"It was like he was in the room with us': patients' and carers' perspectives of telemedicine in acute stroke
"It was like he was in the room with us': patients' and carers' perspectives of telemedicine in acute stroke
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DOI：
10.1111/hex.12333
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发表时间：
2016-02-01
影响因子：
3.2
通讯作者：
Watkins, Caroline
中科院分区：
文献类型：
--
作者：
Gibson, Josephine;Lightbody, Elizabeth;Watkins, Caroline
背景：远程医疗可以促进急性脑卒中患者溶栓治疗。本定性研究的目的是探讨患者和护理人员对他们使用中风远程医疗系统的经验的看法，以促进可靠和可接受的远程医疗系统的发展和卫生保健人员的培训。方法：我们在英格兰西北部的三家医院招募了近期有过急性中风远程医疗会诊的患者和护理人员。采用基于规范化过程理论（NPT）的访谈指南进行半结构化访谈。进行了专题分析。结果共进行了24次访谈，共29人（16名患者，13名护理人员）。11个面试涉及现场远程医疗评估（在入学时）；9例进行了模拟远程医疗评估（入院后48小时内）；其中4人同时进行了两种评估。利用《不扩散核武器条约》领域作为分析框架，与连贯性（意义形成）有关的因素包括人们对远程医疗的知识和理解。认知参与（关系工作）包括工作人员之间以及与患者和护理人员之间的互动。与集体行动（业务工作）有关的问题包括信息交流和支助以及技术事项。与反身性监测（评价）相关的研究结果包括对远程医疗过程的积极和消极印象以及情绪反应。结论尽管远程医疗已为广大患者所接受，但它的使用给急性脑卒中会诊增加了额外的复杂性。咨询的远程性质给一些患者带来了挑战。这些问题可以通过向患者和护理人员提供明确的信息、员工的人际交往能力和团队合作得到改善。
BackgroundTelemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients' and carers' views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health-care staff.MethodWe recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semi-structured interviews were conducted using an interview guide based on normalization process theory (NPT). Thematic analysis was undertaken.ResultsWe conducted 24 interviews with 29 participants (16 patients; 13 carers). Eleven interviews pertained to live' telemedicine assessments (at the time of admission); nine had mock-up telemedicine assessments (within 48h of admission); four had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sense making) included people's knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions.ConclusionAlthough telemedicine was well accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The remote' nature of the consultationposed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking.