Telemedicine for clinical management of diabetes - a process analysis of video consultations
Telemedicine for clinical management of diabetes - a process analysis of video consultations
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DOI：
10.1177/1357633x13506524
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发表时间：
2013-10-01
影响因子：
4.7
通讯作者：
Russell, Anthony W.
中科院分区：
文献类型：
--
作者：
Fatehi, Farhad;Gray, Leonard C.;Russell, Anthony W.
我们分析了布里斯班一家三级教学医院远程内分泌诊所的两名内分泌学家在5个月内提供的56次视频会诊。这些患者患有1型或2型糖尿病，其中41%的患者至少有一种糖尿病并发症。他们的平均年龄为51岁，其中45%是女性。协商提供给了距离布里斯班210-1800公里的十个城市。开发了一份调查问卷，用于分析视频访问。它包括26个问题，分为六个部分：(1)患者特征，(2)转诊原因，(3)程序和结果，(4)建议，(5)远程医疗后勤，(6)顾问意见。在66%的会诊中，护士陪同患者就诊。专家要求护士对其中18%的病例进行体检。在36%的会诊中，药物没有变化。最常见的建议是要求进行实验室检查(75%)、调整胰岛素剂量(39%)和转诊至专职医疗人员(13%)。在56次会诊中，专家表示需要为12名患者进行远程体检。然而，他们要求对三名患者进行面对面的访问。然而，他们认为，在34%的案例中，如果咨询是面对面的，他们本可以做出更好的决定。对于被转介给内分泌专家的糖尿病患者来说，视频会诊可以取代很大比例的面对面专家会诊。
We analysed 56 video consultations provided in a 5-month period by two endocrinologists from the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane. The patients were suffering from type 1 or type 2 diabetes, and 41% of them had at least one diabetic complication. Their mean age was 51 years and 45% were female. The consultations were provided to ten cities located 210-1800 km from Brisbane. A questionnaire was developed for analysing the video visits. It comprised 26 questions, arranged in six sections: (1) Patient characteristics, (2) Reason for referral, (3) Procedures and findings, (4) Recommendations, (5) Telehealth logistics, (6) Consultant's opinion. In 66% of consultations a nurse accompanied the patient. The specialist requested the nurse to perform a physical examination in 18% of these cases. No change in medications was made in 36% of the consultations. The most frequent recommendations were requesting laboratory tests (75%), insulin dose adjustments (39%) and referrals to an allied health professional (13%). Out of 56 consultations, the specialists indicated the need to perform a physical examination for 12 patients that was not possible remotely. However, they requested an in-person (face-to-face) visit for three patients. Nevertheless they believed that in 34% of the cases they could have made a better decision if the consultation had been in-person. Video consultation can substitute for a large proportion of in-person specialist consultations for people with diabetes who are referred to endocrinology specialists.