.
疼痛及其适当治疗是医院和急诊科的一个问题。一种用于管理疼痛的虚拟现实（VR）工具可以作为常见药物镇痛剂的宝贵补充。虽然先前的研究已证明其有效性，但这并不能确保在急诊科得到临床应用。
本研究的主要目的是调查哪些因素会影响瑞士一家大学医院急诊科用于疼痛管理的VR工具的采用及潜在报销情况。
采用深入的半结构化访谈对11名参与者进行关键信息人访谈，这些参与者反映了所有相关利益相关者群体的观点，包括医生、护士、患者、健康技术供应商以及健康保险和报销专家。访谈进行了录音和转录，并使用主题分析和对新出现主题的叙述性综合对提取的数据进行系统分析。采用电子健康采用的综合框架对该主题进行系统调查，并帮助确定哪些采用因素被视为促进因素或障碍，或者与本研究的工具主题不太相关。
根据参与者的说法，三个关键促进因素是：（1）组织环境；（2）变革压力、易用性和可演示性；（3）员工参与度。此外，采用的三个关键障碍是：（1）工作量；（2）临床工作流程和习惯的改变；（3）报销。
本研究得出结论，本研究中医院急诊科采用用于疼痛管理的VR工具，尽管受益于疼痛和工作量管理方面较高的变革压力，但高度依赖于各自的组织环境、临床工作人员的参与度以及报销考虑因素。虽然量身定制的激励结构和大使角色可能有利于初步采用，但需要改变报销格局并进一步调查对工作流程有效性的积极影响，以推动长期采用。
