Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US.
Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US.
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DOI：
10.1001/jamanetworkopen.2020.21476
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Stafford RS
中科院分区：
文献类型：
--
作者：
Alexander GC;Tajanlangit M;Heyward J;Mansour O;Qato DM;Stafford RS
2019冠状病毒病（COVID-19）大流行与美国初级保健就诊的数量、类型和内容之间是否存在可量化的关联？在这项对美国国家疾病和治疗指数审计的横截面分析中，该指数审计了2018年第一季度至2020年第二季度之间的10个日历季度中超过1.258亿次初级保健访问，初级保健就诊次数减少21.4%与2018年和2019年第二季度的平均季度访问量相比。对血压和胆固醇水平的评估减少，原因是远程医疗就诊总次数减少，评估频率降低。2019冠状病毒病疫情与2020年第二季度基层医疗服务结构的变化有关，远程医疗就诊的内容与办公室就诊的内容不同。关于2019冠状病毒病（COVID-19）大流行与美国初级保健服务水平和内容之间的关系，人们知之甚少。量化COVID-19大流行期间提供的初级保健的数量，类型和内容的国家变化，特别是在办公室与远程医疗接触方面。IQVIA国家疾病和治疗指数的系列横断面数据分析，这是一项对2018年第一个日历季度（Q1）至2020年第二个日历季度（Q2）的美国门诊治疗进行的2阶段、分层的全国代表性稽查。总体和按患者人群和地理区域分层的访视类型（基于办公室或远程医疗）;血压或胆固醇测量的评估;以及处方药的开始或继续。在2018年1月1日至2019年12月31日的8个日历季度中，（95% CI，1.173 - 1.275亿）和1.303亿（95% CI，1.247 - 1.359亿）美国发生了季度初级保健访视（平均值，1.258亿; 95% CI，1.217 - 1.299亿），其中大部分是办公室访视（92.9%）。2020年，第一季度的总接触次数减少至1.179亿次（95%CI，1.126 - 1.232亿次），第二季度减少至9930万次（95%CI，9490 - 1.038亿次），较2018年和2019年期间第二季度的平均水平减少了21.4%（2700万次访问）。基于网络的访问量下降50.2%（5910万次访问），与2018-2019年第二季度相比，而远程医疗访问量从2018-2019年第二季度总访问量的1.1%增加（季度访问量为140万次）下降至2020年第一季度的4.1%（480万次访问）和2020年第二季度的35.3%（3500万次访问）。血压水平评估出现下降（下降50.1%，4440万人次）和胆固醇水平评估与2018-2019年第二季度水平相比，2020年第二季度减少36.9%，1020万次访问，远程医疗期间的评估比基于办公室的访问更不常见（血压9.6% vs 69.7%; P <0.001;胆固醇13.5% vs 21.6%; P <0.001）。2020年第二季度的新药物就诊量较2018-2019年第二季度的水平下降了26.0%（1410万次）。远程医疗在白色个体和黑人个体中的采用率相似（2020年第一季度/第二季度分别为19.3%和20.5%的患者就诊率），但因地区而异（低至15.1%的就诊率[东北中部地区]，高至26.8%的就诊率[太平洋地区]），并且与地区COVID-19负担无关。COVID-19大流行与基层医疗服务结构的变化有关，远程医疗就诊的内容与办公室就诊的内容不同。这项横断面研究使用国家疾病和治疗指数的数据，量化与美国COVID-19大流行相关的初级保健就诊量和类型的变化以及就诊内容的变化。
Is there a quantifiable association between the coronavirus disease 2019 (COVID-19) pandemic and the volume, type, and content of primary care encounters in the US? In this cross-sectional analysis of the US National Disease and Therapeutic Index audit of more than 125.8 million primary care visits in the 10 calendar quarters between quarter 1 of 2018 and quarter 2 of 2020, primary care visits decreased by 21.4% during the second quarter of 2020 compared with the average quarterly visit volume of the second quarters of 2018 and 2019. Evaluations of blood pressure and cholesterol levels decreased owing to fewer total visits and less frequent assessment during telemedicine encounters. The COVID-19 pandemic was associated with changes in the structure of primary care delivery during the second quarter of 2020, with the content of telemedicine visits differing from that of office-based encounters. Little is known about the association between the coronavirus disease 2019 (COVID-19) pandemic and the level and content of primary care delivery in the US. To quantify national changes in the volume, type, and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based vs telemedicine encounters. Analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index, a 2-stage, stratified nationally representative audit of outpatient care in the US from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020. Visit type (office-based or telemedicine), overall and stratified by patient population and geographic region; assessment of blood pressure or cholesterol measurement; and initiation or continuation of prescription medications. In the 8 calendar quarters between January 1, 2018, and December 31, 2019, between 122.4 million (95% CI, 117.3-127.5 million) and 130.3 million (95% CI, 124.7-135.9 million) quarterly primary care visits occurred in the US (mean, 125.8 million; 95% CI, 121.7-129.9 million), most of which were office-based (92.9%). In 2020, the total number of encounters decreased to 117.9 million (95% CI, 112.6-123.2 million) in Q1 and 99.3 million (95% CI, 94.9-103.8 million) in Q2, a decrease of 21.4% (27.0 million visits) from the average of Q2 levels during 2018 and 2019. Office-based visits decreased 50.2% (59.1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1.1% of total Q2 2018-2019 visits (1.4 million quarterly visits) to 4.1% in Q1 of 2020 (4.8 million visits) and 35.3% in Q2 of 2020 (35.0 million visits). Decreases occurred in blood pressure level assessment (50.1% decrease, 44.4 million visits) and cholesterol level assessment (36.9% decrease, 10.2 million visits) in Q2 of 2020 compared with Q2 2018-2019 levels, and assessment was less common during telemedicine than during office-based visits (9.6% vs 69.7% for blood pressure; P < .001; 13.5% vs 21.6% for cholesterol; P < .001). New medication visits in Q2 of 2020 decreased by 26.0% (14.1 million visits) from Q2 2018-2019 levels. Telemedicine adoption occurred at similar rates among White individuals and Black individuals (19.3% vs 20.5% of patient visits, respectively, in Q1/Q2 of 2020), varied by region (low of 15.1% of visits [East North Central region], high of 26.8% of visits [Pacific region]), and was not correlated with regional COVID-19 burden. The COVID-19 pandemic has been associated with changes in the structure of primary care delivery, with the content of telemedicine visits differing from that of office-based encounters. This cross-sectional study uses data from the National Disease and Therapeutic Index to quantify changes in volume and type of primary care visits and changes in visit content associated with the COVID-19 pandemic in the US.
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10.1016/s1553-7250(11)37055-9
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影响因子：
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