Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study.
Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study.
复制标题
DOI：
10.9778/cmajo.20200311
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Cram P
中科院分区：
文献类型：
--
作者：
Bhatia RS;Chu C;Pang A;Tadrous M;Stamenova V;Cram P
2019冠状病毒病（COVID-19）大流行被认为增加了虚拟医疗的使用，但缺乏基于人群的研究。我们的目标是使用来自安大略的全面人口数据，评估COVID-19大流行期间虚拟护理的使用情况。这是一项重复的横断面研究设计。我们使用行政数据评估了2012年至2019年COVID-19大流行之前（2012年至2019年）和2020年1月至8月期间（2020年1月至8月）安大略所有居民的面对面和虚拟访问的变化。我们纳入了所有在安大略进行门诊护理访视的患者。我们排除了非安大略居民或健康卡号码无效或缺失的患者的索赔。我们比较了不同年龄组、社区收入五分位数和慢性病亚组的每月或季度虚拟护理使用情况。我们还研究了可能与虚拟护理使用相关的医生特征。在安大略（人口1460万）的所有居民中，虚拟护理从2019年第二季度占门诊总就诊量的1.6%增加到2020年第二季度的70.6%。每年提供1次或以上虚拟就诊的医生比例由2019年第二季度的7. 0%上升至2020年第二季度的85. 9%。进行虚拟访问的安大略省人比例从2019年的1. 3%增加到2020年的29. 2%。老年患者是虚拟护理的最高用户。2012年至2020年期间，向居住在农村地区的患者提供的虚拟就诊总数比例（与城市地区相比）显著下降，反映了虚拟护理向城市中心越来越多使用的服务的转变。虚拟护理使用率在所有条件下和所有收入五分位数中均呈类似增长。我们的研究结果表明，安大略的虚拟护理方法导致了所有提供者群体、患者年龄、慢性病类型和社区收入的广泛采用。这些发现具有政策意义，包括使用虚拟护理账单代码，以在第二波大流行期间及以后继续使用虚拟护理。
The coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population-based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario. This was a repeated cross-sectional study design. We used administrative data to evaluate changes in in-person and virtual visits among all residents of Ontario before (2012–2019) and during (January–August 2020) the COVID-19 pandemic. We included all patients who had an ambulatory care visit in Ontario. We excluded claims for patients who were not Ontario residents or had an invalid or missing health card number. We compared monthly or quarterly virtual care use across age groups, neighbourhood income quintiles and chronic disease subgroups. We also examined physician characteristics that may have been associated with virtual care use. Among all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020. Older patients were the highest users of virtual care. The proportion of total virtual visits that were provided to patients residing in rural areas (v. urban areas) declined significantly between 2012 and 2020, reflecting a shift in virtual care to a service increasingly used in urban centres. The rates of virtual care use increased similarly across all conditions and across all income quintiles. Our findings show that Ontario’s approach to virtual care led to broad adoption across all provider groups, patient age, types of chronic diseases and neighborhood income. These findings have policy implications, including use of virtual care billing codes, for the ongoing use of virtual care during the second wave of the pandemic and beyond.