Social determinants of telemedicine utilization in ambulatory cardiovascular patients during the COVID-19 pandemic.
Social determinants of telemedicine utilization in ambulatory cardiovascular patients during the COVID-19 pandemic.
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DOI：
10.1093/ehjdh/ztab039
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Bhatt AB
中科院分区：
文献类型：
--
作者：
Brown KJ;Mathenge N;Crousillat D;Pagliaro J;Grady C;Katz N;Singh JP;Bhatt AB
2019年冠状病毒病（COVID-19）大流行导致远程医疗（TM）迅速被用于常规心血管护理。目的探讨COVID-19大流行期间门诊心脏病患者TM使用的预测因素。在这项单中心回顾性研究中，对2020年3月16日至6月19日期间发生的所有门诊心血管疾病进行了评估。不同访视类型（面对面、TM电话、TM视频）的基线特征比较采用卡方检验和学生t检验，p值<0.05为差异有统计学意义。采用多元逻辑回归探讨TM与面对面护理的预测因素。在研究期间，共有8446例患者（86%非西班牙裔白人，42%女性，中位年龄66.8±15.2岁）完成了心血管门诊。门诊护理的主要方式是TM电话（n = 4981, 61.5%），其次是TM视频（n = 2693, 33.2%）。黑人[优势比（OR） 0.56, 95%可信区间（CI）： 0.35-0.94；P值= 0.02]，西班牙裔（OR 0.53, 95% CI: 0.29-0.98; P = 0.04），公共保险（医疗补助OR 0.50, 95% CI: 0.32-0.79; P = 0.003，医疗保险OR 0.65, 95% CI: 0.47-0.89; P = 0.009），邮政编码相关的家庭收入中位数< 7.5万美元，年龄介于0 - 85岁之间，以及诊断为心力衰竭的患者与较少的TM视频接触和更高的面对面护理可能性相关。在老年人、低收入人群以及黑人和西班牙裔种族/族裔群体中，门诊心血管护理的TM视频访问存在显著差异。森林图（左图）显示了TM视频遭遇的调整后的优势比。箱形图（右下）显示了心脏人群的平均收入中位数与种族/民族的关系。图表（右上）突出了与心脏人群中低TM视频使用相关的六个因素。AF，心房颤动；冠心病，冠状动脉疾病；CHD，先天性心脏病；HFpEF，保留射血分数的心力衰竭；HFrEF，心力衰竭伴射血分数降低；HTN,高血压。
The coronavirus disease 2019 (COVID-19) pandemic has resulted in the rapid uptake of telemedicine (TM) for routine cardiovascular care. To examine the predictors of TM utilization among ambulatory cardiology patients during the COVID-19 pandemic. In this single-centre retrospective study, all ambulatory cardiovascular encounters occurring between 16 March and 19 June 2020 were assessed. Baseline characteristics by visit type (in-person, TM phone, TM video) were compared using Chi-square and student t-tests, with statistical significance defined by P-value <0.05. Multivariate logistic regression was used to explore the predictors of TM vs. in-person care. A total of 8446 patients [86% Non-Hispanic (NH) White, 42% female, median age 66.8 ± 15.2 years] completed an ambulatory cardiovascular visit during the study period. TM phone (n = 4981, 61.5%) was the primary mode of ambulatory care followed by TM video (n = 2693, 33.2%). NH Black race [odds ratio (OR) 0.56, 95% confidence interval (CI): 0.35–0.94; P-value = 0.02], Hispanic ethnicity (OR 0.53, 95% CI: 0.29–0.98; P = 0.04), public insurance (Medicaid OR 0.50, 95% CI: 0.32–0.79; P = 0.003, Medicare OR 0.65, 95% CI: 0.47–0.89; P = 0.009), zip-code linked median household income of <$75 000, age >85 years, and patients with a diagnosis of heart failure were associated with reduced access to TM video encounters and a higher likelihood of in-person care. Significant disparities in TM video access for ambulatory cardiovascular care exist among the elderly, lower income, as well as Black and Hispanic racial/ethnic groups. The forest plot (left panel) shows adjusted odds ratios for TM video encounters. The box plot (lower right) shows the relationship of averaged median income in our cardiac population to race/ethnicity. The diagram (upper right) highlights the six factors associated with low TM video use in this cardiac population. AF, atrial fibrillation; CAD, coronary artery disease; CHD, congenital heart disease; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HTN, hypertension.
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DOI：
10.1161/circheartfailure.120.007264
发表时间：
2020-08
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Nayak A;Hicks AJ;Morris AA
通讯作者：
Morris AA
DOI：
10.1161/hcq.0000000000000089
发表时间：
2020-08-01
影响因子：
6.9
作者：
Sims, Mario;Kershaw, Kiarri N.;Suglia, Shakira F.
通讯作者：
Suglia, Shakira F.
影响因子：
6
作者：
Gorodeski, Eiran Z.;Goyal, Parag;Starling, Randall C.
通讯作者：
Starling, Randall C.
影响因子：
37.8
作者：
Carnethon, Mercedes R.;Pu, Jia;Yancy, Clyde W.
通讯作者：
Yancy, Clyde W.
影响因子：
9.7
作者：
Stehlik, Josef;Schmalfuss, Carsten;Pham, Michael
通讯作者：
Pham, Michael