The Use of Telephone Consultation in Primary Health Care During COVID-19 Pandemic, Oman: Perceptions from Physicians.
The Use of Telephone Consultation in Primary Health Care During COVID-19 Pandemic, Oman: Perceptions from Physicians.
复制标题
阿曼 COVID-19 大流行期间电话咨询在初级卫生保健中的使用：医生的看法。
DOI：
10.1177/2150132720976480
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发表时间：
2020-01
影响因子：
3.6
通讯作者：
Anwar H
中科院分区：
文献类型：
--
作者：
Hasani SA;Ghafri TA;Al Lawati H;Mohammed J;Al Mukhainai A;Al Ajmi F;Anwar H
为在2019冠状病毒病疫情期间实施物理距离措施，阿曼马斯喀特启动了电话咨询（TC）这一远程医疗形式，作为初级卫生保健（PHC）面对面咨询的替代技术。本研究旨在探讨医师在实施过程中对TC使用的看法；挑战与局限；吸取的教训和前进的方向。这是一项使用解释现象学分析的定性研究。有目的地选择在初级保健中心积极开展TC的医生，并对其进行单独访谈，直到没有得到新的答复。所有访谈都被录音，逐字转录，并使用专题分析进行分析。22名参与者接受了采访。参与者主要是女性（98%）和合格的家庭医生（77.3%）。总体而言，所有与会者都认为这是在COVID-19期间继续提供卫生服务的一种可能方法。关于在初级保健中实施TC过程的看法的主题是；指导方针的不一致的实现，角色和职责的可变性，以及半支持性的基础结构。五个主题被确定为挑战和限制：有限的员工培训，不理想的医患互动，技术支持不足，确保隐私和通信的保密性，以及不同的记录技术的方式。医生们表示，TC在后续COVID-19病例、慢性病和一般简单病例中效果更好。他们还表示，初级保健设施的拥挤程度有所降低，感染COVID-19和其他类型感染的风险有所降低。调整现有的结构性临床环境，开展技术支持使用的能力建设活动，以及提高技术支持的质量，被视为初级保健中技术支持未来可持续性的重要步骤。鉴于COVID-19的特殊情况，目前的证据表明，在初级保健中使用TC，特别是在慢性病例中，是有希望的。然而，从医生的角度来看，培训员工、改善结构设置、选择合适的病例是初级保健中心高质量和可持续的TC服务的主要因素。
To enforce physical distancing measures during COVID-19, Telephone Consultation (TC), a form of telemedicine, was initiated as an alternative technology to face to face consultation in primary health care (PHC) in Muscat, Oman. This study aims to explore the perceptions of physicians about the use of TC with respect to process of implementation; challenges and limitations; lessons learned and the way forward. This was a qualitative study using interpretive phenomenological analysis. Physicians who were actively conducting TC in PHC were purposively selected and individually interviewed until no new responses were obtained. All interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Twenty-two participants were interviewed. Participants were predominantly females (98%) and qualified family physicians (77.3%). Overall, all participants accepted this initiative as a possible method to continue health services during COVID-19. Perceptions about the process of implementing TC in PHC were themed to; inconsistent implementation of the guideline, variability in roles and responsibilities, and Semi-supportive infrastructure. Five themes were identified as challenges and limitations: limited staff training on TC, suboptimal patient-physician interaction, insufficient technical support, ensuring privacy, and confidentiality of the communication, and different ways to document the TC. Physicians expressed that TC worked better in following COVID-19 cases, chronic conditions, and, in general, simple cases. They also expressed a reduction in the crowdedness in PHC facilities and the risk of acquiring COVID-19 and other types of infections. Tailoring the existing structural clinical setting, capacity building activities on the use of TC, and improving the quality of the TC are viewed as essential steps for the future sustainability of TC in PHC. Given the exceptional situation of COVID-19, the current evidence suggests that the use of TC in PHC, especially in chronic cases, is promising. However, measures including training of staff, improving the structural setting, and selecting suitable cases for TC are the main elements for high quality and sustainable TC services in PHC from physician’s perspective.