Integrating acute stroke telemedicine consultations into specialists’ usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom

BMC Health Services Research

on behalf of the VST and ASTUTE investigators¹  Helen M. Dewey²  Hedley C. A. Emsley³  Elaine Day⁴  D. Paul Davies⁵  Alison S. R. McLoughlin⁵  Christopher I. Price⁶  Gary A. Ford⁷  Michelle Vu⁸  Kathleen L. Bagot⁸  Dominique A. Cadilhac⁸  Geoffrey A. Donnan⁸  Christopher F. Bladin⁸  Josephine M. E. Gibson⁹  Caroline L. Watkins⁹  Catherine E. Lightbody⁹  Carl R. May^1,10 

[1] ;Eastern Health Clinical School, Monash University;Lancashire Teaching Hospitals NHS Foundation Trust;Lancashire and South Cumbria Strategic Clinical Network;North Cumbria University Hospitals NHS Trust;Northumbria Healthcare NHS Foundation Trust;Oxford University Hospitals NHS Foundation Trust and Division of Medical Sciences, University of Oxford;Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne;University of Central Lancashire;University of Southampton;

关键词: Telemedicine;    Normalisation process theory;    Implementation;    Barriers;    Facilitators;    Acute;   

DOI  :  10.1186/s12913-017-2694-1

来源: DOAJ

【 摘 要 】

Abstract Background Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Methods Specialist participants were identified using purposive sampling from two new services: Australia’s Victorian Stroke Telemedicine Program (n = 6; 2010–13) and the United Kingdom’s Cumbria and Lancashire telestroke network (n = 5; 2010–2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Results Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Conclusion Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.

【 授权许可】

Unknown