Older adults' access to primary care: Gender, racial, and ethnic disparities in telemedicine.
Older adults' access to primary care: Gender, racial, and ethnic disparities in telemedicine.
复制标题
DOI：
10.1111/jgs.17354
复制
发表时间：
2021-10
影响因子：
6.3
通讯作者：
Brown RT
中科院分区：
文献类型：
--
作者：
Ryskina KL;Shultz K;Zhou Y;Lautenbach G;Brown RT
2020年，初级保健实践采用远程医疗作为面对面访问的替代方案。关于远程医疗是否公平，特别是在老年患者中，人们知之甚少。我们的目标是(1)检查老年人使用远程医疗与面对面初级保健访问的情况；以及(2)比较两组之间因门诊敏感情况(ACSC)而住院的情况。在这项对大西洋中部32家诊所就诊的17,103名65岁≥患者的回顾性横断面研究中，根据2020年3月至5月之间的首次就诊，初级保健患者被分为两组-远程医疗和面对面治疗，并进行了14天的随访。使用多变量Logistic回归，我们测量了通过远程医疗与面对面治疗的几率，作为患者人口统计学、合并症和研究时间的函数。然后，我们通过就诊方式测量了ACSC住院的几率。平均年龄为75.1岁(SD，7.5)，女性占60.6%，白人占64.6%，黑人占28.1%，西班牙裔占2.0%。总体而言，60.3%的患者通过远程医疗获得初级保健。黑人(与白人)患者使用远程医疗的几率较高(AOR，1.30；95%CI，1.14-1.47)，而西班牙裔(与非西班牙裔)患者使用远程医疗的几率较低(AOR，0.63；95%CI，0.42-0.92)。与面对面组相比，远程医疗组患者的ACSC住院几率较低(AOR为0.78；95%CI为0.61-1.00)。在使用远程医疗的患者中，黑人患者比白人患者ACSC住院的几率高1.43(95%CI，1.02-2.01)。与65岁至74岁的患者相比，85岁或以上通过远程医疗就诊的患者ACSC住院的几率更高(AOR 1.60；95%CI，1.03-2.47)。这些发现支持使用远程医疗为老年人提供初级保健。然而，观察到的差异突出了无论访问方式如何，都需要提高护理质量和公平性。
In 2020, primary care practices adopted telemedicine as an alternative to in-person visits. Little is known about whether access to telemedicine was equitable, especially among older patients. Our objectives were to (1) examine older adults’ use of telemedicine versus in-person primary care visits; and (2) compare hospitalization for ambulatory care sensitive conditions (ACSCs) between the groups. In this retrospective cross-sectional study of 17,103 patients aged ≥65 years seen at 32 clinics in the Mid-Atlantic, primary care patients were classified into two groups – telemedicine vs. in-person – based on the first visit between March-May, 2020 and followed for 14 days. Using multivariable logistic regression, we measured the odds of being seen via telemedicine vs. in-person as a function of patient demographics, comorbidities, and week of study period. We then measured the odds of ACSC hospitalization by visit modality. Mean age was 75.1 years (SD, 7.5), 60.6% of patients were female, 64.6% White, 28.1% Black, and 2.0% Hispanic. Overall, 60.3% of patients accessed primary care via telemedicine. Black (vs. White) patients had higher odds of using telemedicine (aOR, 1.30; 95% CI, 1.14–1.47) and Hispanic (vs. not Hispanic) patients had lower odds (aOR, 0.63; 95% CI, 0.42–0.92). Compared to the in-person group, patients in the telemedicine group had lower odds of ACSC hospitalization (aOR 0.78; 95% CI, 0.61–1.00). Among patients who used telemedicine, Black patients had 1.43 higher odds of ACSC hospitalization (95% CI, 1.02– 2.01), compared to White patients. Patients aged 85 or older seen via telemedicine had higher odds of an ACSC hospitalization (aOR 1.60; 95% CI, 1.03–2.47) compared to patients ages 65 to 74. These findings support the use of telemedicine for primary care access for older adults. However, the observed disparities highlight the need to improve care quality and equity regardless of visit modality.
登录
查看更多内容
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
DOI：
10.1177/1090198120965513
发表时间：
2020-12
期刊：
Health education & behavior : the official publication of the Society for Public Health Education
影响因子：
--
作者：
Chatters LM;Taylor HO;Taylor RJ
通讯作者：
Taylor RJ
DOI：
10.1016/0021-9681(87)90171-8
发表时间：
1987-01-01
期刊：
JOURNAL OF CHRONIC DISEASES
影响因子：
--
作者：
CHARLSON, ME;POMPEI, P;MACKENZIE, CR
通讯作者：
MACKENZIE, CR
影响因子：
13.8
作者：
Reed, Mary E.;Huang, Jie;Kim, Eileen
通讯作者：
Kim, Eileen
影响因子：
4.7
作者：
Cimperman, Miha;Brencic, Maja Makovec;Stanonik, Mateja de Leonni
通讯作者：
Stanonik, Mateja de Leonni