Diagnoses and Health Care Utilization for After-Hours Telemedicine Versus Primary Care Visits
Diagnoses and Health Care Utilization for After-Hours Telemedicine Versus Primary Care Visits
复制标题
DOI：
10.1016/j.acap.2021.07.012
复制
发表时间：
2021-11-01
影响因子：
3.1
通讯作者：
Waisman, Yehezkel
中科院分区：
文献类型：
--
作者：
Leventer-Roberts, Maya;Shimoni, Nadav;Waisman, Yehezkel
目的：在以色列，全国范围内使用儿科医生在线（PO）下班后远程医疗服务已经有十多年了。我们试图比较PO访问与初级保健儿科医生（PCP）。方法：这是一项使用以色列最大的卫生保健提供者数据库的回顾性横断面研究。我们纳入了2015年至2018年间使用PO或PCP的0至18岁儿童。我们比较了基线特征，与社会经济地位、慢性疾病和诊断相匹配，并比较了他们的入院率、实验室检测和药物处方。结果：在本研究期间，共有262,541次PO就诊，随机抽取10%的PCP就诊样本，共1,813,103次就诊。PO的使用者更有可能具有较高的社会经济地位（43%对28.9%），发烧（13.3%对4.4%），并且不太可能患有急性呼吸道疾病（8.8%对16.7%）。PO用户24小时内急诊科入院率（2.9%比0.4%）、住院率（0.9%比0.2%）较高，实验室检测率（3.7%比7.4%）和药物处方率（42.0%比52.0%）较低。差异均有统计学意义（P < 0.005）。结论：我们的儿科远程医疗服务已被发现是可行的，并广泛应用于无数的临床条件。PO和PCP的访视特征和结果存在显著差异。然而，尚不清楚这些差异是否反映了患者群体的差异，还是不同临床服务的结果。有必要进一步研究以澄清此事。
OBJECTIVE: The use of a nation-wide, pediatricians online (PO) after-hours telemedicine service has been offered in Israel for more than a decade. We sought to compare PO visits with those to the primary care pediatrician (PCP).METHODS: This is a retrospective cross-sectional study using Israel's largest health care provider database. We included children aged 0 to 18 years using either PO or PCP between 2015 and 2018. We compared the baseline characteristics, matching by socioeconomic status, chronic illness, and diagnosis, and compared their admission rates, laboratory testing, and medication prescription.RESULTS: During this study period there were 262,541 PO visits and a random 10% sample of PCP visits which yielded 1,813,103 visits. Users of PO were more likely to have a higher socioeconomic status (43% vs 28.9%), fever (13.3% vs 4.4%) and less likely to have acute respiratory conditions (8.8% vs 16.7%). Users of PO had higher rates of emergency department admissions (2.9% vs 0.4%), hospital admissions (0.9% vs 0.2%), and lower rates of laboratory testing (3.7% vs 7.4%) and medication prescription (42.0% vs 52.0%) within 24 hours. All differences were statistically significant (P < .005).CONCLUSIONS: Our pediatric telemedicine service operating after-hours has been found to be feasible, and widely used, for a myriad of clinical conditions. Significant differences exist between PO and PCP visit characteristics and outcomes. However, it remained unclear whether these differences reflect the difference in the patient population or whether they are the result of the different clinical services. Further research is warranted to clarify this matter.