从远程医疗视角看新冠肺炎大流行期间及之后的医生类型

M. Ramirez, Maria Minerva P. Calimag
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摘要

新型冠状病毒(CoVid-19)大流行给医疗保健系统带来了巨大影响,包括患者随访和会诊中断。随后,医生使用远程医疗的情况有所增加。虽然这项技术已经被证明可以改善医疗服务,但它在医生中得到了不同程度的接受。具体国家立法的差距、缺乏既定的规则和认证标准以及道德/法律问题都加剧了人们的关切。本研究以技术接受和使用统一理论模型为基础,旨在根据大流行期间医生对远程医疗的看法对他们进行细分。方法:采用q -方法学进行混合方法序贯解释设计,以确定大流行期间医生对远程医疗使用的不同模式和看法。通过文献综述,我们开发了25份远程医疗感知陈述的q样本,并有意选择了24名医生。参与者被要求根据他们的同意/不同意程度将陈述分类到一个分布网格中。整理后的采访,以阐述他们的反应。采用PQMethod 2.35版软件对数据进行逐人因子分析。结果与结论:分析确定了四种类型,分为以下几种类型:“注重结果的医生”,注重正确诊断的重要性,缺乏体格检查;“以病人为中心的医生”在大流行期间考虑病人的方便和安全;“以同理心为中心的医生”重视咨询的情感方面;而“以技术为中心的医生”关心的是病人的技术素养。研究结果可以深入了解远程医疗在医疗实践中的专业、伦理和法律影响,并为医疗机构、学术机构和政策制定者在“新常态”下修改和改进远程医疗服务提供信息和指导。关键词:远程医疗,观念,医生,大流行,CoVid-19
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The Typology of Physicians According to Perspectives on Telemedicine During and Beyond the Covid-19 Pandemic
Introduction: The coronavirus (CoVid-19) pandemic brought about a massive impact to the healthcare system, including disruption of patient follow-ups and consultations. Subsequently, an increase in physicians’ use of telemedicine was seen. While this technology has been documented to improve delivery of care, it has encountered varied acceptance among physicians. Gaps in specific national legislation, lack of established rules and accreditation standards, and ethical/legal implications add to the concerns. Anchored on the Unified Theory of Acceptance and Use of Technology model, this study aimed to segment physicians according to their perspectives regarding telemedicine during the pandemic. Methods: A mixed methods sequential explanatory design using Q-methodology was applied to identify distinct patterns and perceptions of physicians on the use of telemedicine during the pandemic. A Q-sample of 25 statements on perceptions of telemedicine was developed through literature review, and 24 physicians were purposively selected. Participants were instructed to sort statements into a distribution grid according to their degree of agreement/disagreement. Post-sorting interview was conducted to expound on their response. Data were analyzed using by-person factor analysis through the PQMethod software version 2.35. Result and Conclusion: The analysis identified four profiles which were classified under the following perspective typologies: the “Outcomes-focused Physician” focused on the importance of arriving at a correct diagnosis and lack of physical examination; the “Patient-focused Physician” considered patients’ convenience and safety during the pandemic; the “Empathy-focused Physician” gave importance to the emotional aspect of a consultation; and the “Technology-focused Physician” was concerned about the patient’s technology literacy. The results can generate insights into professional, ethical and legal implications of telemedicine in medical practice, and provide healthcare organizations, academic institutions, and policy makers information and guidance in the modification and improvement of telemedicine services in the 'new normal'. Key words: telemedicine, perceptions, physicians, pandemic, CoVid-19
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