Telehealth and pediatric care: policy to optimize access, outcomes, and equity.
Telehealth and pediatric care: policy to optimize access, outcomes, and equity.
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DOI：
10.1038/s41390-022-02306-2
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发表时间：
2022-12
影响因子：
3.6
通讯作者：
Keller, David
中科院分区：
文献类型：
--
作者：
Ray, Kristin N.;Keller, David
医疗保险和医疗补助服务中心（CMS）将远程医疗定义为“当你和病人不在同一地点时，利用电子信息和电信技术延长护理时间”。1 CMS区分了不同的远程医疗模式，包括实时交互（同步）远程医疗、存储转发（异步）远程医疗和远程患者监护。在2019冠状病毒病大流行之前，远程医疗很少用于儿科护理，每年每1000名儿童约有8次就诊2，尽管具体的远程医疗模式正在增长，包括远程精神病学和商业直接面向消费者的远程医疗。3 .采用的障碍包括不同州和医疗计划的支付政策，这些政策限制了可以提供虚拟服务的临床医生、患者可以接受虚拟服务的地点以及可能预期的支付。随着与covid -19相关的突发公共卫生事件（PHE），与临床医生付款、患者共同付款、患者护理地点和HIPAA合规性有关的远程医疗障碍迅速消除。与此同时，使用远程保健的非经济激励突然变得巨大，因为远程护理提高了临床医生和患者免受感染风险的安全性。2020年3月和4月，初级保健和亚专科儿科医生迅速调整了他们的做法，通过实时互动远程医疗视频访问提供大部分护理。4,5随着流行病的发展和公共卫生服务的最终终结迫在眉睫，迫切需要制定政策，以促进最佳儿童健康结果和公平的方式支持远程保健的持续使用。在这里，我们讨论最佳远程医疗使用原则和支持这种使用所需的政策。
The Centers for Medicare and Medicaid Services (CMS) defines telehealth as “the use of electronic information and telecommunications technology to extend care when you and the patient aren’t in the same place at the same time”. 1 CMS differentiates between different telehealth modalities, including live interactive (synchronous) telehealth, store-and-forward (asynchronous) telehealth, and remote patient monitoring. Prior to the COVID-19 pandemic, telehealth was infrequently used in pediatric care, with approximately eight visits annually for every 1000 children, 2 although specific telehealth models were growing including telepsychiatry and commercial direct-to-consumer telehealth. 3 Barriers to uptake included payment policy that varied across state and health plans and that limited the clinicians who could provide virtual services, the locations where patients could receive virtual services, and the payment that could be expected. With the COVID-19-related public health emergency (PHE), barriers to telehealth relating to clinician payment, patient copays, patient site of care, and HIPAA compliance were rapidly removed. At the same time, non-financial incentives to use telehealth were suddenly substantial, in that remote care enhanced safety from infectious risk for both clinicians and patients. In March and April 2020, primary care and subspecialty pediatricians rapidly pivoted their practices to deliver a large proportion of care via live interactive telehealth video visits. 4, 5 As the pandemic evolves and the eventual end of the PHE looms, there is an urgent need to develop policy to support the ongoing use of telehealth in ways that promote optimal child health outcomes and equity. Here we discuss principles of optimal telehealth use and the policies needed to support such use.
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影响因子：
--
作者：
Thompson, C;Margo, T;Lehmann, C U
通讯作者：
Lehmann, C U
DOI：
10.3122/jabfm.2022.03.210509
发表时间：
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影响因子：
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