@Article{信息:doi 10.2196 / / jmir。9897，作者=“格林哈尔，特丽莎和肖，萨拉和惠尔顿，约瑟夫和维贾雅拉格哈万，Shanti和莫里斯，Joanne和Bhattacharya, Satya和Hanson, Philippa和Campbell-Richards, Desir{\'e}e和Ramoutar, Seendy和Collard, Anna和Hodkinson, Isabel”，标题=“宏观、中观和微观层面视频门诊咨询的现实世界实现:混合方法研究”，期刊=“J Med Internet Res”，年=“2018”，月=“Apr”，日=“17”，卷=“20”，数=“4”，页=“e150”，关键词=“远程会诊”;糖尿病;民族志;面试;组织案例研究;背景:人们对使用视频技术的虚拟会诊很感兴趣。随机对照试验表明，在选定的条件和情况下，视频咨询是可接受的、安全的和有效的。然而，这种模式很少被主流化，也很少在现实环境中得到维持。 Objective: The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. Methods: A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). Results: When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2{\%} and 22{\%} of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. Conclusions: Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity. ", issn="1438-8871", doi="10.2196/jmir.9897", url="//www.mybigtv.com/2018/4/e150/", url="https://doi.org/10.2196/jmir.9897", url="http://www.ncbi.nlm.nih.gov/pubmed/29625956" }