Differences in the Use of Telephone and Video Telemedicine Visits During the COVID-19 Pandemic
Differences in the Use of Telephone and Video Telemedicine Visits During the COVID-19 Pandemic
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DOI：
10.37765/ajmc.2021.88573
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发表时间：
2021-01-01
影响因子：
3.2
通讯作者：
Ganguli, Ishani
中科院分区：
文献类型：
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作者：
Rodriguez, Jorge A.;Betancourt, Joseph R.;Ganguli, Ishani
目的：2019冠状病毒病（COVID-19）大流行迫使卫生系统提供视频和电话访问作为亲自访问的替代方案。虽然视频访问提供了一些好处相比，电话访问，他们需要复杂的设置，这可能不利于一些病人由于“数字鸿沟”。“我们的目标是确定与访问model.Study设计相关的患者和邻居的特征：这是一项横断面研究，从2020年4月23日至6月1日，在一个综合卫生系统中，对1652名成人患者的初级保健和专科保健实践进行了研究。我们的主要结果是访问方式（亲自，视频或电话），这是使用计费代码捕获。我们使用多变量逻辑回归评估了使用视频与电话的预测因素。我们使用分层逻辑回归来确定在选择视频或电话访视时患者、医生和实践水平的方差分量的贡献。结果：我们分析了162，102名患者的231，596次访视。65%的访问是虚拟的（31.7%电话，33.5%视频）。年龄超过65岁的患者（校正比值比[AOR]，0.41; 95% CI，0.40-0.43），黑人（AOR，0.60; 95% CI，0.57-0.63），西班牙裔（AOR，0.76; 95% CI，0.73-0.80），西班牙语（AOR，0.57; 95%CI，0.52-0.61），宽带接入低的地区（AOR，0.93; 95%CI，0.88-0.98）不太可能使用视频访问。实践（38%）和临床医生（26%）比患者（9%）在视频访问使用方面的差异更大。结论：远程医疗访问差异可能会加剧慢性疾病和COVID-19结果的差异。机构应监测视频访问使用人口统计学和装备患者，临床医生和做法，以促进远程医疗公平。
OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic forced health systems to offer video and telephone visits as in-person visit alternatives. Although video visits offer some benefits compared with telephone visits, they require complex setup, which may disadvantage some patients due to the "digital divide." Our objective was to determine patient and neighborhood characteristics associated with visit modality.STUDY DESIGN: This was a cross-sectional study across 1652 primary care and specialty care practices of adult patients at an integrated health system from April 23 to June 1, 2020.METHODS: We used electronic health record and administrative data. Our primary outcome was visit modality (in-person, video, or telephone), which was captured using billing codes. We assessed predictors of using video vs telephone using multivariable logistic regression. We used hierarchical logistic regression to determine the contribution of patient-, physician-, and practice-level components of variance in the choice of video or telephone visits.RESULTS: We analyzed 231,596 visits by 162,102 patients. Sixty-five percent of the visits were virtual (31.7% telephone, 33.5% video). Patients who were older than 65 years (adjusted odds ratio [AOR], 0.41; 95% CI, 0.40-0.43), Black (AOR, 0.60; 95% CI, 0.57-0.63), Hispanic (AOR, 0.76; 95% CI, 0.73-0.80), Spanish-speaking (AOR, 0.57; 95% CI, 0.52-0.61), and from areas with low broadband access (AOR, 0.93; 95% CI, 0.88-0.98) were less likely to use video visits. Practices (38%) and clinicians (26%) drove more of the variation in video visit use than patients (9%).CONCLUSIONS: Telemedicine access differences may compound disparities in chronic disease and COVID-19 outcomes. Institutions should monitor video visit use across demographics and equip patients, clinicians, and practices to promote telemedicine equity.