未经评估:远程访问和接受护理(通过电话,视频或在线)成为2019年冠状病毒病(COVID-19)大流行期间的默认选项,但在某些情况下,亲自护理有独特的好处。我们正在研究英国的一般做法,因为他们试图平衡远程和亲自护理,伴随着反复出现的COVID-19波和各种大流行后的积压。
UNASSIGNED:跨11个一般实践的混合方法(主要是定性)案例研究。驻地研究人员与实践建立了关系,并熟悉他们的背景和活动;他们通过工作人员和患者访谈跟踪他们的进展两年,文件和人种学,并通过共同设计支持改进工作。在本文中,我们报告基线数据。
未经评估:反映了我们的最大品种抽样策略,这11种做法的规模各不相同,设置,精神,人员配备,人口统计学和数字成熟度,但具有共同的背景特征-特别是系统级压力源,例如高工作量和人员短缺,以及英国的技术和监管基础设施。我们已经确定了实践之间的共同点和区别:1]管理“数字前门”(访问和分类)并平衡需求和容量;2]努力追求高质量和安全的标准;3]确保数字包容并减轻更广泛的不平等;4]支持和培训他们的员工(临床和非临床),学生和受训人员;5]选择,安装,试点和使用技术以及支持它们的数字基础设施;6]让患者参与改进工作。
未经评估:对大流行引起的破坏性创新的一般做法的反应显得独特而有针对性。我们预计,通过关注深度和细节,这项纵向研究将揭示为什么在一种实践中效果良好的解决方案在另一种实践中根本不起作用。随着研究的展开,我们将探讨实践如何实现紧急或严重疾病的及时诊断,并管理护理的连续性,长期条件和复杂的需求。
UNASSIGNED: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs.
UNASSIGNED: Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data.
UNASSIGNED: Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK\'s technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the \'digital front door\' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts.
UNASSIGNED: General practices\' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
We describe early results from the Remote by Default 2 study, which is following 11 UK general practices for two years as they introduce various kinds of remote appointment booking and clinical consultations. We have been using interviews and ethnography (watching real-world activities), and analysing documents (such as practice reports and websites) to prepare case studies of the 11 practices, which vary widely in size, ethos, geographical location, practice population and digital maturity. Our initial interviews identified the following cross-cutting themes, which showed both commonalities and differences across the 11 practices: - The ‘digital front door’ (patients gaining access using digital portals), which was used to a greater or lesser extent in all practices; some found these systems frustrating and inefficient.- Quality and safety. Staff were concerned about the risk of missing an important diagnosis when consulting remotely, and felt that digitisation could threaten continuity of care.- Digital inclusion. All practices were keen to ensure that patients who lacked digital devices or skills were not disadvantaged; this goal was achieved in different ways (and to different degrees) in different settings.- Staff support and training. Some practices are finding current workload unsustainable due to (among other things) rising patient demand, unfilled staff posts, a post-pandemic backlog of unmet need, and task-shifting from secondary care. Digitisation appears to have increased workload in most practices.- Technologies and infrastructure. The IT infrastructure in each practice had grown in a particular way over time, and was in this sense ‘path-dependent’ (hence, not easily changed). In conclusion, different practices are responding to the ‘disruptive innovation’ of digital technologies in very different ways, reflecting their different practice populations, settings and priorities. We plan to follow the above themes over time and explore additional themes including the experience and role of patients.