Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study.
Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study.
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DOI：
10.2196/29959
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发表时间：
2021-09-01
影响因子：
7.4
通讯作者：
Xu S
中科院分区：
文献类型：
--
作者：
Qian L;Sy LS;Hong V;Glenn SC;Ryan DS;Morrissette K;Jacobsen SJ;Xu S
在新冠肺炎大流行期间，门诊就诊人数急剧减少，远程医疗就诊人数突然增加，但尚不清楚这些变化是否因患者人口结构和社会经济地位而异。这项研究旨在通过不同人群的人口特征和家庭收入来评估大流行对面对面门诊和远程保健(电话和视频)的影响。我们计算了2020年1月5日至2020年10月31日以及2019年同期南加州Kaiser Permanente(KPSC)成员按年龄、性别、种族/民族和邻居级家庭收入中位数进行的每周门诊和远程医疗就诊率。我们在泊松回归模型中估计了每个亚组在大流行早期(2020年3月22日至4月25日)和大流行后期(2020年10月4日至10月31日)从流行前期(2020年1月5日至3月7日)期间就诊率的百分比变化，同时使用2019年数据对季节性进行了调整。我们通过比较不同亚组95%的CI来检验访问率的变化是否在统计学上有所不同。在2020年1月登记的456万名KPSC成员中，15.0%(n=682,947)是≥65岁，51.5%(n=2,345,020)是女性，39.4%(n=1,795,994)是西班牙裔，7.7%(n=350,721)居住在家庭收入中位数40,000美元的地区。在大流行期间，远程医疗就诊的增加因亚组而异，而门诊就诊的减少是相似的，除了年龄。在各年龄组中，≥65岁人群的远程医疗就诊增加最少(236.6%，95%CI为228.8%-244.5%)，在大流行初期为每1人年4.9次，而在流行前期为每1人年1.5次。在同一时期，在种族/民族群体中，拉美裔个人远程医疗就诊的增幅最大(295.5%，95%CI为275.5%-316.5%)。从收入水平来看，低收入人群的远程医疗就诊增幅最大(313.5%，95%CI为294.8%-333.1%)。到2020年10月，西班牙裔、非西班牙裔黑人和低收入群体的门诊和远程医疗就诊率恢复到流行前的水平。西班牙裔群体和低收入群体在应对新冠肺炎大流行时远程医疗利用的百分比增幅最大。虚拟护理的使用有可能减轻大流行对这些弱势群体的卫生保健利用的影响。
Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patient demographics and socioeconomic status. This study aimed to assess the impact of the pandemic on in-person outpatient and telehealth visits (telephone and video) by demographic characteristics and household income in a diverse population. We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) from January 5, 2020, to October 31, 2020, and the corresponding period in 2019. We estimated the percentage change in visit rates during the early pandemic period (March 22 to April 25, 2020) and the late pandemic period (October 4 to October 31, 2020) from the prepandemic period (January 5 to March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% CIs. Among 4.56 million KPSC members enrolled in January 2020, 15.0% (n=682,947) were ≥65 years old, 51.5% (n=2,345,020) were female, 39.4% (n=1,795,994) were Hispanic, and 7.7% (n=350,721) lived in an area of median household income <US $40,000. Increases in telehealth visits during the pandemic varied across subgroups, while decreases in outpatient visits were similar, except by age. Among age groups, the ≥65 years population had the least increase in telehealth visits (236.6%, 95% CI 228.8%-244.5%), with 4.9 per one person-year during the early pandemic period versus 1.5 per one person-year during the prepandemic period. During the same periods, across racial/ethnic groups, Hispanic individuals had the largest increase in telehealth visits (295.5%, 95% CI 275.5%-316.5%). Across income levels, telehealth visits in the low-income group increased the most (313.5%, 95% CI 294.8%-333.1%). The rate of combined outpatient and telehealth visits in the Hispanic, non-Hispanic Black, and low-income groups returned to prepandemic levels by October 2020. The Hispanic group and low-income group had the largest percentage increase in telehealth utilization in response to the COVID-19 pandemic. The use of virtual care potentially mitigated the impact of the pandemic on health care utilization in these vulnerable populations.
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影响因子：
7.4
作者：
Schreiweis, Bjoern;Pobiruchin, Monika;Bergh, Bjoern
通讯作者：
Bergh, Bjoern
影响因子：
7.4
作者：
Xu S;Glenn S;Sy L;Qian L;Hong V;Ryan DS;Jacobsen S
通讯作者：
Jacobsen S
影响因子：
3
作者：
Call, Kathleen T.;McAlpine, Donna D.;Shippee, Tetyana
通讯作者：
Shippee, Tetyana
影响因子：
5.5
作者：
Hechter, Rulin C.;Qian, Lei;Jacobsen, Steven J.
通讯作者：
Jacobsen, Steven J.
DOI：
10.1093/jamia/ocaa217
发表时间：
2021-01-01
影响因子：
6.4
作者：
Chunara, Rumi;Zhao, Yuan;Mann, Devin M.
通讯作者：
Mann, Devin M.