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农村和偏远地区远程患者监测项目面临的挑战:一项定性研究。

Challenges for remote patient monitoring programs in rural and regional areas: a qualitative study.

作者信息

Tagne Joel Fossouo, Burns Kara, O'Brein Teresa, Chapman Wendy, Cornell Portia, Huckvale Kit, Ameen Ishaan, Bishop Jaclyn, Buccheri Alison, Reid Jodie, Shee Anna Wong, Budge Marc, Huggins Catherine E, Peeters Anna, Metcalf Olivia

机构信息

Centre for Digital Transformation of Health, University of Melbourne, Level 8 - Melbourne Connect, 700 Swanston St., Melbourne, VIC, 3010, Australia.

Western District Health Service, Hamilton, Australia.

出版信息

BMC Health Serv Res. 2025 Mar 13;25(1):374. doi: 10.1186/s12913-025-12427-z.

Abstract

BACKGROUND

Access to healthcare significantly influences health outcomes, and rural, regional and remote populations face greater challenges in accessing healthcare than urban populations. Digital health tools, such as remote patient monitoring (RPM), have significant potential to address these healthcare challenges, yet there is little research on the facilitators and barriers of RPM in these regions.

AIM

This study aims to identify and understand the facilitators and barriers healthcare staff face implementing RPM in rural and regional Australia, with focus on challenges that arose after the onset of the COVID-19 pandemic.

METHODS

Semi-structured focus groups were conducted with healthcare professionals from publicly funded health services in western rural and regional Victoria, Australia. An open-ended interview guide based on the Consolidated Framework for Implementation Research (CFIR) was used to identify key themes and strategies for effective RPM implementation. The analysis considered barriers and facilitators at micro, meso, and macro levels.

RESULTS

Several barriers to RPM implementation were identified across different levels: (1) Micro-Level Factors, such as perceived low digital literacy and language barriers among individuals; (2) Meso-Level Factors, including disparities in IT infrastructure and device availability, limited training opportunities, and the need for enhanced governance within healthcare settings; and (3) Macro-Level Factors, encompassing evolving funding models and the reliability of service providers. Despite these challenges, participants acknowledged potential benefits such as improved technological interoperability, enhanced community engagement, and a data-driven approach to quality improvement. Importantly, a flexible, tailored RPM approach to accommodate specific rural and regional needs was deemed valuable.

CONCLUSION

Effective RPM deployment in rural and regional areas is viewed by health professionals as crucial for bridging healthcare divides. However, if strategies developed for urban settings are not recalibrated to address rural challenges, the risk of RPM failure may escalate. Future initiatives must prioritize region-specific strategies and policy reforms aimed at ensuring equitable digital infrastructure and financial resource allocation to enhance healthcare access in rural and regional settings. This approach may ensure that RPM solutions are both adaptable and effective, tailored to the unique needs of each community.

摘要

背景

获得医疗保健服务对健康结果有重大影响,农村、地区和偏远地区的人群在获得医疗保健服务方面面临比城市人群更大的挑战。数字健康工具,如远程患者监测(RPM),在应对这些医疗保健挑战方面具有巨大潜力,但在这些地区对RPM的促进因素和障碍的研究很少。

目的

本研究旨在识别和理解澳大利亚农村和地区的医护人员在实施RPM时面临的促进因素和障碍,重点关注2019年冠状病毒病疫情爆发后出现的挑战。

方法

对来自澳大利亚维多利亚州西部农村和地区公共资助卫生服务机构的医疗专业人员进行了半结构化焦点小组访谈。使用基于实施研究综合框架(CFIR)的开放式访谈指南来确定有效实施RPM的关键主题和策略。分析考虑了微观、中观和宏观层面的障碍和促进因素。

结果

在不同层面确定了几个RPM实施的障碍:(1)微观层面因素,如个人数字素养较低和语言障碍;(2)中观层面因素,包括信息技术基础设施和设备可用性的差异、培训机会有限以及医疗保健机构内部加强治理的必要性;(3)宏观层面因素,包括不断演变的资助模式和服务提供商的可靠性。尽管存在这些挑战,参与者承认了一些潜在好处,如改善技术互操作性、增强社区参与以及采用数据驱动的方法来提高质量。重要的是,一种灵活、量身定制的RPM方法以适应农村和地区的特定需求被认为很有价值。

结论

卫生专业人员认为在农村和地区有效部署RPM对于弥合医疗保健差距至关重要。然而,如果不为应对农村挑战重新调整为城市环境制定的策略,RPM失败的风险可能会增加。未来的举措必须优先考虑针对特定地区的策略和政策改革,以确保公平的数字基础设施和财政资源分配,从而改善农村和地区的医疗保健服务可及性。这种方法可以确保RPM解决方案既具有适应性又有效,能够满足每个社区的独特需求。

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