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Telemedicine for low resource settings: Exploring the generative mechanisms

机译：资源匮乏的远程医疗：探索生成机制

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摘要

Information Communication and Technology for Health (ICT4H) initiatives, such as telemedicine, can potentially bridge the gap between the health care services available in rural and urban areas. However most of such initiatives have not been able to sustain or obtain optimal results. Comprehending knowledge about what drives success in telemedicine initiatives would be highly valuable for practitioners, policymakers and academicians. In this study, through a qualitative analysis of doctor-patient interactions over a telemedicine initiative in India, we attempt to identify the mechanisms that can enable successful telemedicine interventions. Based on the perspective of critical realism, we explore the phenomenon through the lens of 'generative mechanisms'. Specifically, we identify three different mechanisms that underlie successful telemedicine, namely, (1) Mechanism of rich connectivity, which refers to the expanding scope of information flow between the nodes to include multiple aspects-clinical, managerial and technological; and both online and offline communication; (2) Mechanism of tutoring, which involves learning and skill development of the peripheral doctor; and (3) Mechanism of moulding, which concerns the moulding of naive patients to expert patients, both in technology use and self management of disease. In addition, the paper demonstrates the efficacy of critical realism as a philosophical perspective for providing substantive insights in the field of ICT4H initiatives.
机译：诸如远程医疗之类的信息通信和健康技术（ICT4H）计划有可能弥合城乡可用的医疗服务之间的差距。但是，大多数这样的倡议都无法维持或获得最佳结果。理解有关推动远程医疗计划成功的因素的知识对于从业者，政策制定者和院士来说非常有价值。在这项研究中，通过对印度远程医疗计划中医患互动的定性分析，我们试图确定可以实现成功的远程医疗干预的机制。基于批判现实主义的观点，我们通过“生成机制”的视角来探索这种现象。具体来说，我们确定成功的远程医疗所基于的三种不同机制，即：（1）丰富的连接机制，指的是节点之间信息流的扩展范围，包括临床，管理和技术等多个方面；以及在线和离线通信； （2）辅导机制，涉及外围医生的学习和技能发展； （3）成型机制，涉及在技术使用和疾病自我管理方面将天真的患者成型为专家患者。此外，本文还展示了批判现实主义作为一种哲学观点的功效，可为ICT4H计划领域提供实质性见解。

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