背景:COVID-19大流行改变了医疗保健系统,导致远程医疗(TM)的快速发展和实施。TM有可能提高初级卫生保健的质量并增加人口的可及性。然而,它的使用可能对老年人构成挑战,因为由于与年龄相关的感知变化,他们可能与普通人群有不同的需求,电机,和认知能力。我们,因此,旨在确定在老年人初级保健中使用TM的潜在促进因素和障碍,并相应地提出建议。
方法:我们进行了一项定性研究,以探讨在初级保健实践中老年人和医疗保健专业人员(HCP)中使用TM的相关挑战。采访了29名老年人,并组织了三个焦点小组,涉及来自四个McGill家庭医学站点的HCP。采用混合码本主题分析,在实施研究综合框架(CFIR)的指导下,我们确定了影响老年人和HCP最佳使用TM的促进因素和障碍.我们综合了半结构化访谈和焦点小组的结果。然后在与八名参与者的审议对话中介绍了这些发现,包括家庭医生,护士,一个社会工作者,和政府级别的TM专家,来验证我们的结果。目的是收集反馈,确定和完善可操作的建议。随后,我们使用相同的密码本进行主题分析,以综合讨论对话的结果。
结果:参与者一致认为,TM有助于保持护理的连续性,并且在现有或已建立的医患关系或解决次要健康问题时特别方便。TM被发现对行动不便的人有益,减少他们对潜在高风险环境的暴露。然而,参与者对缺乏视觉接触表示担忧,导致重要的细节被忽视。此外,确定了由于语言或听力障碍而导致的沟通错误的问题。HCP认为,大多数老年人不认为电话咨询是医疗行为。参与者对混合方法持开放态度,结合面对面咨询和TM,根据他们的具体健康状况。在这些结果的基础上,我们提出了七项主要建议。
结论:老年人和HCP都认为TM是获得医疗保健服务的良好选择。为了提高TM的有效利用,它的关键是倡导一种混合的方法,集成在人和虚拟的方法。这种方法应积极鼓励和支持个人熟悉技术工具。
BACKGROUND: The COVID-19 pandemic changed the healthcare system, leading to the rapid evolution and implementation of telemedicine (TM). TM has the potential to improve the quality of primary health care and increase accessibility for the population. However, its use may represent challenges for older people, as they may have distinct needs from the general population due to age-related changes in perceptual, motor, and cognitive capacities. We, thus, aimed to identify potential facilitators and barriers to TM use in primary care for older adults and develop recommendations accordingly.
METHODS: We conducted a qualitative
study to explore the challenges associated with TM use among older adults and healthcare professionals (HCPs) in primary care practice. Interviews were conducted with 29 older adults, and three focus groups involving HCPs from four McGill family medicine sites were organized. Employing a hybrid codebook thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR), we identified facilitators and barriers affecting the optimal use of TM by older adults and HCPs. We synthesized the results from semi-structured interviews and focus groups. These findings were then presented during a deliberative dialogue with eight participants, including family physicians, nurses, a social worker, and a government-level TM expert, to validate our results. The purpose was to gather feedback, identify and refine actionable recommendations. Subsequently, we utilized a thematic analysis using the same codebook to synthesize findings from the deliberative dialogue.
RESULTS: Participants agreed that TM contributed to maintaining the continuity of care and was particularly convenient when there was an existing or established patient-physician relationship or for addressing minor health issues. TM was found to be beneficial for people with limited mobility, reducing their exposure to potentially high-risk environments. However, participants expressed concerns about the lack of visual contact, causing essential details to be overlooked. Additionally, issues related to miscommunication due to language or hearing barriers were identified. HCPs perceived that most older adults did not consider phone consultations a medical act. Participants were open to a hybrid approach, combining in-person consultations and TM, based on their specific health conditions. Building upon these results, we formulated seven key recommendations.
CONCLUSIONS: Both older adults and HCPs consider TM a good alternative for accessing healthcare services. To improve the effective use of TM, it\'s crucial to advocate for a hybrid approach that integrates both in-person and virtual methods. This approach should actively encourage and support individuals in becoming familiar with technological tools.