The Feasibility of Using Electronic Consultation in Long-Term Care Homes
The Feasibility of Using Electronic Consultation in Long-Term Care Homes
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DOI：
10.1016/j.jamda.2020.03.003
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发表时间：
2020-08-01
影响因子：
7.6
通讯作者：
Liddy, Clare
中科院分区：
文献类型：
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作者：
Helmer-Smith, Mary;Fung, Celeste;Liddy, Clare
长期护理院 (LTC) 中的患者在获得专家建议方面面临障碍。电子咨询 (eConsult) 有可能改善这些患者的就诊机会。我们使用多种方法来评估加拿大安大略省东部的 LTC 家庭对 Champlain BASE eConsult 服务的采用情况。我们对 2018 年 1 月 1 日至 2018 年 12 月 31 日期间在 LTC 之家工作的初级保健提供者 (PCP) 提交的所有电子咨询进行了横断面研究。收集了服务使用数据并计算了描述性统计数据。我们完成了对 4 个焦点小组的主题分析，其中包括 PCP、高级领导层以及在使用 eConsult 的 LTC 之家工作的护士冠军。 64 例病例由 LTC PCP 提交给 23 个专业和亚专业小组，最常见的是皮肤科 (19%)、老年医学 (11%) 和传染病 (9%)。专家的平均响应时间为 0.6 天，70% 的病例得到解决，而居民无需进行面对面的专家访问。在 60% 的案例中，PCP 收到了关于采取新的或额外的行动方案的建议。参与者描述了 LTC 背景下的复杂性、LTC 中 eConsult 的价值以及实施注意事项。拥有使用该服务经验的 PCP 表示，该服务增加了获得专家建议的机会、易用性以及对自己、居民和家庭的好处。 eConsult 在 LTC 中是可行的，并且应该继续在该地区及其他地区使用，以提高获得专家建议的公平性。研究人员和政策制定者应高度重视解决 LTC 中已发现的限制，这些限制阻碍了专家的获取以及电子咨询和类似创新的采用。 (C) 2020 作者。由 Elsevier Inc. 代表 AMDA（急性后和长期护理医学协会）出版。这是一篇遵循 CC BY-NC-ND 许可证 (http://creativecommons.org/licenses/by-nc-nd/4.0/) 的开放获取文章。
Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study of all eConsults submitted by primary care providers (PCPs) working at LTC homes between January 1, 2018 and December 31, 2018. Service use data were collected and descriptive statistics were calculated. We completed a thematic analysis of 4 focus groups with PCPs, senior leadership, and a nurse champion working in LTC homes where eConsult is used. Sixty-four cases were submitted to 23 specialty and subspecialty groups by LTC PCPs, most frequently dermatology (19%), geriatric medicine (11%), and infectious disease (9%). Specialists responded in a median of 0.6 days, and 70% of cases were resolved without the resident needing a face-to-face specialist visit. In 60% of cases, PCPs received advice for a new or additional course of action. Participants described complexities in the LTC context, the value of eConsult in LTC, and considerations for implementation. PCPs with experience using the service described increased access to specialist advice, ease of use, and benefits to themselves, residents, and families. eConsult is feasible in LTC and should continue to be used in this region and beyond to improve equity of access to specialist advice. Resolving the identified limitations in LTC, which hinder access to specialists and adoption of eConsult and similar innovations, should be of high priority to researchers and policy makers. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).