@文章{info:doi/10.2196/11353，作者="Seto, Emily和Smith, Dallas和Jacques, Matt和Morita, Plinio Pelegrini"，标题="偏远社区远程医疗的机遇与挑战:育空地区远程医疗系统的案例研究"，期刊="JMIR Med Inform"，年="2019"，月=" 11月"，日="1"，卷="7"，数="4"，页="e11353"，关键词="医疗保健系统;远程医疗;远程会诊;育空地区;远程医疗;项目评估;背景:远程保健已被证明可以改善获得医疗保健的机会，并降低患者和医疗保健系统的成本，特别是对生活在农村环境中的患者而言。然而，在偏远社区实施远程保健时出现了独特的挑战。目的:本研究旨在探索育空远程医疗系统的当前使用、挑战和机遇。从这项研究中获得的经验教训被用来确定在试图推进和扩大偏远社区远程医疗项目时需要考虑的重要因素。 Methods: A mixed methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. Web-based questionnaires were administered to nurses in each of the 14 Yukon community health centers outside of Whitehorse and patients who had used telehealth. Qualitative data included focus groups and semistructured interviews with 36 telehealth stakeholders. Results: Since 2008, there has been a consistent number of telehealth sessions of about 1000 per year, with clinical care as the main use (69.06{\%} [759/1099] of all sessions in 2015). From the questionnaire (11 community nurses and 10 patients) and the interview data, there was a consensus among the clinicians and patients that the system provided timely access and cost savings from reduced travel. However, they believed that it was underutilized, and the equipment was outdated. The following 4 factors were identified, which should be considered when trying to advance and expand a telehealth program: (1) patient and clinician buy-in: past telehealth experiences (eg, negative clinician experiences with outdated technology) should be considered when advancing the system. Expansion of services in orthopedics, dermatology, and psychiatry were found to be particularly feasible and beneficial in Yukon; (2) workflow: the use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon telehealth coordinator; (3) access to telehealth technology: clinicians and patients should have easy access to up-to-date telehealth technology. The use of consumer products, such as mobile technology, should be leveraged as appropriate; and (4) infrastructure: the required human resources and technology need to be established when expanding and advancing telehealth. Conclusions: While clinicians and patients had generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to expand the types of telehealth services and the number of telehealth sessions, including the expansion of services in several new specialty areas, updating telehealth equipment to streamline workflows and increase convenience and uptake, and integrating novel technologies. The identified barriers and recommendations from this evaluation can be applied to the development and expansion of telehealth in other remote communities to realize telehealth's potential for providing efficient, safe, convenient, and cost-effective care delivery. ", issn="2291-9694", doi="10.2196/11353", url="http://medinform.www.mybigtv.com/2019/4/e11353/", url="https://doi.org/10.2196/11353", url="http://www.ncbi.nlm.nih.gov/pubmed/31682581" }