Virtual online consultations: advantages and limitations (VOCAL) study.
Virtual online consultations: advantages and limitations (VOCAL) study.
复制标题
DOI：
10.1136/bmjopen-2015-009388
复制
发表时间：
2016-01-29
期刊：
影响因子：
2.9
通讯作者：
Morris J
中科院分区：
文献类型：
--
作者：
Greenhalgh T;Vijayaraghavan S;Wherton J;Shaw S;Byrne E;Campbell-Richards D;Bhattacharya S;Hanson P;Ramoutar S;Gutteridge C;Hodkinson I;Collard A;Morris J
临床医生和患者之间的远程视频会诊在技术上是可能的，并且越来越被接受。在某些情况下，它们与面对面或电话咨询同时采用（有时取代）。为了探索视频咨询的优势和局限性，我们将对嵌入组织案例研究（中水平）的真实的咨询（微观水平）进行深入的定性研究，同时考虑到国家背景（宏观水平）。该研究基于英国伦敦国家卫生服务（NHS）急性信任的2种对比临床环境（糖尿病和癌症）。主要数据来源为：微观层面-音频、视频和屏幕捕捉，以产生关于45次远程咨询的丰富多模式数据;中观层面-访谈、人种学观察和信托机构内部文件分析;宏观层面-国家一级利益攸关方的关键知情人访谈和文件分析。将使用从结构化理论发展的社会技术框架对数据进行分析和综合。City Road和汉普斯特德NHS研究伦理委员会，2014年12月9日，参考14/LO/1883。我们计划为5个主要受众提供产出：（1）学术界：研究出版物和会议介绍;（2）服务提供者：标准作业程序、临时作业指南和关键安全问题;（3）专业机构和防务协会：相关调查结果摘要，为成员提供指导;（4）决策者：关键调查结果摘要;（5）病人和护理人员：“在虚拟咨询中期待什么”。关于视频咨询的研究文献很少。这种咨询为患者（免除了旅行的费用和不便）和医疗保健系统（例如，它们可能更具成本效益）提供了潜在的优势，但人们担心它们可能具有临床风险和/或患者或工作人员不太接受，并且它们带来了重大的技术，后勤和监管挑战。我们预计，这项研究将有助于平衡评估何时，如何以及在什么情况下可能会引入这种模式。
Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel—audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel—interviews, ethnographic observations and analysis of documents within the trust; macrolevel—key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: ‘what to expect in your virtual consultation’. The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges. We anticipate that this study will contribute to a balanced assessment of when, how and in what circumstances this model might be introduced.