Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis
Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis
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DOI：
10.1111/imj.12793
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发表时间：
2015-09-01
影响因子：
2.1
通讯作者：
Cadilhac, D. A.
中科院分区：
文献类型：
--
作者：
Moloczij, N.;Mosley, I.;Cadilhac, D. A.
背景：对急性脑卒中患者的快速诊断和治疗可以减少随后的残疾。虽然远程医疗可以改善农村社区获得专家的机会，促进及时诊断和治疗决策，但在澳大利亚，它并没有广泛用于中风。目的确定临床医生参与和利用远程医疗咨询的障碍和促进因素，可以加快在农村和偏远地区的实施。方法采用阳性抽样的方法，对同一医院科室具有不同远程医疗经验的医护人员进行识别和招募。进行了24次深入的面对面访谈，研究了卒中远程医疗的各个方面。进行了归纳定性专题分析，并有两位研究者对编码进行了验证。结果发现的主要障碍是对溶栓治疗急性中风的效用的不同看法，对远程医疗系统缺乏信心，认为专家建议的需求有限，以及对接受不熟悉的医生的建议的担忧。促进因素包括在诊断和治疗方面提供协助，需要一个用户友好的系统，以及在复杂病例中获得专家的帮助。结论远程医疗对急性脑卒中的接受程度是多方面的，与地区临床医生对脑卒中溶栓治疗价值的看法密切相关，突出了一个重要的教育领域。消除对治疗效果和其他可感知障碍的信念对于建立卒中远程医疗规划很重要。
BackgroundFast diagnosis and delivery of treatment to patients experiencing acute stroke can reduce subsequent disability. While telemedicine can improve rural community access to specialists and facilitate timely diagnosis and treatment decisions, it is not widely used for stroke in Australia.AimIdentifying the barriers and facilitators to clinician engagement with, and utilisation of, telemedicine consultations could expedite implementation in rural and remote locations.MethodsPurposive sampling was used to identify and recruit medical and nursing staff varying in telemedicine experience across one hospital department. Twenty-four in-depth, face-to-face interviews were conducted examining aspects surrounding stroke telemedicine uptake. Inductive qualitative thematic analysis was undertaken, and two further researchers verified coding.ResultsThe main barriers identified were contrasting opinions about the utility of thrombolysis for treating acute stroke, lack of confidence in the telemedicine system, perceived limited need for specialist advice and concerns about receiving advice from an unfamiliar doctor. Facilitators included assistance with diagnosis and treatment, the need for a user-friendly system and access to specialists for complex cases.ConclusionsAcceptability of telemedicine for acute stroke was multifaceted and closely aligned with regional clinician beliefs about the value of thrombolysis for stroke, highlighting an important area for education. Addressing beliefs about treatment efficacy and other perceived barriers is important for establishing a stroke telemedicine programme.