Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19.
Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19.
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DOI：
10.1001/jamanetworkopen.2021.4157
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Ebinger JE
中科院分区：
文献类型：
--
作者：
Yuan N;Pevnick JM;Botting PG;Elad Y;Miller SJ;Cheng S;Ebinger JE
在COVID-19大流行期间，向远程心脏病门诊就诊的过渡是否与患者获得护理、诊断测试订购和/或药物处方的差异有关？在这项包含176781次动态心脏病学访视的横断面研究中，使用COVID时代远程访视的患者更可能是亚洲人，黑人或西班牙裔人，拥有私人保险，并患有心血管合并症。与新冠肺炎前的亲自就诊相比，新冠肺炎时代的视频和电话就诊期间的临床医生订购任何药物以及大多数测试的几率明显较低。某些传统上服务不足的患者群体更经常使用远程心脏病诊所访视，但也与不太频繁的测试和处方相关。这项横断面研究检查了心脏病门诊访视数据，以及COVID-19期间向远程访视的过渡是否与患者使用护理、诊断测试订购和药物处方的差异相关。COVID-19大流行导致门诊心血管护理从面对面到远程访问的前所未有的转变。了解向远程访视的过渡是否与患者使用护理、诊断测试订购和药物处方的差异相关。这项横断面研究使用了加州洛杉矶县城市多地点卫生系统在两个时期内所有动态心脏病学就诊的电子健康记录数据：2019年4月1日至2019年12月31日（新冠疫情前）和2020年4月1日至12月31日（新冠疫情时期）。于二零二一年一月至二月进行统计分析。在COVID前期或COVID时期，在31个门诊中的一个进行现场或远程动态心脏病学门诊访视。比较4种访视类型（COVID前亲自（参考）、COVID时代亲自、COVID时代视频、COVID时代电话）的患者特征和药物订购和心脏病特异性检测频率。这项研究分析了87，182例新冠疫情前的面对面访问、74，498例新冠疫情期间的面对面访问、4，720例新冠疫情期间的视频访问和10，381例新冠疫情期间的电话访问的数据。在各次访视中，79 572例患者为女性（45.0%），127 080例患者为非西班牙裔白色人（71.9%），平均（SD）年龄为68.1（17.0）岁。访问COVID时代远程访问的患者更有可能是亚洲人，黑人或西班牙裔人（（cid：129）24 934次疫情前的亲自到访[28. 6%] vs 19 742次疫情期间的亲自到访[26. 5%] vs 3633次疫情期间的视频到访[30. 4%] vs 1435次疫情期间的电话到访[35. 0%]; P <0.001，所有比较），有私人保险（（cid：129）新冠肺炎疫情前的34 063次亲自到访[39. 1%] vs新冠肺炎疫情期间的25 474次亲自到访[34. 2%] vs新冠肺炎疫情期间的2 562次视频到访[54. 3%] vs新冠肺炎疫情期间的4 264次电话到访[41. 1%]; P <0.001，COVID时代面对面与视频和COVID时代面对面与电话），并有心血管合并症（例如，高血压：37 166次COVID前亲自访问[42.6%] vs 31 359次COVID时代亲自访问[42.1%] vs 2006年COVID时代视频访问[42.5%] vs 5181次COVID时代电话访问[49.9%];P <0.001的COVID时代的人与电话;和心力衰竭：14 319个COVID前的人访问[16.4%] vs 10 488 COVID时代的人访问[14.1%] vs 1172 COVID时代的视频访问[24.8%] vs 2674 COVID时代的电话访问[25.8%]; P <0.001，COVID时代面对面与视频和COVID时代面对面与电话）。在调整患者和就诊特征后，与新冠肺炎前的亲自就诊相比，在视频和电话就诊期间，临床医生订购任何药物的几率都较低（新冠肺炎时代的面对面：比值比[OR]，0.62 [95% CI，0.60-0.64]，新冠肺炎时代的视频：OR，0.22 [95% CI，0.20-0.24];新冠肺炎时代的电话：OR，0.14 [95% CI，0.13-0.15]）或检查，如心电图（新冠肺炎疫情时期面对面：OR，0.60 [95% CI，0.58-0.62];新冠肺炎疫情时期视频：OR，0.03 [95% CI，0.02-0.04];新冠肺炎疫情时期电话：OR，0.02 [95%CI，0.01-0.03]）或超声心动图（新冠时代面对面：OR，1.21 [95%CI，1.18-1.24];新冠时代视频：OR，0.47 [95%CI，0.42-0.52];新冠时代电话：OR，0.28 [95%CI，0.25-0.31]）。亚洲人、黑人或西班牙裔患者，有私人保险，并且至少有一种心血管合并症，在COVID时代更频繁地使用远程心血管护理。当比较COVID前与COVID时代以及面对面与远程访问时，临床医生订购诊断测试和药物的数量持续下降。需要进一步的研究来澄清这些减少是否代表了过度使用测试和药物的减少，而不是指示测试和处方的使用不足。
Is the transition to remote cardiology ambulatory visits during the COVID-19 pandemic associated with disparities in patient access to care, ordering of diagnostic tests, and/or medication prescribing? In this cross-sectional study of 176 781 ambulatory cardiology visits, patients using COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals, have private insurance, and have cardiovascular comorbidities. Compared with pre-COVID in-person visits, clinicians during COVID-era video and telephone visits had a significantly lower odds of ordering any medication as well as most tests. Remote cardiology clinic visits were used more often by certain traditionally underserved patient groups but were also associated with less frequent testing and prescribing. This cross-sectional study examines ambulatory cardiology clinic visit data and whether the transition to remote visits during COVID-19 is associated with disparities in patient use of care, diagnostic test ordering, and medication prescribing. The COVID-19 pandemic has led to an unprecedented shift in ambulatory cardiovascular care from in-person to remote visits. To understand whether the transition to remote visits is associated with disparities in patient use of care, diagnostic test ordering, and medication prescribing. This cross-sectional study used electronic health records data for all ambulatory cardiology visits at an urban, multisite health system in Los Angeles County, California, during 2 periods: April 1, 2019, to December 31, 2019 (pre-COVID) and April 1 to December 31, 2020 (COVID-era). Statistical analysis was performed from January to February 2021. In-person or remote ambulatory cardiology clinic visit at one of 31 during the pre-COVID period or COVID-era period. Comparison of patient characteristics and frequencies of medication ordering and cardiology-specific testing across 4 visit types (pre-COVID in-person (reference), COVID-era in-person, COVID-era video, COVID-era telephone). This study analyzed data from 87 182 pre-COVID in-person, 74 498 COVID-era in-person, 4720 COVID-era video, and 10 381 COVID-era telephone visits. Across visits, 79 572 patients were female (45.0%), 127 080 patients were non-Hispanic White (71.9%), and the mean (SD) age was 68.1 (17.0) years. Patients accessing COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals (24 934 pre-COVID in-person visits [28.6%] vs 19 742 COVID-era in-person visits [26.5%] vs 3633 COVID-era video visits [30.4%] vs 1435 COVID-era telephone visits [35.0%]; P < .001 for all comparisons), have private insurance (34 063 pre-COVID in-person visits [39.1%] vs 25 474 COVID-era in-person visits [34.2%] vs 2562 COVID-era video visits [54.3%] vs 4264 COVID-era telephone visits [41.1%]; P < .001 for COVID-era in-person vs video and COVID-era in-person vs telephone), and have cardiovascular comorbidities (eg, hypertension: 37 166 pre-COVID in-person visits [42.6%] vs 31 359 COVID-era in-person visits [42.1%] vs 2006 COVID-era video visits [42.5%] vs 5181 COVID-era telephone visits [49.9%]; P < .001 for COVID-era in-person vs telephone; and heart failure: 14 319 pre-COVID in-person visits [16.4%] vs 10 488 COVID-era in-person visits [14.1%] vs 1172 COVID-era video visits [24.8%] vs 2674 COVID-era telephone visits [25.8%]; P < .001 for COVID-era in-person vs video and COVID-era in-person vs telephone). After adjusting for patient and visit characteristics and in comparison with pre-COVID in-person visits, during video and telephone visits, clinicians had lower odds of ordering any medication (COVID-era in-person: odds ratio [OR], 0.62 [95% CI, 0.60-0.64], COVID-era video: OR, 0.22 [95% CI, 0.20-0.24]; COVID-era telephone: OR, 0.14 [95% CI, 0.13-0.15]) or tests, such as electrocardiograms (COVID-era in-person: OR, 0.60 [95% CI, 0.58-0.62]; COVID-era video: OR, 0.03 [95% CI, 0.02-0.04]; COVID-era telephone: OR, 0.02 [95% CI, 0.01-0.03]) or echocardiograms (COVID-era in-person: OR, 1.21 [95% CI, 1.18-1.24]; COVID-era video: OR, 0.47 [95% CI, 0.42-0.52]; COVID-era telephone: OR, 0.28 [95% CI, 0.25-0.31]). Patients who were Asian, Black, or Hispanic, had private insurance, and had at least one of several cardiovascular comorbidities used remote cardiovascular care more frequently in the COVID-era period. Clinician ordering of diagnostic testing and medications consistently decreased when comparing pre-COVID vs COVID-era and in-person vs remote visits. Further studies are needed to clarify whether these decreases represent a reduction in the overuse of tests and medications vs an underuse of indicated testing and prescribing.
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