Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers.
Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers.
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DOI：
10.1111/1475-6773.14055
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发表时间：
2023-02
影响因子：
3.4
通讯作者：
Moo, Lauren R.
中科院分区：
文献类型：
--
作者：
Dryden, Eileen M.;Kennedy, Meaghan A.;Conti, Jennifer;Boudreau, Jacqueline H.;Anwar, Chitra P.;Nearing, Kathryn;Pimentel, Camilla B.;Hung, William W.;Moo, Lauren R.
探讨退伍军人健康管理局（VHA）老年专科远程医疗服务（GRECC连接）在农村，老年患者和护理人员中的感知效益，以促进其质量和价值的评估。在2021年春季，我们采访了一个来自不同地区的农村老年患者及其护理人员样本，他们参加了GRECC Connect远程医疗访问。一项横断面定性研究重点关注患者和护理人员的远程医疗体验，包括感知的益处和挑战。我们通过视频会议或电话对VHA招募的农村老年（≥65岁）患者及其护理人员进行了30次半结构化定性访谈。访谈记录，转录，并使用快速定性分析方法进行分析。参与者描述了老年专科远程医疗访问，重点是认知评估，量身定制的物理治疗，药物管理，疾病进展教育，支持管理多种合并症，以及改善身体功能的建议。参与者报告说，除了处方药物和订购测试，临床医生加快转诊，协调护理，并听取和验证患者和护理人员的关注。感知的益处包括改善患者健康;增加患者和护理人员对症状管理的理解和信心;以及更大的赋权感、责任感和支持感。挑战包括难以获得一些推荐的计划和服务，与指示或后续行动有关的不确定性，以及没有收到所需的信息或治疗。访问的内容与年龄友好的卫生系统和老年5 M框架（药物，心理，流动性，最重要的是什么，以及多重复杂性）的领域保持一致。患者和护理人员的经验与广泛使用的综合老年护理模型的一致表明，可以通过虚拟模式提供高质量的老年护理。还需要开展更多的工作，以制定应对挑战的战略，优化和扩大老年专科远程医疗的使用。
Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value. In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits. A cross‐sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges. We conducted 30 semi‐structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach. Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow‐up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age‐Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi‐complexity). Alignment of patient and caregiver experiences with widely‐used models of comprehensive geriatric care indicates that high‐quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.
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