PDF(Pubmed)
Abstract：
UNASSIGNED: Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices\' varied experiences over time as they seek to establish remote forms of accessing and delivering care.
UNASSIGNED: This protocol is for a mixed-methods multi-site case study with co-design and national stakeholder engagement. 11 general practices were selected for diversity in geographical location, size, demographics, ethos, and digital maturity. Each practice has a researcher-in-residence whose role is to become familiar with its context and activity, follow it longitudinally for two years using interviews, public-domain documents and ethnography, and support improvement efforts. Research team members meet regularly to compare and contrast across cases. Practice staff are invited to join online learning events. Patient representatives work locally within their practice patient involvement groups as well as joining an online patient learning set or linking via a non-digital buddy system. NHS Research Ethics Approval has been granted. Governance includes a diverse independent advisory group with lay chair. We also have policy in-reach (national stakeholders sit on our advisory group) and outreach (research team members sit on national policy working groups).
UNASSIGNED: We expect to produce rich narratives of contingent change over time, addressing cross-cutting themes including access, triage and capacity; digital and wider inequities; quality and safety of care (e.g. continuity, long-term condition management, timely diagnosis, complex needs); workforce and staff wellbeing (including non-clinical staff, students and trainees); technologies and digital infrastructure; patient perspectives; and sustainability (e.g. carbon footprint).
UNASSIGNED: By using case study methods focusing on depth and detail, we hope to explain why digital solutions that work well in one practice do not work at all in another. We plan to inform policy and service development through inter-sectoral network-building, stakeholder workshops and topic-focused policy briefings.
The pandemic required general practices to introduce remote (phone, video and email) consultations. That policy undoubtedly saved lives at the time but there are also clear benefits of face-to-face consultations in some circumstances, and the exact role of remote care still needs to be worked out. Despite best efforts, remote care tends to worsen health inequities (people who were poor or less well educated are less able to access and navigate the system and secure the type of appointment they need or prefer). Workstream 1: We will look at 11 GP surgeries across England, Scotland and Wales. We have selected a variety of sites: urban and rural, serving a range of different communities. Each surgery has a different approach to technology. A researcher from our team will work alongside surgery staff to learn what methods and technologies each practice uses to deliver care. They will gather information (mostly qualitative) about how different technological solutions are playing out over time. Workstream 2: Many people experience barriers to accessing care when it is done through technology. This could be because they lack understanding of how to do it, don’t have the right equipment, can’t afford data, or other reasons. We will ask patients about their experiences and work with them and staff to develop ideas about how to overcome barriers. Workstream 3: We will take what we have learnt in Workstreams 1 and 2 to make suggestions to inform national stakeholders and to influence policymakers. Patients and members of the public helped shape the research design. They continue to help guide our research by reading our reports, giving us their opinions and advising on how best to share our research so everyone can benefit from what we have learnt. Our governance panel is chaired by a member of the public.
UNASSIGNED: This protocol is for a mixed-methods multi-site case study with co-design and national stakeholder engagement. 11 general practices were selected for diversity in geographical location, size, demographics, ethos, and digital maturity. Each practice has a researcher-in-residence whose role is to become familiar with its context and activity, follow it longitudinally for two years using interviews, public-domain documents and ethnography, and support improvement efforts. Research team members meet regularly to compare and contrast across cases. Practice staff are invited to join online learning events. Patient representatives work locally within their practice patient involvement groups as well as joining an online patient learning set or linking via a non-digital buddy system. NHS Research Ethics Approval has been granted. Governance includes a diverse independent advisory group with lay chair. We also have policy in-reach (national stakeholders sit on our advisory group) and outreach (research team members sit on national policy working groups).
UNASSIGNED: We expect to produce rich narratives of contingent change over time, addressing cross-cutting themes including access, triage and capacity; digital and wider inequities; quality and safety of care (e.g. continuity, long-term condition management, timely diagnosis, complex needs); workforce and staff wellbeing (including non-clinical staff, students and trainees); technologies and digital infrastructure; patient perspectives; and sustainability (e.g. carbon footprint).
UNASSIGNED: By using case study methods focusing on depth and detail, we hope to explain why digital solutions that work well in one practice do not work at all in another. We plan to inform policy and service development through inter-sectoral network-building, stakeholder workshops and topic-focused policy briefings.
The pandemic required general practices to introduce remote (phone, video and email) consultations. That policy undoubtedly saved lives at the time but there are also clear benefits of face-to-face consultations in some circumstances, and the exact role of remote care still needs to be worked out. Despite best efforts, remote care tends to worsen health inequities (people who were poor or less well educated are less able to access and navigate the system and secure the type of appointment they need or prefer). Workstream 1: We will look at 11 GP surgeries across England, Scotland and Wales. We have selected a variety of sites: urban and rural, serving a range of different communities. Each surgery has a different approach to technology. A researcher from our team will work alongside surgery staff to learn what methods and technologies each practice uses to deliver care. They will gather information (mostly qualitative) about how different technological solutions are playing out over time. Workstream 2: Many people experience barriers to accessing care when it is done through technology. This could be because they lack understanding of how to do it, don’t have the right equipment, can’t afford data, or other reasons. We will ask patients about their experiences and work with them and staff to develop ideas about how to overcome barriers. Workstream 3: We will take what we have learnt in Workstreams 1 and 2 to make suggestions to inform national stakeholders and to influence policymakers. Patients and members of the public helped shape the research design. They continue to help guide our research by reading our reports, giving us their opinions and advising on how best to share our research so everyone can benefit from what we have learnt. Our governance panel is chaired by a member of the public.
摘要：
■在大流行驱动的向远程服务提供的转变之后，英国一般做法提供电话，视频或在线咨询选项与面对面。这项研究探讨了随着时间的推移，他们寻求建立远程访问和提供护理形式的各种实践经验。
■该协议是针对混合方法的多站点案例研究，具有共同设计和国家利益相关者的参与。为地理位置的多样性选择了11种一般做法，尺寸,人口统计，精神,数字成熟度。每个实践都有一个驻地研究员，其作用是熟悉其背景和活动，用访谈纵向跟踪两年，公共领域文件和人种学，支持改进工作。研究小组成员定期开会，对不同病例进行比较和对比。邀请实践人员参加在线学习活动。患者代表在其实践患者参与小组中进行本地工作，并通过非数字伙伴系统加入在线患者学习集或链接。NHS研究伦理批准已获得批准。治理包括一个多元化的独立咨询小组，该小组设有外行主席。我们也有政策接触（国家利益相关者坐在我们的咨询小组）和外联（研究小组成员坐在国家政策工作组）。
■我们期望随着时间的推移产生丰富的或有变化的叙述，解决交叉主题，包括访问，分诊和容量；数字和更广泛的不平等；护理质量和安全性(例如，连续性、长期状况管理，及时诊断,复杂的需求)；劳动力和员工福利(包括非临床员工，学生和学员）；技术和数字基础设施；患者观点；和可持续性（例如碳足迹）。
■通过使用侧重于深度和细节的案例研究方法，我们希望解释为什么在一种实践中运行良好的数字解决方案在另一种实践中根本不起作用。我们计划透过跨部门网络建设,为政策及服务发展提供资讯,利益攸关方研讨会和以主题为重点的政策简报。
大流行需要一般做法来引入远程(电话，视频和电子邮件)咨询。这项政策无疑在当时挽救了生命，但在某些情况下，面对面协商也有明显的好处，远程护理的确切作用仍然需要解决。尽管尽了最大努力,远程护理往往会加剧健康不平等(穷人或受教育程度较低的人不太可能进入和浏览系统，也不太可能确保他们需要或更喜欢的预约类型)。工作流1：我们将查看英格兰的11项GP手术，苏格兰和威尔士。我们选择了各种各样的地点：城市和农村，服务于一系列不同的社区。每种手术都有不同的技术方法。我们团队的研究人员将与手术人员一起工作，了解每种实践使用哪些方法和技术来提供护理。他们将收集有关不同技术解决方案随着时间的推移如何发挥作用的信息（主要是定性的）。工作流2：当通过技术完成护理时，许多人在获得护理方面遇到障碍。这可能是因为他们对如何做到这一点缺乏了解，没有合适的设备，负担不起数据，或其他原因。我们将向患者询问他们的经历，并与他们和工作人员一起发展如何克服障碍的想法。工作流3：我们将利用我们在工作流1和2中学到的知识来提出建议，以告知国家利益相关者并影响政策制定者。患者和公众帮助塑造了研究设计。他们继续通过阅读我们的报告来帮助指导我们的研究，向我们提供他们的意见，并就如何最好地分享我们的研究提出建议，以便每个人都可以从我们所学到的知识中受益。我们的治理小组由一名公众担任主席。
■该协议是针对混合方法的多站点案例研究，具有共同设计和国家利益相关者的参与。为地理位置的多样性选择了11种一般做法，尺寸,人口统计，精神,数字成熟度。每个实践都有一个驻地研究员，其作用是熟悉其背景和活动，用访谈纵向跟踪两年，公共领域文件和人种学，支持改进工作。研究小组成员定期开会，对不同病例进行比较和对比。邀请实践人员参加在线学习活动。患者代表在其实践患者参与小组中进行本地工作，并通过非数字伙伴系统加入在线患者学习集或链接。NHS研究伦理批准已获得批准。治理包括一个多元化的独立咨询小组，该小组设有外行主席。我们也有政策接触（国家利益相关者坐在我们的咨询小组）和外联（研究小组成员坐在国家政策工作组）。
■我们期望随着时间的推移产生丰富的或有变化的叙述，解决交叉主题，包括访问，分诊和容量；数字和更广泛的不平等；护理质量和安全性(例如，连续性、长期状况管理，及时诊断,复杂的需求)；劳动力和员工福利(包括非临床员工，学生和学员）；技术和数字基础设施；患者观点；和可持续性（例如碳足迹）。
■通过使用侧重于深度和细节的案例研究方法，我们希望解释为什么在一种实践中运行良好的数字解决方案在另一种实践中根本不起作用。我们计划透过跨部门网络建设,为政策及服务发展提供资讯,利益攸关方研讨会和以主题为重点的政策简报。
大流行需要一般做法来引入远程(电话，视频和电子邮件)咨询。这项政策无疑在当时挽救了生命，但在某些情况下，面对面协商也有明显的好处，远程护理的确切作用仍然需要解决。尽管尽了最大努力,远程护理往往会加剧健康不平等(穷人或受教育程度较低的人不太可能进入和浏览系统，也不太可能确保他们需要或更喜欢的预约类型)。工作流1：我们将查看英格兰的11项GP手术，苏格兰和威尔士。我们选择了各种各样的地点：城市和农村，服务于一系列不同的社区。每种手术都有不同的技术方法。我们团队的研究人员将与手术人员一起工作，了解每种实践使用哪些方法和技术来提供护理。他们将收集有关不同技术解决方案随着时间的推移如何发挥作用的信息（主要是定性的）。工作流2：当通过技术完成护理时，许多人在获得护理方面遇到障碍。这可能是因为他们对如何做到这一点缺乏了解，没有合适的设备，负担不起数据，或其他原因。我们将向患者询问他们的经历，并与他们和工作人员一起发展如何克服障碍的想法。工作流3：我们将利用我们在工作流1和2中学到的知识来提出建议，以告知国家利益相关者并影响政策制定者。患者和公众帮助塑造了研究设计。他们继续通过阅读我们的报告来帮助指导我们的研究，向我们提供他们的意见，并就如何最好地分享我们的研究提出建议，以便每个人都可以从我们所学到的知识中受益。我们的治理小组由一名公众担任主席。
