پديد آورندگان :
فدايي زاده، ليدا داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ و ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﯽ- درﻣﺎﻧﯽ ﺷﻬﯿﺪ ﺑﻬﺸﺘﯽ - ﻣﺮﮐﺰ ﺗﺤﻘﯿﻘﺎت ﭘﺰﺷﮑﯽ از راه دور - ﭘﮋوﻫﺸﮑﺪه ﺳﻞ و ﺑﯿﻤﺎري ﻫﺎي رﯾﻮي - ﻣﺮﮐﺰ آﻣﻮزﺷﯽ، ﭘﮋوﻫﺸﯽ و درﻣﺎﻧﯽ ﺳﻞ و ﺑﯿﻤﺎري ﻫﺎي رﯾﻮي - ﺑﯿﻤﺎرﺳﺘﺎن دكتر مسيح دانشوري , شجره، الهام داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ و ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﯽ- درﻣﺎﻧﯽ ﺷﻬﯿﺪ ﺑﻬﺸﺘﯽ - ﻣﺮﮐﺰ ﺗﺤﻘﯿﻘﺎت ﭘﺰﺷﮑﯽ از راه دور - ﭘﮋوﻫﺸﮑﺪه ﺳﻞ و ﺑﯿﻤﺎري ﻫﺎي رﯾﻮي - ﻣﺮﮐﺰ آﻣﻮزﺷﯽ، ﭘﮋوﻫﺸﯽ و درﻣﺎﻧﯽ ﺳﻞ و ﺑﯿﻤﺎري ﻫﺎي رﯾﻮي - ﺑﯿﻤﺎرﺳﺘﺎن دكتر مسيح دانشوري , طاهري، محمد جعفر داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ و ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﯽ- درﻣﺎﻧﯽ ﺷﻬﯿﺪ ﺑﻬﺸﺘﯽ - ﻣﺮﮐﺰ ﺗﺤﻘﯿﻘﺎت ﭘﺰﺷﮑﯽ از راه دور - ﭘﮋوﻫﺸﮑﺪه ﺳﻞ و ﺑﯿﻤﺎري ﻫﺎي رﯾﻮي - ﻣﺮﮐﺰ آﻣﻮزﺷﯽ، ﭘﮋوﻫﺸﯽ و درﻣﺎﻧﯽ ﺳﻞ و ﺑﯿﻤﺎري ﻫﺎي رﯾﻮي - ﺑﯿﻤﺎرﺳﺘﺎن دكتر مسيح دانشوري
كليدواژه :
ﭘﺰﺷﮑﯽ از راه دور , ﻣﺸﺎوره از راه دور , وب ﮐﻨﻔﺮاﻧﺲ , وﯾﺪﯾﻮ ﮐﻨﻔﺮاﻧﺲ
چكيده فارسي :
در ﻋﺼﺮ ﺣﺎﺿﺮ، اﺳﺘﻔﺎده از ﻓﻨﺎوريﻫﺎي ارﺗﺒﺎﻃﯽ در ﺗﻤﺎم ﺣﻮزهﻫﺎي ﻋﻠﻮم از ﺟﻤﻠﻪ ﻋﻠﻢ ﭘﺰﺷﮑﯽ اﺟﺘﻨﺎبﻧﺎﭘﺬﯾﺮ اﺳﺖ. از ﮐﺎرﺑﺮدﻫﺎي اﯾﻦ ﻓﻨﺎوري در ﻋﻠﻢ ﭘﺰﺷﮑﯽ اراﺋﻪ ﺧﺪﻣﺎت ﺗﺨﺼﺼﯽ ﺑﻪ ﻣﻨﺎﻃﻖ ﻣﺤﺮوم، ﺻﺮﻓﻪﺟﻮﯾﯽ در زﻣﺎن و ﮐﻢ ﮐﺮدن ﻣﺴﺎﻓﺖ دﺳﺘﯿﺎﺑﯽ ﺑﻪ ﺧﺪﻣﺎت ﭘﺰﺷﮑﯽ ﻣﯽ ﺑﺎﺷﺪ. در ﻫﻤﯿﻦ راﺳﺘﺎ ﺑﺮ آن ﺷﺪﯾﻢ ﺗﺎ ﺑﺎ راه اﻧﺪازي ﺷﺒﮑﻪ ﭘﺰﺷﮑﯽ از راه دور در ﮐﺸﻮر اﯾﺮان؛ ﻣﺰاﯾﺎ، ﻣﻌﺎﯾﺐ و ﺗﻔﺎوت روش ﻫﺎي ﻣﺨﺘﻠﻒ اﺟﺮاﯾﯽ آن را ارزﯾﺎﺑﯽ ﮐﻨﯿﻢ.
ﺳﺎﻣﺎﻧﻪ ﭘﺰﺷﮑﯽ از راه دور در ﻓﺎز اول در ﯾﮏ ﺑﯿﻤﺎرﺳﺘﺎن ﺷﻬﺮ ﺗﻬﺮان و دو ﺑﯿﻤﺎرﺳﺘﺎن اﻗﻤﺎري ﭘﺎﯾﺘﺨﺖ، ﺗﺤﺖ ﻋﻨﻮان ﻣﺮﮐﺰ ﻣﺮاﻗﺒﺖ ﻫﺎي ﭘﺰﺷﮑﯽ از راه دور )ﺳﺘﺎد ﻣﭙﺎد(، ﺟﻬﺖ اﻧﺠﺎم ﻣﺸﺎوره ﻫﺎي ﭘﺰﺷﮑﯽ راه اﻧﺪازي ﺷﺪ. ﺑﻌﺪ از 3 ﺳﺎل از ﺷﺮوع ﻃﺮح، ﻣﺸﺎوره ﻫﺎي اﻧﺠﺎم ﺷﺪه ﻃﯽ اﯾﻦ ﻣﺪت ارزﯾﺎﺑﯽ ﮔﺮدﯾﺪ. در ﻓﺎز دوم ﺗﻌﺪاد ﺑﯿﻤﺎرﺳﺘﺎن ﻫﺎ ﺑﻪ 7 ﺑﯿﻤﺎرﺳﺘﺎن در داﺧﻞ ﺷﻬﺮ ﺗﻬﺮان ﮔﺴﺘﺮش ﯾﺎﻓﺖ. در اداﻣﻪ ﻧﺘﺎﯾﺞ ﻣﺸﺎوره ﻫﺎ ﻣﻮرد ارزﯾﺎﺑﯽ و ﻣﻘﺎﯾﺴﻪ ﻗﺮار ﮔﺮﻓﺖ.
در ﻃﯽ ﺳﻪ ﺳﺎل ﻓﺎز اول ﻃﺮح 22 ﺑﯿﻤﺎر ﺗﺤﺖ ﻣﺸﺎوره ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﺑﯿﺸﺘﺮﯾﻦ ﺳﺮوﯾﺲ ﻣﻮرد درﺧﻮاﺳﺖ ﺟﻬﺖ ﻣﺸﺎوره، رﯾﻪ )8 ﻣﻮرد، 36/4%( و ﺳﭙﺲ ﻗﻠﺐ و ﻋﺮوق )6 ﻣﻮرد، 27/3%( ﺑﻮد. در ﻃﯽ ده ﻣﺎه ﻓﺎز دوم ﻣﭙﺎد 42 ﻣﺸﺎوره اﻧﺠﺎم ﺷﺪ ﮐﻪ ﺑﯿﺸﺘﺮﯾﻦ ﻣﺸﺎوره ﻫﺎ در زﻣﯿﻨﻪ ﻧﻮروﻟﻮژي )23 ﻣﻮرد( و ﭘﺲ از آن ﺟﺮاﺣﯽ اﻋﺼﺎب )5 ﻣﻮرد( ﺑﻮد. ﺗﻌﺪاد ﻣﺸﺎوره ﻫﺎ در ﻓﺎز دوم ﻧﺴﺒﺖ ﺑﻪ ﻓﺎز اول 588 در ﻣﯿﺎﻧﮕﯿﻦ ﻣﺎﻫﺎﻧﻪ اﻓﺰاﯾﺶ ﭘﯿﺪا ﮐﺮد. ﻫﻤﭽﻨﯿﻦ ﻫﺰﯾﻨﻪ ﻫﺎ در ﺑﺨﺶ ﻫﺎي ﻣﺨﺘﻠﻒ اﯾﺠﺎد زﯾﺮﺳﺎﺧﺖ، اﯾﺠﺎد ﺳﯿﺴﺘﻢ ارﺗﺒﺎﻃﯽ و آﺑﻮﻧﻤﺎن ﻣﺎﻫﺎﻧﻪ ﺑﻪ ﺗﺮﺗﯿﺐ 83/7%، 88/4% و 88/4% در ﻓﺎز دوم ﻧﺴﺒﺖ ﺑﻪ ﻓﺎز اول ﮐﺎﻫﺶ داﺷﺖ.
از ﻣﻬﻤﺘﺮﯾﻦ ﻣﺸﮑﻼت ﻓﺎز اول، ﻋﺪم ﺗﻮاﻧﺎﯾﯽ ﮔﺴﺘﺮش ﺷﺒﮑﻪ ﺗﻠﻪ ﻣﺪﯾﺴﯿﻦ )Telemedicine( ﺑﻮد ﮐﻪ در ﻓﺎز دوم ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار ﻫﺎي وب ﮐﻨﻔﺮاﻧﺲ اﯾﻦ ﻣﻌﻀﻞ ﺗﺎ ﺣﺪود زﯾﺎدي ﻣﺮﺗﻔﻊ ﮔﺮدﯾﺪ. ﺑﮑﺎرﮔﯿﺮي وب ﮐﻨﻔﺮاﻧﺲ ﺑﺠﺎي وﯾﺪﯾﻮ ﮐﻨﻔﺮاﻧﺲ ﺑﺎﻋﺚ ﮐﺎﻫﺶ ﻫﺰﯾﻨﻪ ﻫﺎ، اﻣﮑﺎن ﮔﺴﺘﺮش ﺷﺒﮑﻪ ﺑﻄﻮر وﺳﯿﻊ و ﺑﻪ ﺣﺪاﻗﻞ رﺳﺎﻧﺪن ﺟﺎﺑﺠﺎﯾﯽ ﺑﯿﻤﺎران ﺷﺪ. ﻋﻠﯽ رﻏﻢ ﺗﻤﺎم ﻣﺰاﯾﺎي اﺳﺘﻔﺎده از اﯾﻦ روش، ﮔﺴﺘﺮش ﺷﺒﮑﻪ ﺗﻠﻪ ﻣﺪﯾﺴﯿﻦ ﺑﻮﯾﮋه در ﮐﺸﻮرﻫﺎي در ﺣﺎل ﺗﻮﺳﻌﻪ ﻧﯿﺎزﻣﻨﺪ ﻓﺮﻫﻨﮓ ﺳﺎزي و آﻣﻮزش ﻫﺎي ﭘﯿﻮﺳﺘﻪ ﭘﺮﺳﻨﻞ درﻣﺎﻧﯽ و ﻫﻤﭽﻨﯿﻦ ﺑﯿﻤﺎران ﻣﯽ ﺑﺎﺷﺪ.
چكيده لاتين :
Nowadays, utilization of communication technologies is essential in all fields of science, including medicine. Applying this technologies in medicine can provide specialized care services to deprived areas, save time and reduce distance of accessibility to medical facilities. The present study was conducted to assess advantages and disadvantages of the different methods of telemedicine network execution in Iran.
At the primary phase, the telemedicine network was established between two cooperator district hospitals and one central hospital in Tehran. Then, all of the performed consultations in following three years were evaluated. By the second phase, the telemedicine network was extended to seven cooperative hospitals in Tehran. Following that, the results of the consultations were evaluated and compared, too.
Twenty two patients were entered the study in the first phase. Pulmonary diseases were the most frequently requested consultation (36.4%), followed by cardiology consultations (27.3%). During the ten months of the second phase, 42 teleconsultations were performed; while the most frequent consultation was neurology (23 cases), followed by neurosurgery (5 cases). At the second phase, the mean number of teleconsultations per month increased by 588%, compared to phase one. Also, the costs of the infrastructures, installment of the communication systems and monthly payments of the second phase were decreased by 83.7%, 88.4% and 88.4%, respectively.
One of the most important problems in the primary phase was restricted resources for extension of the telemedicine network. This problem was resolved by using the web conference software during the second phase. Utilization of web conference softwares, instead of video conference ones, resulted in costs reduction, allowed expansion of the network and minimized displacement of the patients. Despite advantages of this facility, expansion of the telemedicine network needs continuous education of medical staff and patients, especially in the developing countries.
