Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians
Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians
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DOI：
10.1001/jamanetworkopen.2020.5873
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发表时间：
2020-06-17
影响因子：
13.8
通讯作者：
Kim, Eileen
中科院分区：
文献类型：
--
作者：
Reed, Mary E.;Huang, Jie;Kim, Eileen
问题 哪些患者特征与选择同一初级保健临床医生的远程医疗就诊或办公室就诊相关？结果 在这项对 110 万名患者和 220 万次初级保健就诊的数据进行的横断面研究中，14% 的就诊被安排为远程医疗（主要通过电话），患者更有可能选择与个人初级保健临床医生一起进行远程医疗。患者人口特征和就诊障碍与选择远程医疗显着相关。意义 这项研究为患者在远程医疗就诊和办公室就诊之间做出选择提供了微妙的背景；本研究中确定的关联可能表明那些面临面对面就诊障碍的人有机会接触移动技术。 重要性视频或电话远程医疗可以让患者无需安排交通或在候诊室花费时间即可获得临床医生的帮助，但人们对选择远程医疗或办公室就诊相关的患者特征知之甚少。目的 检查与选择远程医疗就诊与相同初级保健临床医生就诊相关的患者特征。设计、设置和参与者 这项横断面研究包括 1,131,722 名患者的数据，这些患者在 2016 年 1 月 1 日至 2018 年 5 月 31 日期间通过北加州 Kaiser Permanente 患者门户安排了初级保健预约。确定了通过患者门户预订的所有已完成的初级保健预约。仅包括 7 天内没有任何其他临床就诊的索引就诊，以定义相对独特的患者发起的就医事件。不符合远程医疗资格的常规体检被排除在外。数据分析时间为2018年7月1日至2019年12月31日。 主要结果和措施 患者选择就诊、视频或电话就诊。患者社会人口特征（年龄、性别、种族/族裔、社区社会经济地位、语言偏好）、技术获取（社区住宅互联网、移动门户使用）、拜访患者自己的个人初级保健临床医生以及亲自就诊障碍（旅行时间、停车、费用分摊）的相对风险比（RRR），与选择视频或电话远程医疗（与办公室就诊）相关。结果 在 1 131 722 名患者安排的 2 178 440 次初级保健就诊中，86% 安排为办公室就诊，14% 安排为远程医疗就诊，其中 7% 通过视频进行远程医疗就诊。选择远程医疗与患者的社会人口特征具有统计学显着相关性。例如，65岁及以上的患者比18至44岁的患者选择远程医疗的可能性更低（视频就诊的RRR，0.24；95% CI，0.22-0.26；电话就诊的RRR 0.55；95% CI，0.54-0.57）。选择远程医疗也与技术获取存在显着相关性（居住在住宅互联网接入率高的社区的患者比居住在互联网接入率低的社区的患者更有可能选择视频就诊：RRR，1.10；95% CI，1.06-1.14）；以及亲自就诊的障碍（诊所有付费停车设施的患者比设施有免费停车场的患者更有可能选择远程医疗就诊：视频就诊的 RRR，1.70；95% CI，1.41-2.05；电话就诊的 RRR，1.73，95% CI，1.61-1.86）。结论和相关性 在这项横断面研究中，患者在通过门户网站在线预约时通常选择亲自就诊。远程医疗可能有可能覆盖弱势患者群体，并改善因交通、停车或就诊成本障碍而导致患者就诊的机会。这项横断面研究检查了患者的社会人口特征、技术获取和潜在的面对面就诊障碍，以评估患者特征与远程医疗与面对面医疗保健就诊之间的关联。
Question Which patient characteristics are associated with choosing either a telemedicine visit or an office visit with the same primary care clinician? Findings In this cross-sectional study of data from 1.1 million patients with 2.2 million primary care visits, 14% of visits were scheduled as telemedicine (primarily by telephone), with patients more likely to choose telemedicine with their personal primary care clinician. Patient demographic characteristics, and office visit barriers were significantly associated with choosing telemedicine. Meaning This study suggests a nuanced context for patient choice between a telemedicine visit and an office visit; the associations identified in this study may indicate opportunities for engagement with mobile technology access for those who face barriers to in-person visits.Importance Video or telephone telemedicine can offer patients access to a clinician without arranging for transportation or spending time in a waiting room, but little is known about patient characteristics associated with choosing between telemedicine or office visits. Objective To examine patient characteristics associated with choosing a telemedicine visit vs office visit with the same primary care clinicians. Design, Setting, and Participants This cross-sectional study included data from 1 131 722 patients who scheduled a primary care appointment through the Kaiser Permanente Northern California patient portal between January 1, 2016, and May 31, 2018. All completed primary care appointments booked via the patient portal were identified. Only index visits without any other clinical visits within 7 days were included to define a relatively distinct patient-initiated care-seeking episode. Visits for routine physical, which are not telemedicine-eligible, were excluded. Data were analyzed from July 1, 2018, to December 31, 2019. Main Outcomes and Measures Patient choice between an office, video, or telephone visit. Relative risk ratios (RRRs) for patient sociodemographic characteristics (age, sex, race/ethnicity, neighborhood socioeconomic status, language preference), technology access (neighborhood residential internet, mobile portal use), visiting the patient's own personal primary care clinician, and in-person visit barriers (travel-time, parking, cost-sharing), associated with choice of video or telephone telemedicine (vs office visit). Results Of 2 178 440 patient-scheduled primary care visits scheduled by 1 131 722 patients, 86% were scheduled as office visits and 14% as telemedicine visits, with 7% of the telemedicine visits by video. Choosing telemedicine was statistically significantly associated with patient sociodemographic characteristics. For example, patients aged 65 years and over were less likely than patients aged 18 to 44 years to choose telemedicine (RRR, 0.24; 95% CI, 0.22-0.26 for video visit; RRR 0.55; 95% CI, 0.54-0.57 for telephone visit). Choosing telemedicine was also statistically significantly associated with technology access (patients living in a neighborhood with high rates of residential internet access were more likely to choose a video visit than patients whose neighborhoods had low internet access: RRR, 1.10; 95% CI, 1.06-1.14); as well as in-person visit barriers (patients whose clinic had a paid parking structure were more likely to choose a telemedicine visit than patients whose facility had free parking: RRR, 1.70; 95% CI, 1.41-2.05 for video visit; and RRR, 1.73, 95% CI, 1.61-1.86 for telephone visit). Conclusions and Relevance In this cross-sectional study, patients usually chose an in-person visit when scheduling an appointment online through the portal. Telemedicine may offer the potential to reach vulnerable patient groups and improve access for patients with transportation, parking, or cost barriers to clinic visits.This cross-sectional study examines patient sociodemographic characteristics, technology access, and potential in-person visit barriers to assess the association between patient characteristics and telemedicine vs in-person health care visits.