Teledermatology Operational Considerations, Challenges, and Benefits: The Referring Providers' Perspective
Teledermatology Operational Considerations, Challenges, and Benefits: The Referring Providers' Perspective
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DOI：
10.1089/tmj.2011.0241
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发表时间：
2012-10-01
影响因子：
4.7
通讯作者：
Shewry, Sandra Louise
中科院分区：
文献类型：
--
作者：
Armstrong, April W.;Kwong, Mei W.;Shewry, Sandra Louise
背景：远程皮肤病学已被用于为医疗服务不足的社区提供更多的专业服务。在加州，政策允许加州医疗补助（Medi-Cal）计划为存储转发（S&F）和现场互动远程皮肤科咨询提供报销。为了评估远程皮肤科手术对这一人群的有效性，了解转诊提供者的观点至关重要。本研究的主要目的是通过关注Medi-Cal人群背景下参与远程皮肤科转诊的操作考虑因素、挑战和益处，探索远程皮肤科转诊初级保健提供者（PCP）的观点。研究对象和方法：我们对10名PCP进行了长达一小时的一对一访谈，他们定期将患者转诊到远程皮肤科，每年平均转诊2，760例。结果如下：在每年总计2，760次远程皮肤科转诊中，PCP报告说，他们主要为未保险或保险不足的人群提供服务，并参加S&F咨询。大多数接受调查的PCP自己治疗常见的皮肤病。然而，这些PCP将更多的患者推荐给远程皮肤科咨询，而不是亲自皮肤科咨询。有几个因素影响PCP决定是否转介到远程皮肤科，其中包括皮肤问题的复杂性、与皮肤科医生的距离、患者的保险和患者的偏好。PCP确定了改进的工作流程，加强与皮肤科医生的沟通，以及更快的建议周转，这是转诊医生希望在远程皮肤病学方面改进的三个方面。结论：了解转介供应商的角度，并随后采取政策和实践解决方案，以解决他们的挑战是至关重要的，以促进进一步的远程皮肤病学参与服务不足的社区。
Background: Teledermatology has been used to provide increased specialty access for medically underserved communities. In California, policies enable the California Medicaid (Medi-Cal) program to provide reimbursement for both store-and-forward (S&F) and live-interactive teledermatology consultations. To assess the effectiveness of teledermatology operations for this population, understanding the referring providers' perspective is crucial. The primary objective of this study was to explore the perspective of referring primary care providers (PCPs) on teledermatology by focusing on the operational considerations, challenges, and benefits to participating in teledermatology referral in the context of the Medi-Cal population. Subjects and Methods: We conducted hour-long one-on-one interviews with 10 PCPs who refer patients to teledermatology regularly and who together serve an average aggregate referral base of 2,760 teledermatology cases yearly. Results: Of the 2,760 aggregate annual teledermatology referrals, PCPs reported that they serve predominantly uninsured or underinsured populations and participate in S&F consultations. The majority of surveyed PCPs treat common skin conditions themselves. However, these PCPs refer more patients to teledermatology consultations than in-person dermatology encounters. Several factors influence PCPs' decision to refer to teledermatology, which include complexity of the skin problem, distance to accessible dermatologist, patient's insurance, and patient's preferences. PCPs identified improved workflow, enhanced communication with dermatologists, and faster turnaround for recommendations as three areas that referring physicians would like improved in their experience with teledermatology. Conclusions: Understanding the referring provider's perspective and subsequently adopting policy and practice solutions to address their challenges are vital to prompting further teledermatology participation for underserved communities.