@Article{信息:doi 10.2196 / / jmir。8943，作者=“Hensel, Jennifer M和Yang, Rebecca和Rai, Minnie和Taylor, Valerie H”，标题=“优化初级保健提供者和精神科医生之间的电子咨询:混合方法研究”，期刊=“J医学互联网研究”，年=“2018”，月=“Apr”，日=“06”，卷=“20”，数=“4”，页=“e124”，关键词=“eHealth;精神病学;初级保健;咨询;背景:初级保健提供者(pcp)和精神科医生之间使用电子会诊(e-会诊)具有潜力，考虑到初级保健中精神健康问题的高患病率和获得专家护理的问题。然而，利用和吸收似乎比预期的要低。目的:本研究旨在调查pcp和精神科医生之间电子会诊的实际使用情况，并调查pcp对这种精神科咨询形式的看法，以告知如何优化效用，从而吸收这项服务。方法:在这项混合方法研究中，我们对加拿大安大略省早期实施的2个平台上的精神病学电子咨询(N=37)进行了图表回顾，以及对不同经验水平和不同实践环境的pcp (N=10)进行了3次小组访谈和1次单独访谈。图表回顾评估了响应时间和转诊内容，包括请求类型、转诊附件和咨询师的答复。 Interviews explored the perceptions of the PCPs about the uses and barriers of psychiatry e-consult. Thematic content analysis of interview data identified common themes as well as themes unique to different provider profiles (eg, experienced PCPs vs new PCPs and rural vs urban practice). On the basis of interpretation of the quantitative and qualitative findings, we developed recommendations for the optimization of psychiatry e-consultation services. Results: During the study period, psychiatry e-consults comprised 3.66{\%} (49/1339) of all e-consults submitted on the studied platforms. Among the e-consults reviewed, different psychiatric diagnoses were represented: 70{\%} of requests (26/37) queried about medication safety or side effects, whereas 59{\%} (22/37) asked about psychiatric symptom management. Moreover, 81{\%} (30/37) of e-consults were answered within 24 hours, and 65{\%} (24/37) were addressed in a single exchange. Themes from the interview data included psychiatry having a complexity that differentiates it from other specialties and may limit the utility of e-consult, other than for psychopharmacology advice. Variability in awareness exists in the way e-consultation could be used in psychiatry, with new PCPs feeling unsure about the appropriateness of a question. In general, new PCPs and PCPs practicing in rural areas were more receptive to psychiatry e-consult. PCPs viewed e-consult as an opportunity to collaborate and desired that it be integrated with other available services. Recommendations include the need for appropriate specialist staffing to address a wide range of requests, adequate education to referrers regarding the use of psychiatry e-consult, and the need to integrate psychiatry e-consult with other geographically relevant services, given the complexity of psychiatric issues. Conclusions: E-consult is a viable and timely way for PCPs to get much-needed psychiatric advice. For optimizing its utility and uptake, e-consult needs to be integrated into reliable care pathways with adequate referrer and consultant preparation. ", issn="1438-8871", doi="10.2196/jmir.8943", url="//www.mybigtv.com/2018/4/e124/", url="https://doi.org/10.2196/jmir.8943", url="http://www.ncbi.nlm.nih.gov/pubmed/29625949" }