Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study.
Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study.
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DOI：
10.2196/49170
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发表时间：
2024-01-16
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
自 2020 年以来，家长有越来越多的机会为孩子使用远程医疗，但相对于其他护理地点，家长如何决定是否使用远程医疗进行急性儿科护理尚不清楚。父母为孩子寻求紧急护理的最常见原因之一是急性呼吸道感染 (ARTI)。本研究旨在调查家长对通过远程医疗对儿科 ARTI 进行护理的期望，对比对通过初级保健远程医疗和直接面向消费者 (DTC) 的远程医疗提供的护理的期望。我们进行了顺序混合方法分析，以研究父母如何评估远程医疗对孩子的急性护理。我们使用 ARTI 作为案例研究来检验家长对远程医疗的看法。首先，我们分析了半结构化访谈，重点关注家长对远程医疗使用的反应。父母讨论的每个因素都经过编码，以反映父母是否表示它会激励或抑制他们对远程医疗与面对面护理的偏好。结果按照先前生成的父母医疗保健寻求的 7 维框架进行组织，其中包括与护理场所相关的维度（预期访问、负担能力、临床质量和场所质量）以及与儿童或家庭因素相关的维度（感知的疾病严重程度、感知的儿童易感性和父母自我效能）。其次，我们分析了一项全国调查的回复，该调查询问了家长对初级保健远程医疗、商业 DTC 远程医疗和 3 个现场护理场所（初级保健、紧急护理和急诊科）的期望，涵盖了通过之前的定性工作确定的 21 个因素。为了评估家长是否对不同的远程医疗模式有不同的期望，我们使用加权逻辑回归比较了初级保健远程医疗和商业 DTC 远程医疗的调查结果。受访者 (n=40) 描述了影响他们对远程医疗作为儿科 ARTI 护理方式看法的因素。一般来说，与可及性和可负担性相关的因素（例如，减少等待时间和降低自付费用）被讨论为远程医疗使用的潜在激励因素，而与感知疾病严重程度、儿童易感性和临床医生质量（例如，可信度）相关的因素被讨论为远程医疗使用的潜在阻碍因素。在调查回复中 (n=1206)，初级保健和商业 DTC 远程医疗在与预期可及性和可负担性相关的项目上的评级相似。相比之下，在与预期护理质量相关的项目上，初级保健远程医疗被视为与现场初级保健相似，而商业 DTC 远程医疗的评级较低。例如，69.7%（加权；842/1197）的受访者预计他们的孩子会对初级保健远程医疗感到舒适和合作，而49.7%（加权；584/1193）的受访者预计他们的孩子会接受商业 DTC 远程医疗（P<.001）。在针对 ARTI 远程医疗的混合方法分析中，与基于初级保健的远程医疗相比，家长对商业 DTC 模型中的远程医疗质量表示更多担忧。这些结果可以帮助卫生系统更好地设计远程医疗计划，以支持以家庭为中心的护理。
Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children’s acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care–based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.
影响因子：
7.4
作者：
Ray, Kristin N.;Wittman, Samuel R.;Burns, Sarah;Doan, Tran;Schweiberger, Kelsey A.;Yabes, Jonathan G.;Hanmer, Janel;Krishnamurti, Tamar
通讯作者：
Krishnamurti, Tamar
影响因子：
3.6
作者：
Ray, Kristin N.;Keller, David
通讯作者：
Keller, David