طراحی الگوی مدیریت خدمات پزشکی از راه دور در ایران
محورهای موضوعی : -مدیریت خدمات بهداشتی و درمانیمنیره فلک باز 1 , کامران حاجی نبی 2 * , لیلا ریاحی 3 , لیلا نظری منش 4
1 - دانشجوی دکتری مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
2 - استادیار گروه مدیریت خدمات بهداشتی درمانی، واحد علوم وتحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
3 - دانشیار گروه مدیریت خدمات بهداشتی درمانی، واحد علوم وتحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
4 - استادیار گروه مدیریت خدمات بهداشتی درمانی، واحد علوم وتحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: پزشکی از راه دور, ارتقاء دسترسی به خدمات سلامت, برنامه ریزی, هماهنگی, سازماندهی, کنترل, تامین مالی.,
چکیده مقاله :
مقدمه: پزشکی از راه دور داراي بيشترين نقش در گسترش مراقبت از سلامت در مناطق محروم و روستاها بوسيله فراهم آوردن امكاناتي براي پزشك و يا ديگر عوامل حوزه سلامت براي معاينه بيمار از طريق ويدئو كنفرانس، اينترنت و ... به متخصص مشاور در مركز پزشکی از راه دور ميباشد. پژوهش حاضر با هدف طراحی و ارزیابی یک الگوی پزشکی از راه دور و ارتقاء دسترسی به خدمات سلامت انجام شد.
روش پژوهش: در این پژوهش از روش آمیخته که ترکیبی از روش کیفی و کمی میباشد، استفاده شد. اطلاعات مورد نياز اين تحقيق، ابتدا از طريق مصاحبه نیمه ساختاریافته با 10 نفر از خبرگان دانشگاهی، مدیران و کارشناسان وزارت بهداشت به روش نمونهگیری گلوله برفی، استخراج گردید و در طی سه مرحله به روش تحلیل مضمون (کدگذاری باز، کدگذاری محوری و کدگذاری انتخابی) با نرم افزار مکس کیودا تحلیل شد و در نهایت طبق مصاحبهها ابعاد و مولفه و شاخصها استخراج و پرسشنامه محقق ساخته طراحی شد. بر اساس فرآیند مصاحبه، کدگذاری و آزمونهای انجام شده نهایتاً مدل نهایی پژوهش ارائه گردید. سپس در بخش کمی، پرسشنامه بین 384 نفر توزیع شد و از مدلسازی معادلات ساختاری و نرم افزار اسمارت پی ال اس (3smart pls) میزان ارتباط بین ابعاد مشخص گشت.
یافتهها: نتایج نشان داد بین ابعاد برنامه ریزی، هماهنگی، سازماندهی، کنترل، تامین مالی و خدمات پزشکی از راه دور در ایران رابطه مثبت و معناداری وجود دارد.
نتیجهگیری: با توجه به این که ارائه خدمات پزشکی از راه دور گرایش جدیدی است که در سالهای اخیر به واسطه شرایط خاص بهداشتی و شیوع کرونا ویروس بیش از پیش مورد توجه قرار گرفته است و لذا ضروری است تا برنامهریزی لازم برای استقرار الگوی خدمات پزشکی از راه دور در ایران برای همگان و به ویژه مناطق دور افتاده صورت پذیرد.
Introduction: Telemedicine has the greatest role in the expansion of health care in deprived areas and villages by providing facilities for doctors or other health workers to examine patients through video conference, internet and etc., to a consultant specialist in a telemedicine center. The current research was conducted with the aim of designing and evaluating a telemedicine model and improving access to health services.
Methods: In this research, a mixed method was used, which is a combination of qualitative and quantitative methods. The information needed for this research was firstly extracted through semi-structured interviews with 10 university experts, managers and experts of the Ministry of Health using snowball sampling method, and during three stages using thematic analysis method (open coding, axial coding, and selective coding) was analyzed with MAXQDA software and finally, according to the interviews, dimensions, components and indicators were extracted and a researcher-made questionnaire was designed. Based on the interview process, coding and tests, the final model of the research was presented. Then, in the quantitative part, the questionnaire was distributed among 384 people and the relationship between the dimensions was determined from structural equation modeling and Smart PLS software.
Results: The results showed that there is a positive and significant relationship between the dimensions of planning, coordination, organization, control, financing and telemedicine services in Iran.
Conclusion: Considering that the provision of telemedicine services is a new trend that has received more attention in recent years due to special health conditions and the spread of the corona virus, and therefore it seems necessary to plan for the establishment of a model telemedicine services in Iran for everyone, especially remote areas. It is also recommended to create an economic plan to make money from the telemedicine program.
1- Hamelink, C. J. New information and communication technologies, social development and cultural change. Geneva: United Nations Research Institute for Social Development; 1997.
2- Doshmanghir, Leila; Ismailzadeh, Hamid; Arab Zozani, Morteza. The strategic position of using telemedicine technology in Iran's health system, Journal of Kerman Faculty of Medical Information and Management, 2014; 2(2): 144-51. [Persian].
3- Kho, J., Gillespie, N., & Martin-Khan, M. A systematic scoping review of change management practices used for telemedicine service implementations. BMC health services research, 2020; 20: 1-16.
4- Amirani, Hossein. Principles and requirements of telemedicine. No Andish Sabz Educational Research Information Quarterly, 9th year. 2014; 9 (34-35). [Persian].
5- Amini, Hamidreza. Designing a comprehensive electronic health system based on electronic monitoring of treatment. Master's thesis in the field of management. Business management - marketing. Isfahani Shahid Ashrafi University, Faculty of Administrative Sciences and Economics; 2018. [Persian].
6- Mousavi Baigi, S. F., Raei Mehneh, M., Sarbaz, M., Norouzi Aval, R., & Kimiafar, K. Telerehabilitation in Response to Critical Coronavirus: A Systematic Review Based on Current Evidence. Journal of Isfahan Medical School, 2022; 40(678): 498-508.
7- Piette, J. D., Datwani, H., Gaudioso, S., Foster, S. M., Westphal, J., Perry, W., & Marinec, N. Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries. Telemedicine and e-Health, 2012; 18(8): 613-620.
8- Barati, Mehrdad. Designing a telemedicine service model in comprehensive health service centers implementing a specialized family medicine program, based on a need's assessment model, in Tehran University of Medical Sciences, PhD thesis in the field of general medicine. Department of Social Medicine, University of Tehran; 2017. [Persian].
9- Zarezadeh, nabiollah. Challenges of establishing telemedicine in Jahrom University of Medical Sciences. Master's thesis. Islamic Azad University, Maroodasht Branch, Faculty of Basic Sciences; 2016. [Persian].
10- Rabieifar, Fatemeh, Radfar, Reza, and Toloui Ashlaghi, Abbas. Designing an electronic health record model with high security in telemedicine based on the Internet of Things. Health Management (Health System), 2023; 13(1 (43)): 7-21. [Persian].
11- Darkins, A. W., & Cary, M. A. Telemedicine and telehealth: principles, policies, performances and pitfalls. Springer publishing company; 2000.
12- Bhaskar, S., Bradley, S., Sakhamuri, S., Moguilner, S., Chattu, V. K., Pandya, S. & Banach, M. Designing futuristic telemedicine using artificial intelligence and robotics in the COVID-19 era. Frontiers in public health, 2020; 8: 708.
13- Moini, Ebrahim and Bakhtiari, Zohra. Identification and investigation of effective factors in the use of telemedicine technology in Iranian hospitals, the 4th Iran Technology Management Conference, Tehran; 2019. https://civilica.com/doc/94716 [Persian].
14- Preston, J., Brown, F. W., & Hartley, B. Using telemedicine to improve health care in distant areas. Psychiatric Services, 1992; 43(1): 25-32.
15- Granja, C., Janssen, W., & Johansen, M. A. Factors determining the success and failure of eHealth interventions: systematic review of the literature. Journal of medical Internet research, 2018; 20(5): e10235.
16- Melnychuk, N., & de Loë, R. Legitimacy assessment throughout the life of collaborative water governance. Environmental Policy and Governance, 2023; 30(1): 14-28. [DOI:10.1002/eet.1872].
17- Biancone, P., Secinaro, S., Marseglia, R., & Calandra, D. E-health for the future. Managerial perspectives using a multiple case study approach. Technovation, 2023; 120: 102406.
18- Boumans, D., & Ferry M. Networks and efficient policy implementation: insights from cohesion policy. Evaluation, 2022; 25(4): 411-429.
19- Manning, L. A., & Gillespie, C. M. E-Health and telemedicine in otolaryngology: Risks and rewards. Otolaryngologic Clinics of North America, 2022; 55(1): 145-151.
20- Mousavi Baigi Seyedah Fatemeh, Kimiyafar Khalil, Sarbaz Masoumeh, Abbaszadeh Ali, Mousavi Atefeh Sadat. Investigating the effect of remote medicine in military medicine: a review study, paramedical sciences and military health; 2023; 17(2): 77-89 . [Persian].
21- Badi Arshiya, Rahbar Farhad. Development of remote medicine system during the outbreak of epidemic diseases using virtual social network, Journal of Health and Biomedical Informatics; 2022; 8(4): 359-377 [Persian].
22- Li, W., Gui, J., Luo, X., Yang, J., Zhang, T., & Tang, Q. Determinants of intention with remote health management service among urban older adults: A Unified Theory of Acceptance and Use of Technology perspective. Frontiers in Public Health, 2023; 11: 1117518.
23- Torabipour A, Minaie F, Jahanbani Vashareh E, Zarei J. Presenting a model for telemedicine implementation: A case study of Ahvaz Jundishapur University of Medical Sciences. JMIS, 2022; 7(4): 4-13. [Persian].
24- Mousavi Baigi S F, Kimiafar K, Sarbaz M, Abbaszadeh A, Mousavi A S. Effect of Telemedicine in Military Medicine: A Literature Review. Paramedical Sciences and Military Health, 2022; 17(2): 77-89[Persian].
25- Sclafani, A. P., Shomorony, A., Stewart, M. G., Grunstein, E., & Overdevest, J. B. Telemedicine lessons learned during the COVID-19 pandemic: The augmented outpatient otolaryngology teleconsultation. American Journal of Otolaryngology, 2021; 42(4): 102960.
26- Badi A, Rahbar F. Development of Telemedicine System during the Outbreak of Epidemic Diseases using Virtual Social Networks. Jhbmi, 2022; 8(4): 359-377. [Persian].
27- Lu, Y. A knowledge-driven decision support system for remote medical management. Math. Biosci. Eng, 2023; 20: 2732-2749.
28- Narcisse, M. R., Andersen, J. A., Felix, H. C., Hayes, C. J., Eswaran, H., & McElfish, P. A. Factors associated with telehealth use among adults in the United States: findings from the 2020 National Health Interview Survey. Journal of Telemedicine and Telecare; 2022: 1357633X221113192.
29- Khosravi Z, Javadzade H, Mahmoodi M, Basirian-Jahromi R. The Effectiveness web-based Educational Program on Optimal Use of Smartphones among Students with Nomophobia based on Self-Efficacy Theory: The Role of the Medical Librarian. Iran J Health Educ Health Promot, 2021; 9(3): 246-257. [Persian].
30- Gupta, N., Gupta, M. K., Joshi, N. K., Mantri, N., Sridevi, G., Patel, M., & Bhardwaj, P. Is telemedicine a holy grail in healthcare policy: clinicians’ and patients’ perspectives from an Apex Institution in Western India. BMC Health Services Research, 2023; 23(1): 161.
31- Gharib M, Rahmani N. Telerehabilitation During the COVID-19 Pandemic. jrehab 2021; 22 (1): 2-9. [Persian].