Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom.
Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom.
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DOI：
10.1186/s12913-017-2694-1
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发表时间：
2017-11-21
影响因子：
2.8
通讯作者：
VST and ASTUTE investigators
中科院分区：
文献类型：
--
作者：
Bagot KL;Cadilhac DA;Bladin CF;Watkins CL;Vu M;Donnan GA;Dewey HM;Emsley HCA;Davies DP;Day E;Ford GA;Price CI;May CR;McLoughlin ASR;Gibson JME;Lightbody CE;VST and ASTUTE investigators
中风远程医疗可以通过增加对专家的访问来减少医疗保健的不公平。成功的远程医疗网络需要专家调整临床实践，以提供远程咨询。不同国家专家的经验差异不明。为了支持未来的实施，我们比较了澳大利亚和英国专家提供远程急性中风咨询的看法。专家参与者是从两个新的服务使用有目的的抽样确定的：澳大利亚的维多利亚州中风远程医疗计划（n = 6; 2010-13）和英国的坎布里亚郡和兰开夏远程中风网络（n = 5; 2010-2012）。半结构化访谈进行了实施前和实施后，记录和逐字转录。演绎的主题和内容分析（NVivo）进行了两个独立的编码器使用规范化过程理论，探索整合远程医疗到实践中。编码器之间的一致性为M = 91%，SD = 9，加权平均κ = 0.70。在这两个国家，专家介绍了新旧咨询做法、远程医疗系统的目的和价值，以及对请求远程医疗支持的不知名同事的评估和诊断技能的信心问题。澳大利亚专家讨论了远程咨询如何影响到通常的作用，并提出了今后的改进建议，而联合王国专家则讨论了系统治理、政策和程序。澳大利亚和联合王国的专家报告说，远程医疗需要改变工作做法和发展新的技能。两个小组都描述了中风远程医疗系统的改进潜力，澳大利亚专家更侧重于角色转变，英国侧重于系统治理问题。未来的研究应检查跨文化差异是否反映了不同的护理模式，并扩展到其他网络。
Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Specialist participants were identified using purposive sampling from two new services: Australia’s Victorian Stroke Telemedicine Program (n = 6; 2010–13) and the United Kingdom’s Cumbria and Lancashire telestroke network (n = 5; 2010–2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.
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影响因子：
3.2
作者：
Gibson, Josephine;Lightbody, Elizabeth;Watkins, Caroline
通讯作者：
Watkins, Caroline
影响因子：
9.9
作者：
Jagolino, Amanda L.;Jia, Judy;Wu, Tzu-Ching
通讯作者：
Wu, Tzu-Ching
影响因子：
2.1
作者：
Moloczij, N.;Mosley, I.;Cadilhac, D. A.
通讯作者：
Cadilhac, D. A.
影响因子：
8.3
作者：
Moskowitz, Ari;Chan, Yu-Feng Yvonne;Levine, Steven R.
通讯作者：
Levine, Steven R.
影响因子：
7.2
作者：
May, Carl R.;Mair, Frances;Montori, Victor M.
通讯作者：
Montori, Victor M.