Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans' experience with the VA TeleSleep program.
Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans' experience with the VA TeleSleep program.
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DOI：
10.1186/s12913-021-06080-5
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发表时间：
2021-01-21
影响因子：
2.8
通讯作者：
Sarmiento KF
中科院分区：
文献类型：
--
作者：
Nicosia FM;Kaul B;Totten AM;Silvestrini MC;Williams K;Whooley MA;Sarmiento KF
阻塞性睡眠呼吸暂停在农村退伍军人中很常见，然而，获得睡眠诊断测试、睡眠专家和治疗设备的机会有限。为了改善睡眠护理，退伍军人健康管理局（VA）实施了一项全国性的睡眠远程医疗计划。TeleSleep程序的组成部分包括：1)虚拟临床会面；2)家庭睡眠呼吸暂停测试；3)退伍军人和医疗服务提供者远程监控症状、睡眠质量和使用气道正压（PAP）治疗的web应用程序。本研究旨在确定影响退伍军人对TeleSleep项目的参与、满意度和体验的因素，作为质量改进计划的一部分。半结构化访谈问题引出了患者对访问和参与远程睡眠护理的观点和偏好。采用卫生服务研究的快速定性和矩阵分析方法对定性数据进行组织和描述。从6个VA远程医疗“中心”招募的30名患有阻塞性睡眠呼吸暂停（OSA）的退伍军人参加了访谈。退伍军人报告了睡眠远程医疗的积极体验，包括睡眠质量、其他健康状况和生活质量的改善。由于旅行负担的减轻以及临床医生和退伍军人远程监测和跟踪个人睡眠数据的能力，获得护理的机会得到了改善。远程保健技术的总体经验是积极的。退伍军人表示，与非退伍军人社区睡眠护理相比，退伍军人对退伍军人睡眠护理有强烈的偏好。患者对改变的建议包括改善日程安排、沟通的连续性和及时性，以及设备补充过程。退伍军人事务部的TeleSleep项目在多个方面改善了患者的护理体验，包括减少了旅行负担，增加了与临床医生的接触和远程监控，以及患者报告的健康和生活质量结果，尽管仍然存在一些沟通和连续性挑战。实施远程医疗服务还可以改善其他专科或医疗保健系统所服务的患者的体验。
Obstructive sleep apnea is common among rural Veterans, however, access to diagnostic sleep testing, sleep specialists, and treatment devices is limited. To improve access to sleep care, the Veterans Health Administration (VA) implemented a national sleep telemedicine program. The TeleSleep program components included: 1) virtual clinical encounters; 2) home sleep apnea testing; and 3) web application for Veterans and providers to remotely monitor symptoms, sleep quality and use of positive airway pressure (PAP) therapy. This study aimed to identify factors impacting Veteran’s participation, satisfaction and experience with the TeleSleep program as part of a quality improvement initiative. Semi-structured interview questions elicited patient perspectives and preferences regarding accessing and engaging with TeleSleep care. Rapid qualitative and matrix analysis methods for health services research were used to organize and describe the qualitative data. Thirty Veterans with obstructive sleep apnea (OSA) recruited from 6 VA telehealth “hubs” participated in interviews. Veterans reported positive experiences with sleep telemedicine, including improvements in sleep quality, other health conditions, and quality of life. Access to care improved as a result of decreased travel burden and ability of both clinicians and Veterans to remotely monitor and track personal sleep data. Overall experiences with telehealth technology were positive. Veterans indicated a strong preference for VA over non-VA community-based sleep care. Patient recommendations for change included improving scheduling, continuity and timeliness of communication, and the equipment refill process. The VA TeleSleep program improved patient experiences across multiple aspects of care including a reduction in travel burden, increased access to clinicians and remote monitoring, and patient-reported health and quality of life outcomes, though some communication and continuity challenges remain. Implementing telehealth services may also improve the experiences of patients served by other subspecialties or healthcare systems.
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