"I'm Not Feeling Like I'm Part of the Conversation" Patients' Perspectives on Communicating in Clinical Video Telehealth Visits
"I'm Not Feeling Like I'm Part of the Conversation" Patients' Perspectives on Communicating in Clinical Video Telehealth Visits
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DOI：
10.1007/s11606-020-05673-w
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发表时间：
2020-02-03
影响因子：
5.7
通讯作者：
Gopal, Ravi K.
中科院分区：
文献类型：
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作者：
Gordon, Howard S.;Solanki, Pooja;Gopal, Ravi K.
背景：临床视频远程保健（CVT）为改善医疗服务不足地区获得医疗保健提供者的机会提供了机会。然而，由于CVT遭遇是通过技术介导的，它们可能导致与患者-提供者互动相关的意想不到的后果。方法对27例既往至少有一次远程医疗就诊经历的2型糖尿病患者进行访谈，了解他们在远程医疗就诊过程中与服务提供者沟通的障碍和便利因素。半结构化的电话采访时间约为30分钟，录音和转录。我们对采访笔录进行了主题内容分析。使用不断比较的方法将转录本中的代码分组为主题类别，每个主题都用说明性引号表示。结果我们确定了与CVT患者观点相关的几个主题。一般来说，患者对CVT就诊表示满意，包括更好的预约、更短的旅行时间和更少的候诊室时间。然而，与面对面就诊相比，患者也发现了CVT就诊的一些挑战和担忧，包括由于难以完成体检而对其护理中的错误的担忧，认为提供者对他们的关注较少，畅所欲言和提出问题的障碍，以及难以建立医患关系。患者报告说，在就诊过程中感觉不太投入，很难找到说话的机会，感觉被医生赶了过来。结论患者认为CVT可以改善其获得护理的机会，但可能阻碍与医生的沟通，部分患者担心体检的完整性和准确性。
Background Clinical video telehealth (CVT) offers the opportunity to improve access to healthcare providers in medically underserved areas. However, because CVT encounters are mediated through technology, they may result in unintended consequences related to the patient-provider interaction. Methods Twenty-seven patients with type 2 diabetes mellitus enrolled in Veteran Affairs Health Care and at least one previous telehealth visit experience were interviewed regarding their perspectives on facilitators and barriers to communication with their provider during their CVT visit. The semi-structured telephone interviews were approximately 30 min and were audio-recorded and transcribed. We conducted a thematic content analysis of the interview transcripts. Codes from the transcripts were grouped into thematic categories using the constant comparison method and each theme is represented with illustrative quotes. Results We identified several themes related to patients' perspectives on CVT. In general, patients expressed satisfaction with CVT visits including better access to appointments, shorter travel time, and less time in the waiting room. Yet, patients also identified several challenges and concerns about CVT visits compared with in-person visits, including concerns about errors in their care because of perceived difficulty completing the physical exam, perceptions that providers paid less attention to them, barriers to speaking up and asking questions, and difficulty establishing a provider-patient relationship. Patients reported feeling less involved during the visit, difficulty finding opportunities to speak, and feeling rushed by the provider. Conclusions Patients believed that CVT can improve their access to care, but could hinder communication with their provider, and some were concerned about the completeness and accuracy of the physical exam.