Telehealth: A Very Useful Tool That Enables and Improves Patient Access
Telehealth: A Very Useful Tool That Enables and Improves Patient Access
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远程医疗：一个非常有用的工具，可以实现和改善患者的访问
DOI：
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发表时间：
2016
影响因子：
2.9
通讯作者：
C. Doarn
中科院分区：
文献类型：
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作者：
C. Doarn
Coffman等人在本期杂志中谈到了美国医学的一个重大挑战。在他们的文章《谁在初级保健中使用远程医疗？》“安全网诊所和健康维护组织”，他们讨论了美国家庭医生学会进行的一项调查结果，并由罗伯特格雷厄姆中心进行了分析。这项调查让我们相信，在调查的2014年，使用和不使用远程医疗服务的家庭医生之间存在显著差异。这可以看作是一个很好的指标，说明在小样本的一般医疗实践中如何采用远程保健以及如何不采用远程保健。首先，我们需要了解有关使用技术远程提供卫生保健的术语。远程医疗和远程医疗这两个术语经常互换使用。然而，它们是不同的。远程医疗已经存在了很长一段时间，并且已经被许多个人和组织以多种方式定义。远程保健是一个更具包容性的术语。此外，近年来还出现了更多的术语，包括虚拟健康、电子健康、移动健康，当然还有远程监控等术语。无论世界如何，都可以通过远程医疗有效地管理病人的健康。Purcell等人对慢性心血管疾病患者的远程监测进行了系统综述。患者应能在高度发达国家获得卫生保健服务，这种机会不应受到距离或地理位置的限制。这就是远程医疗可以发挥重要作用的地方。然而，在整个美国医疗保健领域采用远程医疗充满了许多障碍和挑战，包括访问问题、教育、法律问题、报销、态度、地理以及采用技术的驱动倾向。我们必须在许多情况下审视这些障碍。是否接受远程医疗或其他新的医疗保健提供方法可能取决于个人的邮政编码。并非所有50个州都有关于远程医疗的相同规则和条例。美国远程医疗协会最近完成了一项关于远程医疗覆盖范围和报销的信息性“差距”分析。这份2016年的分析报告回顾了美国50个州在这两个重要问题上的情况。初级保健在我们的卫生保健系统中起着核心作用。随着美国和世界各地医生的短缺，我们必须想出新的有效的方法来治疗我们的病人，包括改变我们的教育模式或实践模式。在最近的一篇文章中，Bashshur等人回顾了远程医疗干预初级保健的经验证据。他们回顾了2005年至2015年发表的2300篇研究论文，只有86篇符合他们分析的纳入标准。该审查还表明，在采用和使用方面存在显著差异；然而，很明显，患者比提供者更容易接受远程医疗。尽管远程医疗和远程保健已成为全世界初级保健的组成部分，但在美国采用远程保健仍然面临挑战，包括技术和方法的验证。如果家庭医学医生意识到远程医疗，但没有使用远程医疗，是因为报销或法律障碍，如责任和来自俄亥俄州辛辛那提市辛辛那提大学家庭和社区医学系。资金:没有。利益冲突：没有声明。通讯作者：Charles R. Doarn，工商管理硕士，辛辛那提大学家庭和社区医学系，231 Albert Sabin Way, msb# 4453B, Cincinnati, OH 45140-0582 E-mail: charles.doarn@uc.edu。
Coffman et al address a significant challenge in American medicine in this issue of the journal. In their article, “Who Is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations,” they discuss the results of a survey conducted by the American Academy of Family Physicians and analyzed by the Robert Graham Center. This survey leads us to believe that there is a significant difference between family physicians who used and who did not use telehealth services in 2014, the year of the survey. This can be seen as a good indicator of how telehealth is being adopted and how it is not adopted within general medical practice in a small sample. At the onset, we need to understand the terminology surrounding the use of technology for the remote delivery of health care. The terms telehealth and telemedicine are often used interchangeably. They are, however, different. Telemedicine has been around for a long time and has been defined in many ways by many individuals and organizations. Telehealth is a more inclusive term. In addition, even more terms have entered the lexicon in recent years, including virtual health, e-Health, m-Health, and, of course, terms such as telemonitoring. Regardless of the word, a patient’s health can be managed effectively using telehealth. Purcell et al conducted a systematic review of telemonitoring of patients with chronic cardiovascular disease. Patients should have access to health care services in highly developed countries, and that access should not be limited by distance or geography. This is where telehealth can play a significant role. However, the adoption of telehealth across the landscape of American health care is fraught with many barriers and challenges, including access issues, education, legal issues, reimbursement, attitudes, geography, and a driving penchant to adopt technology. We must look at these barriers in many contexts. Whether telehealth or other new approaches to health care delivery are embraced may be driven by an individual’s zip code. Not all 50 states have the same rules and regulations surrounding telehealth. The American Telemedicine Association recently completed an informative “gap” analysis of telemedicine coverage and reimbursement. This 2016 analysis provides a review of where each of the 50 states are with regard to these two important issues. Primary care plays a central role in our health care system. With the predicted shortage of physicians across the United States and the world, we must think of new and effective ways of treating our patients, including changes in our education model or our practice model. In a recent article, Bashshur et al review the empirical evidence of telemedicine interventions in primary care. They reviewed 2300 articles on studies published from 2005 to 2015, and only 86 met the inclusion criteria for their analysis. This review also indicated a significant variance in adoption and use; however, it was clear that patients found telemedicine to be more acceptable than did providers. Even though telemedicine and telehealth have become integral parts of primary care worldwide, the adoption of telehealth in the United States still faces challenges, including validation of technologies and methodologies. If family medicine physicians have an awareness of and are not using telehealth, is it because of reimbursement or legal barriers such as liability and From the Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH. Funding: none. Conflict of interest: none declared. Corresponding author: Charles R. Doarn, MBA, Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, MSB#4453B, Cincinnati, OH 45140-0582 E-mail: charles.doarn@uc.edu .