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提高远程医疗(电话/视频咨询)的使用率:方法与经验教训

Improving uptake of telemedicine (phone/video consult): methods and lessons learnt.

作者信息

Chu Michael, Jiang Bochao, Li Huanghuan, Teh Francis, Quek Jonathan, Tan Andrew, Lin Kenneth, Tan Chin Kimg, Fock Kwong Ming, Ang Tiing Leong, Kwek Andrew, Wong Yu Jun

机构信息

Gastroenterology, Changi General Hospital, Singapore.

Gastroenterology, Changi General Hospital, Singapore

出版信息

BMJ Open Qual. 2025 Apr 7;14(2):e003179. doi: 10.1136/bmjoq-2024-003179.

Abstract

Telemedicine can improve care delivery through reducing clinic wait-time, improving accessibility to specialist care, minimising cross-infection risk at patient's convenience. Despite these benefits, telemedicine uptake remained low within our gastroenterology department, with only four teleconsultations conducted in 6 months prior to this project's conceptualisation. This quality improvement (QI) project aimed to improve telemedicine utilisation within our department by 20% over a 3-month period. Surveys conducted during the planning phase identified key barriers to telemedicine adoption, including high clinic load, concerns over medicolegal issues and unfamiliarity with data security protocols. To address these issues, a multistakeholder QI team introduced several key measures, including streamlining telemedicine workflow, providing clinician training and implementing patient educational posters. These interventions successfully increased the adoption of telemedicine (median 8 (IQR 2.5) vs 31 (IQR 13) teleconsultations per month, p<0.01) over the intervention period, with 84% of patients reporting positive experiences. Additionally, this project reduced carbon emissions, saving approximately 3446 kg of CO2, equivalent to 388 gallons of gasoline. This QI project highlights the potential for telemedicine to enhance healthcare delivery while promoting environmental sustainability. Key lessons include the importance of structured workflows and stakeholder engagement to overcome barriers. Future interventions should aim to refine telemedicine pricing models and expand the initiative to other departments within the hospital to ensure long-term sustainability.

摘要

远程医疗可以通过减少门诊等待时间、提高专科护理的可及性、在患者方便时将交叉感染风险降至最低来改善医疗服务的提供。尽管有这些好处,但我们胃肠病科的远程医疗使用率仍然很低,在这个项目构思前的6个月里,仅进行了4次远程会诊。这个质量改进(QI)项目旨在在3个月内将我们科室的远程医疗使用率提高20%。在规划阶段进行的调查确定了远程医疗采用的关键障碍,包括门诊工作量大、对医疗法律问题的担忧以及对数据安全协议不熟悉。为了解决这些问题,一个多利益相关方的QI团队引入了几项关键措施,包括简化远程医疗工作流程、提供临床医生培训以及张贴患者教育海报。在干预期间,这些干预措施成功地提高了远程医疗的采用率(每月远程会诊中位数从8(四分位间距2.5)次增加到31(四分位间距13)次,p<0.01),84%的患者报告了积极的体验。此外,这个项目减少了碳排放,节省了约3446千克二氧化碳,相当于388加仑汽油。这个QI项目凸显了远程医疗在改善医疗服务提供的同时促进环境可持续性的潜力。关键经验教训包括结构化工作流程和利益相关方参与以克服障碍的重要性。未来的干预措施应旨在完善远程医疗定价模式,并将该举措扩展到医院的其他科室,以确保长期可持续性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d416/11977467/f016ed07af5f/bmjoq-14-2-g001.jpg

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