Getting the most out of remote care: Co-developing a Toolkit to improve the delivery of remote kidney care appointments for underserved groups

IF 1.5 4区医学 Q3 NURSING Journal of renal care Pub Date : 2024-06-04 DOI:10.1111/jorc.12504

Patricia Tum MSc, Fez Awan, Jyoti Baharani MD, Emma Coyne ClinPsyD, Gavin Dreyer MD, Catriona Ewart MSc, Chipiliro Kalebe-Nyamomgo PhD, Udita Mitra MSc, Martin Wilkie MD, Nicola Thomas PhD

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Abstract

Background

Telephone and video appointments are still common post-pandemic, with an estimated 25%–50% of kidney appointments in the United Kingdom still conducted remotely. This is important as remote consultations may exacerbate pre-existing inequalities in those from underserved groups. Those from underserved groups are often not represented in health research and include those with learning disability, mental health needs, hearing/sight problems, young/older people, those from ethnic minority groups.

Objectives

The aim was to develop a Toolkit to improve the quality of remote kidney care appointments for people from different underserved groups.

Design

A parallel mixed methods approach with semistructured interviews/focus groups and survey. We also conducted workshops to develop and validate the Toolkit.

Participants

Seventy-five renal staff members completed the survey and 21 patients participated in the interviews and focus groups. Patients (n = 11) and staff (n = 10) took part in the Toolkit development workshop, and patients (n = 13) took part in the Toolkit validation workshop.

Results

Four themes from interviews/focus groups suggested areas in which remote appointments could be improved. Themes were quality of appointment, patient empowerment, patient–practitioner relationship and unique needs for underserved groups. Staff reported difficulty building rapport, confidentiality issues, confidence about diagnosis/advice given, technical difficulties and shared decision making.

Conclusion

This study is the first to explore experiences of remote appointments among both staff and those from underserved groups living with kidney disease in the United Kingdom. While remote appointments can be beneficial, our findings indicate that remote consultations need optimisation to meet the needs of patients. The project findings informed the development of a Toolkit which will be widely promoted and accessible in the United Kingdom during 2024.

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充分利用远程医疗：共同开发工具包，改善为服务不足群体提供的远程肾脏护理预约服务。

背景：大流行后，电话和视频预约仍很普遍，据估计，英国 25%-50% 的肾脏预约仍通过远程方式进行。这一点非常重要，因为远程会诊可能会加剧那些来自服务不足群体的人原有的不平等。健康研究中往往没有来自服务不足群体的代表，这些群体包括有学习障碍者、精神健康需求者、有听力/视力问题者、年轻人/老年人、少数民族群体：目的：旨在开发一个工具包，以提高不同服务不足群体的远程肾脏护理预约的质量：设计：采用半结构式访谈/焦点小组和调查并行的混合方法。我们还举办了研讨会，以开发和验证工具包：75名肾脏科工作人员完成了调查，21名患者参加了访谈和焦点小组。患者（11 人）和工作人员（10 人）参加了工具包开发研讨会，患者（13 人）参加了工具包验证研讨会：访谈/焦点小组的四个主题提出了可以改进远程预约的领域。这些主题包括预约质量、患者授权、患者与医生的关系以及服务不足群体的独特需求。工作人员报告了建立融洽关系的困难、保密问题、对诊断/建议的信心、技术困难和共同决策：这项研究首次探讨了英国肾病患者中的工作人员和服务不足群体的远程预约经验。虽然远程会诊可以带来益处，但我们的研究结果表明，远程会诊需要优化以满足患者的需求。该项目的研究结果为工具包的开发提供了依据，该工具包将于 2024 年在英国广泛推广和使用。

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来源期刊

Journal of renal care Nursing-Advanced and Specialized Nursing

CiteScore

3.50

自引率

5.30%

发文量

期刊介绍： The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA). The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given. The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.