Comparing Patients' Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey
Comparing Patients' Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey
复制标题
DOI：
10.1007/s11606-020-05703-7
复制
发表时间：
2020-02-19
影响因子：
5.7
通讯作者：
Shipman, Scott A.
中科院分区：
文献类型：
--
作者：
Ackerman, Sara L.;Gleason, Nathaniel;Shipman, Scott A.
背景迄今为止，还没有大规模的研究，患者的经验与电子咨询（eConsult）之间的初级和专科护理。目的比较eConsult和转诊在专家面对面咨询中的应用经验。在9个美国学术医疗中心的eConsult或转诊后2-6周设计在线调查。参与者在前一个月内从初级保健提供者（PCP）获得不超过一个eConsult或转诊订单的成年患者。在9个月的时间里，共发送了29，291封电子邮件邀请（88%为推荐; 12%为电子咨询）。对PCP的信任和满意度;咨询类型意识;同意寻求专家意见的决定;护理的及时性; PCP-患者电子咨询沟通的模式;对专家建议的满意度;未来对电子咨询或转诊的偏好。27.6%的回复率产生了8087名受访者（88.4%转介; 11.6%电子咨询）。许多人不知道他们的PCP已经进行了转诊（32.8%不知道）或电子咨询（52.9%），并且报告健康状况更好的患者的电子咨询意识明显更高（OR 1.62，95% CI 1.18-2.23）。大多数人（81.4%的电子咨询; 82.0%的转介）对专家的建议感到满意。那些有良好初级保健经验的人更有可能感到满意（eConsult：OR 10.63，95% CI 2.95-38.32;转诊：OR 2.87，95% CI 1.86-4.44）。对于未来类似的问题，78%的eConsult和32%的转诊患者更喜欢eConsult。结论这项多中心研究表明，许多患者发现虚拟咨询是一种可接受的策略，他们的医疗条件的管理和一个人的PCP的信任和信心是一个令人满意的eConsult体验的关键因素。许多患者是该服务的受益者，但他们对eConsult缺乏认识，因此需要加大努力，将患者纳入eConsult决策和沟通。需要进一步的研究来评估eConsult在更多样化的患者人群中的可接受性和满意度。
Background There have been no large-scale studies to date of patients' experiences with electronic consultation (eConsult) between primary and specialty care. Objective Compare experiences with eConsult and referral for in-person specialist consultation. Design Online survey 2-6 weeks following eConsult or referral at 9 US academic medical centers. Participants Adult patients with no more than one eConsult or referral order from a primary care provider (PCP) in the prior month. Over 9 months, 29,291 email invitations were sent (88% referral; 12% eConsult). Main Measures Trust in and satisfaction with PCP; consult type awareness; agreement with decision to seek specialist input; timeliness of care; mode of PCP-patient eConsult communication; satisfaction with specialist's recommendations; future preference for eConsult or referral. Key Results A 27.6% response rate yielded 8087 respondents (88.4% referral; 11.6% eConsult). Many did not know that their PCP had placed a referral (32.8% unaware) or eConsult (52.9%), and eConsult awareness was significantly higher among patients reporting better health (OR 1.62, 95% CI 1.18-2.23). Most (81.4% eConsult; 82.0% referral) were satisfied with the specialist's recommendations. Those who had a good primary care experience were more likely to be satisfied (eConsult: OR 10.63, 95% CI 2.95-38.32; referral: OR 2.87, 95% CI 1.86-4.44). For a similar problem in the future, 78% of eConsult and 32% percent of referral patients preferred eConsult. Conclusions This multisite study demonstrates that many patients find virtual consultation to be an acceptable strategy for the management of their medical condition and that trust and confidence in one's PCP are crucial ingredients for a satisfying eConsult experience. The lack of awareness of eConsult among many patients who were beneficiaries of the service warrants an increased effort to include patients in eConsult decision-making and communication. Further research is needed to assess eConsult acceptability and satisfaction in more diverse patient populations.