Physicians' experiences, attitudes and challenges in a Pediatric Telemedicine Service
Physicians' experiences, attitudes and challenges in a Pediatric Telemedicine Service
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DOI：
10.1038/s41390-018-0117-6
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发表时间：
2018-11-01
影响因子：
3.6
通讯作者：
Baron-Epel, Orna
中科院分区：
文献类型：
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作者：
Haimi, Motti;Brammli-Greenberg, Shuli;Baron-Epel, Orna
背景：远程医疗，尤其是电话分诊，被认为是一项高压力的临床活动，涉及在不确定和紧急条件下的决策。目的：我们想要了解在以色列运营的一家儿科远程医疗服务的医生的经历、态度和挑战，并探索在这种情况下医生在做出临床决策时是否使用了非医疗因素(与医疗问题无关)。方法：我们使用定性的方法来获得反映参与者主观经验的丰富数据。15名在过去5年中在“Clalit的儿科医生在线”服务中工作的医生接受了采访。对数据进行了专题分析。FINDINGS：揭示了医生在这项服务中面临的七个主要挑战，包括远程诊断困难、治疗陌生患者、独自工作、电话的紧迫性和工作量、技术障碍以及满足父母期望和维持护理标准之间的“道德冲突”。医生表示，非医疗因素也会影响他们的决策。结论：在远程医疗环境下，医生面临着各种困难和挑战，需要特殊的专业知识、素质和技能。需要采取特别措施，以获得适当的诊断和决定。
BACKGROUND: Telemedicine in general, and telephone triage, in particular, is considered a high-stress clinical activity and involves decision making under conditions of uncertainty and urgency.AIM: We wanted to explore the experiences, attitudes, and challenges of the physicians in a Pediatric Telemedicine Service operated in Israel, and to explore whether the doctors are using non-medical factors (not related to the medical problem), when making the clinical decisions in this setting.METHODS: We used a qualitative methodology in order to obtain rich data that would reflect the participants' subjective experiences. Fifteen physicians who worked during the last 5 years in the "Pediatrician Online of Clalit" service were interviewed. Data were analyzed thematically.FINDINGS: Seven main themes concerning the physicians' challenges during their work at this service were revealed, including difficulties diagnosing from a distance, treating unfamiliar patients, working alone, urgency and load of calls, technological obstacles, and a "moral conflict" between the desire to meet parents' expectations and maintain standards of care. The physicians stated that non-medical factors also affect their decisions.CONCLUSIONS: In telemedicine setting, physicians face various difficulties and challenges, requiring special expertise, qualities and skills. Special measures are needed to obtain proper diagnosis and decisions.