Disconnected: a survey of users and nonusers of telehealth and their use of primary care
Disconnected: a survey of users and nonusers of telehealth and their use of primary care
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DOI：
10.1093/jamia/ocy182
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发表时间：
2019-05-01
影响因子：
6.4
通讯作者：
Bazemore, Andrew W.
中科院分区：
文献类型：
--
作者：
Liaw, Winston R.;Jetty, Anuradha;Bazemore, Andrew W.
目的：本研究旨在从患者的角度评估远程保健在初级保健中的认知、认知和价值。材料和方法：我们对能够获得远程保健服务的成年人进行了一项基于网络的横断面调查，这些成年人在远程保健期间就诊的20种最常见的诊断中的任何一种都去了医疗保健提供者那里。结果：在32831名受邀患者中，3219人(9.8%)回答，766人符合资格标准并完成调查：390人(51%)RU，117人(15%)，259人(34%)。RU最不可能有初级保健通常的护理来源(65.6%vs78.6%vs80.0%；NRNUs；P<；.001)。近一半(46.8%)的RU无法预约他们的医生，34.8%的人表示他们的医生办公室关闭了。在这3个群体中，远程医疗用户最有可能就业(89.5%比88.9%比82.2%；P=.007)，受过高中后教育(94.4%比93.2%比86.5%；P=.003)，以及生活在城市(81.0%比69.2%比76.0%；P=.021)。结论：远程医疗用户报告他们依赖视频直播来增强访问，与初级保健联系较少。远程保健可能会扩大服务机会，但如果不能与通常的病人护理来源更好地协调和分享信息，就有可能进一步分散护理，破坏初级保健职能。
Objective: The study sought to assess awareness, perceptions, and value of telehealth in primary care from the perspective of patients.Materials and Methods: We conducted a cross-sectional, Web-based survey of adults with access to telehealth services who visited healthcare providers for any of the 20 most-commonly seen diagnoses during telehealth visits. Three groups were studied: registered users (RUs) of telehealth had completed a LiveHealth Online (a health plan telehealth service provider) visit, registered nonusers (RNUs) registered for LiveHealth Online but had not conducted a visit, and nonregistered nonusers (NRNUs) completed neither step.Results: Of 32831 patients invited, 3219 (9.8%) responded and 766 met eligibility criteria and completed surveys: 390 (51%) RUs, 117 (15%) RNUs, and 259 (34%) NRNUs. RUs were least likely to have a primary care usual source of care (65.6% vs 78.6% for RNUs vs 80.0% for NRNUs; P < .001). Nearly half (46.8%) of RUs were unable to get an appointment with their doctor, and 34.8% indicated that their doctor's office was closed. Among the 3 groups, RUs were most likely to be employed (89.5% vs 88.9% vs 82.2%; P = .007), have post-high school education (94.4% vs 93.2% vs 86.5%; P = .003), and live in urban areas (81.0% vs 69.2% vs 76.0%; P = .021).Conclusions: Telehealth users reported that they relied on live video for enhanced access and were less connected to primary care than nonusers were. Telehealth may expand service access but risks further fragmentation of care and undermining of the primary care function absent better coordination and information sharing with usual sources of patients' care.