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Telehealth in long-term care facilities during the Covid-19 pandemic - Lessons learned from patients, physicians, nurses and healthcare workers. 新冠肺炎大流行期间长期护理机构的远程医疗——从患者、医生、护士和医护人员那里吸取的教训
Pub Date : 2023-01-01 Epub Date: 2023-01-24 DOI: 10.1186/s44247-022-00003-y
Zhaoli Dai

Background: Telehealth and telecare are particularly important and beneficial to long-term care facilities due to care demands, workforce, and the unique environment. Stemming from the recent findings on telehealth utilisation in residential aged-care facilities in Australia, this commentary seeks to identify lessons and perspectives learned during the Covid-19 pandemic from multiple users, including patients, physicians, nurses, and healthcare workers in long-term care (LTC) settings.

Main body: From patients' perspectives, older adults residing in LTC settings often opt not to use virtual care, with the majority preferring in-person visits. This is despite residents expressing their willingness to use telehealth, and virtual care has advantages in LTC settings or in remote areas. Additionally, hearing, vision, or cognitive impairment can limit residents' ability to use information technology to access care, so their preferences for phone or video consultations depend on the health conditions or care requirement. From physicians' perspectives, most healthcare practitioners have a positive attitude toward using telehealth. However, telephone consultations tended to be the dominant mode during the early period of the Covid-19 pandemic. Physicians also raised several major concerns, including technical and equipment-related issues, expanded roles, or additional workloads of LTC staff that could negatively affect clinical decision-making and unequal access in rural, older, and cognitively impaired patients. Most nurses and healthcare workers perceived telehealth positively as a way to enhance patients' care access. However, the majority had concerns about acquiring appropriate knowledge of using the technology for themselves and their patients. In remote areas, nurses expressed higher efficiency and higher care quality when utilising telehealth in caring for older patients than in the regular in-person care mode.

Conclusion: Since the beginning of the Covid-19 pandemic, telehealth has continued as an alternative platform in clinical services. However, as a healthcare platform that offers flexibilities of time, location, and improved efficiency, changing the traditional mindset is essential to shift the paradigm to use telehealth when appropriate. Importantly, telehealth needs substantial support in rural or remote long-term care facilities. Doing so will contribute to the reduction of healthcare inequity in long-term care facilities in remote settings and those with social disparities.

背景:由于护理需求、劳动力和独特的环境,远程医疗和远程医疗对长期护理机构尤其重要和有益。根据最近关于澳大利亚养老院远程医疗利用情况的调查结果,本评论旨在确定在2019冠状病毒病大流行期间从多个用户(包括长期护理环境中的患者、医生、护士和卫生保健工作者)那里学到的经验教训和观点。主体:从患者的角度来看,居住在LTC环境中的老年人通常选择不使用虚拟护理,大多数人更喜欢亲自就诊。尽管居民表示愿意使用远程医疗,但虚拟医疗在长期医疗中心环境或偏远地区具有优势。此外,听力、视力或认知障碍会限制居民使用信息技术获得护理的能力,因此他们对电话或视频咨询的偏好取决于健康状况或护理要求。从医生的角度来看,大多数医疗从业人员对使用远程医疗持积极态度。然而,在新冠肺炎大流行初期,电话咨询往往是主要模式。医生们还提出了几个主要问题,包括技术和设备相关问题、角色扩大或LTC工作人员的额外工作量,这些问题可能对临床决策产生负面影响,并对农村、老年和认知障碍患者的不平等机会产生影响。大多数护士和保健工作者积极地认为远程保健是提高患者获得护理机会的一种方式。然而,大多数人担心如何为自己和病人获得使用这项技术的适当知识。在偏远地区,护士表示,与常规的面对面护理模式相比,利用远程保健护理老年患者的效率和护理质量更高。结论:自2019冠状病毒病大流行开始以来,远程医疗一直是临床服务的替代平台。然而,作为一个提供时间、地点灵活性和提高效率的医疗保健平台,改变传统的思维方式对于转变范式,在适当的时候使用远程医疗至关重要。重要的是,远程保健需要农村或偏远长期护理设施的大力支持。这样做将有助于减少偏远地区和存在社会差异的长期护理设施中的医疗保健不平等现象。
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