Use of an electronic consultation system primary care: a qualitative interview study
Use of an electronic consultation system primary care: a qualitative interview study
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DOI：
10.3399/bjgp17x693509
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发表时间：
2018-01-01
影响因子：
5.9
通讯作者：
Horwood, Jeremy
中科院分区：
文献类型：
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作者：
Banks, Jon;Farr, Michelle;Horwood, Jeremy
背景&段落；&对位;对初级保健的需求水平继续增加。电子或电子咨询使患者能够在线咨询他们的全科医生，并被推广为有可能改善访问和效率。&对位;&对位;Aim & para；&对位;评估电子会诊系统是否提高了执业人员管理工作量和访问的能力。&对位;&对位;设计与设置&参数；&对位;在2015年至2016年期间，对英格兰西部全科实践进行了为期15个月的电子咨询系统试点定性访谈研究。&对位;&对位;Method & para；&对位;有目的地按地点和电子咨询使用水平对实践进行抽样。临床、行政和管理人员在每个实践中招募。采访被记录下来并按主题进行分析。&对位;&对位;结果&段落；&对位;在六个全科诊所进行了23次访谈。常规的电子咨询为实践提供了好处，因为它们可以在GP和患者之间没有直接联系的情况下完成。然而，大多数电子咨询导致全科医生需要跟进电话或面对面的预约，因为电子咨询不包含足够的信息来告知临床决策。这被认为增加了工作量，并为一些患者提供了进入预约系统的替代途径。尽管这被认为对病人有好处，但这种做法的好处似乎更少。&对位;&对位;结论&段落；&对位;本研究的实践经验表明，以目前的形式，该技术不能为临床医生提供与患者协商的有效平台，也不能证明他们对该系统的财务投资是合理的。该研究还强调了远程咨询的挑战，因为远程咨询缺乏实时互动的设施。
Background & para;& para;The level of demand on primary care continues to increase. Electronic or e-consultations enable patients to consult their GP online and have been promoted as having potential to improve access and efficiency.& para;& para;Aim & para;& para;To evaluate whether an e-consultation system improves the ability of practice staff to manage workload and access.& para;& para;Design and setting & para;& para;A qualitative interview study in general practices in the West of England that piloted an e-consultation system for 15 months during 2015 and 2016.& para;& para;Method & para;& para;Practices were purposefully sampled by location and level of e-consultation use. Clinical, administrative, and management staff were recruited at each practice. Interviews were transcribed and analysed thematically.& para;& para;Results & para;& para;Twenty-three interviews were carried out across six general practices. Routine e-consultations offered benefits for the practice because they could be completed without direct contact between GP and patient. However, most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making. This was perceived as adding to the workload and providing some patients with an alternative route into the appointment system. Although this was seen as offering some patient benefit, there appeared to be fewer benefits for the practices.& para;& para;Conclusion & para;& para;The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system. The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.