مقايسه معاينه بيماران از طريق فناوري پزشكي از راه دور و بر بالين بيمار: معاينه ريه

Comparison of physical examination via telemedicine technology and bed side method: Lung Examination

ﺗﻠﻪﻣﺪﯾﺴﯿﻦ ﺑﻪﻣﻌﻨﺎي اراﺋﻪ ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﯽ درﻣﺎﻧﯽ ﺗﻮﺳﻂ ﻓﻨﺎوريﻫﺎي ارﺗﺒﺎﻃﯽ ﻣﯽﺑﺎﺷﺪ. در ﺑﯿﺸﺘﺮﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﯽ درﻣﺎﻧﯽ ﺟﺰ اﺻﻠﯽ و اوﻟﯿﻪ اراﺋﻪ ﺧﺪﻣﺎت ﺷﺎﻣﻞ ﺷﺮح ﺣﺎل و ﻣﻌﺎﯾﻨﻪ ﺑﺎﻟﯿﻨﯽ ﻣﯽﺑﺎﺷﺪ. ﻟﺬا ﺑﺮاي اراﺋﻪ اﯾﻦ ﺧﺪﻣﺎت از ﻃﺮﯾﻖ ﺗﻠﻪﻣﺪﯾﺴﯿﻦ ﻧﯿﺎز ﺑﻪ ﺣﺼﻮل اﻃﻤﯿﻨﺎن از ﻗﺎﺑﻞ اﻋﺘﻤﺎد ﺑﻮدن اﯾﻦ ﻣﻌﺎﯾﻨﺎت وﺟﻮد دارد. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮ آن ﺷﺪﯾﻢ ﺗﺎ ﺑﻪ ﺗﻮاﻓﻖ ﻣﻌﺎﯾﻨﻪ رﯾﻪ ﺑﯿﻤﺎران ﺑﺎ اﺳﺘﻔﺎده از ﺳﯿﺴﺘﻢ ﺗﻠﻪﻣﺪﯾﺴﯿﻦ ﺑﺎ ﻣﻌﺎﯾﻨﻪ از ﻃﺮﯾﻖ ﺑﺎﻟﯿﻦ در ﺑﯿﻤﺎرﺳﺘﺎن ﻣﺴﯿﺢ داﻧﺸﻮري ﺑﭙﺮدازﯾﻢ. ﺑﺮاي اﻧﺠﺎم اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﯿﻤﺎران ﺑﻪ ﺻﻮرت ﺗﺼﺎدﻓﯽ از ﺑﺨﺶﻫﺎي ﻣﺨﺘﻠﻒ ﺑﯿﻤﺎرﺳﺘﺎن دﮐﺘﺮ ﻣﺴﯿﺢ داﻧﺸﻮري اﻧﺘﺨﺎب ﻣﯽﺷﺪﻧﺪ. ﭘﺰﺷﮏ ﻣﻌﺎﯾﻨﻪ ﮐﻨﻨﺪه در اﺗﺎق ﺟﺪاﮔﺎﻧﻪاي ﺣﻀﻮر داﺷﺖ و ﭘﺲ از ﻣﺸﺎﻫﺪه و ﺳﻤﻊ ﻗﺴﻤﺖ ﻫﺎي ﻣﺨﺘﻠﻒ رﯾﻪ از راه دور و ﺑﺎ اﺳﺘﻔﺎده از ﮔﻮﺷﯽ ﭘﺰﺷﮑﯽ دﯾﺠﯿﺘﺎل، ﯾﺎﻓﺘﻪﻫﺎي ﻣﻌﺎﯾﻨﻪ ﺧﻮد را در ﭘﺮﺳﺸﻨﺎﻣﻪ ﭘﺮ ﻣﯽﮐﺮد. ﺳﭙﺲ ﻫﻤﺎن ﭘﺰﺷﮏ ﺑﺮ ﺑﺎﻟﯿﻦ ﺑﯿﻤﺎر رﻓﺘﻪ و ﺗﻤﺎم ﻣﻌﺎﯾﻨﺎت را ﺧﻮد ﻣﺠﺪدا اﻧﺠﺎم ﻣﯽداد و در ﻧﻬﺎﯾﺖ ﺑﺮاي ﺑﺎر دوم ﭘﺮﺳﺸﻨﺎﻣﻪ را ﭘﺮ ﻣﯽﻧﻤﻮد و ﺗﺸﺨﯿﺺ ﻧﻬﺎﯾﯽ را اراﺋﻪ ﻣﯽداد. از ﻣﯿﺎن 84 ﻣﺘﻐﯿﺮ ﻣﻮرد ﺑﺮرﺳﯽ 58 ﻣﻮرد ﺗﻮاﻓﻖ ﺑﯿﻦ ﻣﻌﺎﯾﻨﻪ از راه دور و ﻧﺰدﯾﮏ وﺟﻮد داﺷﺖ ﮐﻪ 47 ﻣﻮرد )55/95%( از اﯾﻦ ﺗﻮاﻓﻖﻫﺎ ﺑﺎ ﮐﺎﭘﺎي ﺑﯿﻦ 1-0/8 ﺑﻮد ﮐﻪ ﺑﻪ ﻣﻌﻨﺎي ﺗﻮاﻓﻖ ﻋﺎﻟﯽ اﺳﺖ و 10 ﻣﻮرد )11/9%( از ﺗﻮاﻓﻖﻫﺎ داراي ﮐﺎﭘﺎي 0/8-0/6 ﺑﻮد ﮐﻪ ﺗﻮاﻓﻖ ﻗﺎﺑﻞ ﻗﺒﻮل ﻣﯽﺑﺎﺷﺪ و ﯾﮏ ﻣﻮرد )1/19%( ﺗﻮاﻓﻖ 0/4 ﺗﺎ 0/6 داﺷﺖ ﮐﻪ ﺗﻮاﻓﻖ ﻣﺘﻮﺳﻂ اﺳﺖ. در 30/95% از ﻣﻮارد، ﺗﻮاﻓﻖ ﺑﯿﻦ ﻣﻌﺎﯾﻨﺎت از راه دور و ﻧﺰدﯾﮏ وﺟﻮد ﻧﺪاﺷﺖ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﯿﺎﻧﮕﺮ ﺗﻮاﻓﻖ ﻣﻌﺎﯾﻨﺎت رﯾﻪ از ﻃﺮﯾﻖ ﺗﻠﻪﻣﺪﯾﺴﯿﻦ و ﺑﺮ ﺑﺎﻟﯿﻦ ﺑﯿﻤﺎران ﻣﯽﺑﺎﺷﺪ ﮐﻪ ﻣﯽﺗﻮاﻧﺪ ﺳﺒﺐ اﻃﻤﯿﻨﺎن ﺑﯿﺸﺘﺮ ﭘﺰﺷﮑﺎن ﺟﻬﺖ اﻧﺠﺎم ﻣﺸﺎوره از ﻃﺮﯾﻖ اﯾﻦ ﺗﮑﻨﻮﻟﻮژي ﺷﻮد.

Telemedicine is the science of using modern technologies in providing health care services. Clinical history taking and physical examination are the main and primary components in the process of delivering medical and healthcare services. Thus ensuring the reliability of such examinations is essential in delivering medical and healthcare services through telemedicine. Therefore it is necessary to compare the findings of remote examinations with those of bedside physical examinations in order to demonstrate the reliability thereof and to ensure both the medical staff and the patient that they may safely rely on the accuracy of remote examinations. The present study examines compatibility between findings of examination of a sample of patients with pulmonary disease at Dr. MasihDaneshvari Hospital obtained both remotely and at bed side.For the purpose of this study, patients were randomly selected from various wards of Dr. MasihDaneshvari Hospital.Observation and auscultation were remotely carried out by a physician who was stationed in a separate room and filled a questionnaire. Then the same physician repeated all the physical examinations at the patient's bedside and filled a second questionnaire. Thereafter the final diagnosis was presented. There was compatibility between the results of the two methods i.e. remote and physical examination in 58 out of the total 84 studied variables of which 47 (55.95%) cased demonstrated a Kappa of 0.8 to 1, which is rated as "excellent", 10 (11.9%) cases demonstrated a Kappa of 0.6 to 0.8, which is rated as "acceptable", and one case (1.19%) demonstrated a Kappa of 0.4 to 0.6, which is rated as "moderate". There was no compatibility between the results of the two methods in 30.95 percent of the cases. The present study suggests that the results of the lung examinations conducted remotely and at bed side are compatible. This finding can further assure the medical staff and encourage them to cooperate more in performing telemedicine consultations which will in turn promote utilization of this method of medical management.