Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic.
Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic.
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DOI：
10.1016/j.jpurol.2020.09.028
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发表时间：
2020-12
影响因子：
2
通讯作者：
Kern NG
中科院分区：
文献类型：
--
作者：
Winkelman AJ;Beller HL;Morgan KE;Corbett ST;Leroy SV;Noona SW;Berry KL;Kern NG
远程医疗视频就诊是一种未得到充分利用的医疗保健提供方式。然而，由于 COVID-19 大流行，实践正在迅速采用远程医疗来进行患者护理。我们描述了我们在三级学术儿科泌尿外科实践中快速引入视频就诊的经验，主要为 COVID-19 大流行期间的农村患者提供服务。本研究的主要目的是评估访问成功率并确定完成视频访问的障碍。第二个目标是确定适合视频访问的病理类型并节省旅行时间。我们假设社会经济地位是一次成功访问的预测因素。前瞻性地收集和分析视频访问的数据，重点关注访问成功，定义为提供商评估的访问圆满完成。收集的其他变量包括持续时间、视频平台和技术问题。通过图表审查收集回顾性数据并进行分析，包括人口统计、保险和护理距离。使用根据患者邮政编码生成的贫困社区指数来估计社会经济状况。在 116 次尝试访问中，81% 成功。失败的两大原因是“未出现”（64%）和无法连接（14%）。在患者年龄 (p = 0.23)、性别 (p = 0.42)、就诊类型（初次与已确定）(p = 0.51) 和社会经济地位 (p = 0.39) 方面，就诊成功与失败的情况相似。在对种族、社会经济地位和提供者类型进行调整后，拥有公共保险仍然是失败的重要预测因素 (p = 0.017)。对多种常见儿科泌尿系统问题进行了成功的就诊（不包括检查时需要触诊的就诊），在大多数情况下，视频足以进行体检（汇总表）。平均节省了 2.25 小时的出行时间。解决了主要诊断问题。虽然使用贫困社区指数估计的社会经济地位并不能预测视频就诊的成功，但拥有公共保险的患者更有可能视频就诊失败。有令人信服的证据表明，在儿科泌尿外科实践中，可以用最少的准备时间快速实现对某些病理的有效视频访问。
Telemedicine video visits are an under-utilized form of delivering health care. However due to the COVID-19 pandemic, practices are rapidly adapting telemedicine for patient care. We describe our experience in rapidly introducing video visits in a tertiary academic pediatric urology practice, serving primarily rural patients during the COVID-19 pandemic. The primary aim of this study was to assess visit success rate and identify barriers to completing video visits. The secondary aim identified types of pathologies feasible for video visits and travel time saved. We hypothesize socioeconomic status is a predictor of a successful visit. Data was prospectively collected and analyzed on video visits focusing on visit success, defined by satisfactory completion of the visit as assessed by the provider. Other variables collected included duration, video platform and technical problems. Retrospective data was collected via chart review and analyzed including demographics, insurance, and distance to care. Socioeconomic status was estimated using the Distressed Communities Index generated for patient zip code. Out of 116 attempted visits, 81% were successful. The top two reasons for failure were “no-show” (64%) and inability to connect (14%). Success versus failure of visit was similar for patient age (p = 0.23), sex (p = 0.42), type of visit (initial vs. established) (p = 0.51), and socioeconomic status (p = 0.39). After adjusting for race, socioeconomic status, and type of provider, having public insurance remained a significant predictor of failure (p = 0.017). Successful visits were conducted on multiple common pediatric urologic problems (excluding visits requiring palpation on exam), and video was sufficient for physical exams in most cases (Summary Table). A median of 2.25 h of travel time was saved. Primary diagnoses addressed. While socioeconomic status, estimated using the Distressed Communities Index, did not predict success of video visits, patients with public insurance were more likely to have a failed video visit. There is compelling evidence that effective video visits for certain pathologies can be rapidly achieved in a pediatric urology practice with minimal preparation time.
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