Stacey Lovo, Liz Harrison, Megan E O'Connell, Thomas Rotter, Brenna Bath
{"title":"物理治疗师和护士执业模式护理慢性背痛使用远程医疗:诊断和管理的一致性。","authors":"Stacey Lovo, Liz Harrison, Megan E O'Connell, Thomas Rotter, Brenna Bath","doi":"10.1177/1357633X221098904","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Virtual care using videoconference links between urban-based physical therapists and nurse practitioners in rural primary care may overcome access challenges and enhance care for rural and remote residents with chronic low back disorders (CBD). The purpose of this study was to evaluate the concordance of this new model of care with two traditional models.</p><p><strong>Methods: </strong>In this cross-sectional study design, each of 27 participants with CBD were assessed by: 1) a team of a nurse practitioner (NP) located with a patient, joined by a physical therapist (PT) using videoconferencing (NP/PT<sub>team</sub>); 2) in-person PT (PT<sub>alone</sub>); and 3) in-person NP (NP<sub>alone</sub>). Diagnostic and management concordance between the three groups were assessed with percent agreement and kappa.</p><p><strong>Results: </strong>Overall diagnostic categorization was compared for PT<sub>alone</sub> versus NP<sub>alone</sub> and NP/PT<sub>team</sub>: percent agreement was 77.8% (<i>k</i> = 0.474, <i>p</i> = 0.001) and 74.1% (<i>k</i> = 0.359, <i>p</i> = 0.004), respectively. In terms of management recommendations, the PT<sub>alone</sub> and NP<sub>alone</sub> demonstrated strong agreement on \"need for urgent surgical referral\" (92.6%, <i>k</i> = 0.649 (<i>p</i> < 0.00) and slight agreement for \"refer to primary physician for pharmacology, lab or imaging\" (81.5%, <i>k</i> = 0.372 (<i>p</i> = 0.013). The PT<sub>alone</sub> and NP/PT<sub>team</sub> demonstrated strong agreement on \"need for urgent surgical referral\" (96.3%, <i>k</i> = 0.649, <i>p</i> = 0.000) and \"recommendation for PT follow up\" (88.9%, <i>k</i> = 0.664, <i>p</i> = 0.000).</p><p><strong>Discussion: </strong>The diagnostic categorization and management recommendations of the team using videoconferencing for CBD were similar to decisions made by an in-person PT. This model of care may provide a method for enhancing access to PT for CBD assessment and initial management in underserved areas.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":"1 1","pages":"842-850"},"PeriodicalIF":3.5000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331670/pdf/","citationCount":"0","resultStr":"{\"title\":\"A physical therapist and nurse practitioner model of care for chronic back pain using telehealth: Diagnostic and management concordance.\",\"authors\":\"Stacey Lovo, Liz Harrison, Megan E O'Connell, Thomas Rotter, Brenna Bath\",\"doi\":\"10.1177/1357633X221098904\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Virtual care using videoconference links between urban-based physical therapists and nurse practitioners in rural primary care may overcome access challenges and enhance care for rural and remote residents with chronic low back disorders (CBD). The purpose of this study was to evaluate the concordance of this new model of care with two traditional models.</p><p><strong>Methods: </strong>In this cross-sectional study design, each of 27 participants with CBD were assessed by: 1) a team of a nurse practitioner (NP) located with a patient, joined by a physical therapist (PT) using videoconferencing (NP/PT<sub>team</sub>); 2) in-person PT (PT<sub>alone</sub>); and 3) in-person NP (NP<sub>alone</sub>). Diagnostic and management concordance between the three groups were assessed with percent agreement and kappa.</p><p><strong>Results: </strong>Overall diagnostic categorization was compared for PT<sub>alone</sub> versus NP<sub>alone</sub> and NP/PT<sub>team</sub>: percent agreement was 77.8% (<i>k</i> = 0.474, <i>p</i> = 0.001) and 74.1% (<i>k</i> = 0.359, <i>p</i> = 0.004), respectively. In terms of management recommendations, the PT<sub>alone</sub> and NP<sub>alone</sub> demonstrated strong agreement on \\\"need for urgent surgical referral\\\" (92.6%, <i>k</i> = 0.649 (<i>p</i> < 0.00) and slight agreement for \\\"refer to primary physician for pharmacology, lab or imaging\\\" (81.5%, <i>k</i> = 0.372 (<i>p</i> = 0.013). The PT<sub>alone</sub> and NP/PT<sub>team</sub> demonstrated strong agreement on \\\"need for urgent surgical referral\\\" (96.3%, <i>k</i> = 0.649, <i>p</i> = 0.000) and \\\"recommendation for PT follow up\\\" (88.9%, <i>k</i> = 0.664, <i>p</i> = 0.000).</p><p><strong>Discussion: </strong>The diagnostic categorization and management recommendations of the team using videoconferencing for CBD were similar to decisions made by an in-person PT. This model of care may provide a method for enhancing access to PT for CBD assessment and initial management in underserved areas.</p>\",\"PeriodicalId\":50024,\"journal\":{\"name\":\"Journal of Telemedicine and Telecare\",\"volume\":\"1 1\",\"pages\":\"842-850\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331670/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Telemedicine and Telecare\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/1357633X221098904\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/5/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Telemedicine and Telecare","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/1357633X221098904","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/5/12 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
在城市物理治疗师和农村初级保健护士之间使用视频会议链接的虚拟护理可以克服访问挑战，并加强对农村和偏远地区患有慢性腰背部疾病(CBD)的居民的护理。本研究的目的是评估这种新的护理模式与两种传统模式的一致性。方法在横断研究设计中，27名CBD参与者中的每一位都由以下人员进行评估:1)由一名护士执业(NP)组成的团队与一名物理治疗师(PT)一起通过视频会议(NP/PTteam);2)当面PT (PTalone);3)亲身NP (NPalone)。三组之间的诊断和管理的一致性评估同意百分比和kappa。结果PTalone与NPalone、NP/PTteam的总体诊断分类比较:符合率分别为77.8% (k = 0.474, p = 0.001)和74.1% (k = 0.359, p = 0.004)。在管理建议方面，PTalone和NPalone在“需要紧急手术转诊”方面表现出强烈的一致性(92.6%，k = 0.649 (p < 0.00))，在“请主治医师进行药理学、实验室或影像学检查”方面表现出轻微的一致性(81.5%，k = 0.372 (p = 0.013))。PTalone和NP/PTteam在“需要紧急手术转诊”(96.3%，k = 0.649, p = 0.000)和“建议PT随访”(88.9%，k = 0.664, p = 0.000)方面表现出强烈的一致性。讨论小组使用视频会议对CBD的诊断分类和管理建议与现场PT做出的决定相似。这种护理模式可能为服务不足地区提供一种增加CBD评估和初始管理PT的方法。
A physical therapist and nurse practitioner model of care for chronic back pain using telehealth: Diagnostic and management concordance.
Introduction: Virtual care using videoconference links between urban-based physical therapists and nurse practitioners in rural primary care may overcome access challenges and enhance care for rural and remote residents with chronic low back disorders (CBD). The purpose of this study was to evaluate the concordance of this new model of care with two traditional models.
Methods: In this cross-sectional study design, each of 27 participants with CBD were assessed by: 1) a team of a nurse practitioner (NP) located with a patient, joined by a physical therapist (PT) using videoconferencing (NP/PTteam); 2) in-person PT (PTalone); and 3) in-person NP (NPalone). Diagnostic and management concordance between the three groups were assessed with percent agreement and kappa.
Results: Overall diagnostic categorization was compared for PTalone versus NPalone and NP/PTteam: percent agreement was 77.8% (k = 0.474, p = 0.001) and 74.1% (k = 0.359, p = 0.004), respectively. In terms of management recommendations, the PTalone and NPalone demonstrated strong agreement on "need for urgent surgical referral" (92.6%, k = 0.649 (p < 0.00) and slight agreement for "refer to primary physician for pharmacology, lab or imaging" (81.5%, k = 0.372 (p = 0.013). The PTalone and NP/PTteam demonstrated strong agreement on "need for urgent surgical referral" (96.3%, k = 0.649, p = 0.000) and "recommendation for PT follow up" (88.9%, k = 0.664, p = 0.000).
Discussion: The diagnostic categorization and management recommendations of the team using videoconferencing for CBD were similar to decisions made by an in-person PT. This model of care may provide a method for enhancing access to PT for CBD assessment and initial management in underserved areas.
期刊介绍：
Journal of Telemedicine and Telecare provides excellent peer reviewed coverage of developments in telemedicine and e-health and is now widely recognised as the leading journal in its field. Contributions from around the world provide a unique perspective on how different countries and health systems are using new technology in health care. Sections within the journal include technology updates, editorials, original articles, research tutorials, educational material, review articles and reports from various telemedicine organisations. A subscription to this journal will help you to stay up-to-date in this fast moving and growing area of medicine.
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