Disparities in telehealth utilization in patients with pain during COVID-19.
Disparities in telehealth utilization in patients with pain during COVID-19.
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DOI：
10.1097/pr9.0000000000001001
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发表时间：
2022-05
期刊：
影响因子：
4.8
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中科院分区：
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补充数字内容可在文本中获得。对于第一波COVID-19期间纽约市的疼痛患者，社会人口因素与远程医疗利用之间的关系随着时间的推移而演变。在2019冠状病毒病大流行期间，从亲自就诊到远程就诊的转变给疼痛患者带来了独特的挑战。在获得保健服务方面的差距已经存在，远程保健对这些不平等的影响尚未得到研究。在COVID-19大流行期间，随着社会距离限制的发展，确定通过视频、电话和当面就诊获得护理的疼痛患者的社会人口学特征。使用我们的机构临床数据仓库，我们在基线期间（2019年9月23日- 2020年3月22日）在纽约市一家大型学术机构确定了3314名接受治疗的疼痛患者，并统计了以下情况下的电话、视频和亲自就诊：一个是关闭期（2020年3月23日至2020年5月23日），严格限制非必要的亲自访问，另一个是重新开放期（2020年5月23日至2020年9月23日），放宽限制，允许亲自访问。根据完成访问的技术将患者分为四组：(1)视频，(2)电话，(3)亲自，(4)不访问。在关闭期间的电话访问组和重新开放期间的亲自访问组中，年龄较大，公共保险，并确定为黑人或西班牙裔的患者比例过高。关闭期间的视频访问增加了在重新开放期间继续使用视频访问的可能性，尽管返回了亲自访问。结果显示，在一个社会距离较远的世界，疼痛患者如何获得临床护理的差异，以及卫生保健提供方法的灵活性可能会减少获得障碍。未来的研究将确定导致疼痛患者远程医疗使用异质性的因素（例如，互联网接入、数字素养、医患关系）。
Supplemental Digital Content is Available in the Text. For patients living with pain in New York City during the first wave of COVID-19, the relationship between sociodemographic factors and telehealth utilization evolved with time. The shift from in-person visits to telehealth visits during the COVID-19 pandemic presented unique challenges for patients with pain. Disparities in health care access already existed, and the impact of telehealth on these inequities has not been studied. To identify sociodemographic characteristics of patients with pain obtaining care through video, telephone, and in-person visits as social distancing restrictions evolved during the COVID-19 pandemic. Using our institutional clinical data warehouse, we identified 3314 patients with pain receiving care at a large academic institution in New York City during a baseline period (September 23, 2019–March 22, 2020) and counted telephone, video, and in-person visits during the following conditions: a shutdown period (March 23, 2020–May 23, 2020), when nonessential in-person visits were strictly limited, and a reopening period (May 23, 2020–September 23, 2020), when restrictions were relaxed and in-person visits were available. Patients were categorized into 4 groups based on the technology used to complete a visit: (1) video, (2) telephone, (3) in-person, and (4) no visit. Patients who were older, publicly insured, and identified as Black or Hispanic were overrepresented in the telephone visit group during shutdown and the in-person group during reopening. A video visit during shutdown increased the likelihood of continued video visit use during reopening despite the return of in-person visits. Results show differences in how patients with pain accessed clinical care in a socially distanced world and that flexibility in method of health care delivery may reduce barriers to access. Future research will identify factors (eg, Internet access, digital literacy, provider–patient relationships) driving heterogeneity in telehealth use in patients with pain.