Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV.
Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV.
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DOI：
10.1177/1357633x20976036
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发表时间：
2023-04
影响因子：
4.7
通讯作者：
Havlir DV
中科院分区：
文献类型：
--
作者：
Hickey MD;Sergi F;Zhang K;Spinelli MA;Black D;Sola C;Blaz V;Nguyen JQ;Oskarsson J;Gandhi M;Havlir DV
2019冠状病毒病大流行需要将许多常规的初级保健就诊转向远程医疗，这可能会扩大弱势群体在获得护理方面的差距。在一家公共资助的艾滋病毒诊所中，我们的目标是评估基于电话的就诊前规划干预措施，以解决远程医疗的预期障碍。我们对计划于2020年4月15日至5月15日在旧金山弗朗西斯科的Ward 86 HIV诊所接受基于电话的HIV初级保健访视的患者进行了一项务实的随机对照试验。一旦通过电话联系到患者，患者被随机分为两组，一组接受结构化的访视前计划干预，以解决即将到来的远程医疗访视的障碍，另一组接受标准提醒电话。主要结局是远程医疗就诊率。在476次预定的远程医疗就诊中，280名患者通过访视前电话进行了登记。如果病毒未受抑制（比值比（OR）0.11，95%置信区间（CI）0.03-0.48），CD 4 < 200（OR 0.24，95% CI 0.07-0.85）或无家可归（OR 0.24，95% CI 0.07 -0.87），则患者不太可能获得治疗。干预组和对照组的计划访视出勤率无差异（83% v. 78%，OR 1.38，95% CI 0.67-2.81）。一个结构化的电话为基础的规划呼吁，以解决障碍，远程医疗在公共艾滋病毒诊所是不太可能达到患者控制不良的艾滋病毒和无家可归的患者，这表明可能需要在这一人群中的额外的干预措施，以确保获得远程医疗为基础的护理。在通过电话联系的患者中，远程医疗就诊率很高，并且没有通过结构化的访视前干预得到改善，这表明标准提醒在这一人群中可能是足够的。
The COVID-19 pandemic has required a shift of many routine primary care visits to telemedicine, potentially widening disparities in care access among vulnerable populations. In a publicly-funded HIV clinic, we aimed to evaluate a pre-visit phone-based planning intervention to address anticipated barriers to telemedicine. We conducted a pragmatic randomized controlled trial of patients scheduled for a phone-based HIV primary care visit at the Ward 86 HIV clinic in San Francisco from 15 April to 15 May 2020. Once reached by phone, patients were randomized to either have a structured pre-visit planning intervention to address barriers to an upcoming telemedicine visit versus a standard reminder call. The primary outcome was telemedicine visit attendance. Of 476 scheduled telemedicine visits, 280 patients were reached by a pre-visit call to offer enrollment. Patients were less likely to be reached if virally unsuppressed (odds ratio (OR) 0.11, 95% confidence intervals (CI) 0.03–0.48), CD4 < 200 (OR 0.24, 95% CI 0.07–0.85), or were homeless (OR 0.24, 95% CI 0.07–0.87). There was no difference between intervention and control in scheduled visit attendance (83% v. 78%, OR 1.38, 95% CI 0.67–2.81). A structured phone-based planning call to address barriers to telemedicine in a public HIV clinic was less likely to reach patients with poorly-controlled HIV and patients experiencing homelessness, suggesting additional interventions may be needed in this population to ensure access to telemedicine-based care. Among patients reachable by phone, telemedicine visit attendance was high and not improved with a structured pre-visit intervention, suggesting that standard reminders may be adequate in this population.