The association between video or telephone telemedicine visit type and orders in primary care.
The association between video or telephone telemedicine visit type and orders in primary care.
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DOI：
10.1186/s12911-022-02040-z
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发表时间：
2022-11-19
影响因子：
3.5
通讯作者：
Reed, Mary
中科院分区：
文献类型：
--
作者：
Juergens, Nathan;Huang, Jie;Gopalan, Anjali;Muelly, Emilie;Reed, Mary
远程医疗越来越依赖于初级保健的护理服务，但访问类型对临床订购行为的影响是不确定的。在Kaiser Permanente北方加州，我们确定了在2020年4月1日至2020年10月31日期间，在COVID-19的物理距离限制实施期间，自行安排并完成与其个人初级保健提供者或同一医疗组中另一名可用初级保健提供者的远程医疗接触的患者。我们收集了患者的社会人口统计学和临床特征，技术访问的措施，并对最常见的初次就诊诊断进行分类。我们测量了八个诊断组（皮肤和软组织，肌肉骨骼疼痛，背痛，一般胃肠道，高血压和糖尿病，精神健康，上呼吸道和腹痛）中每个组的患者计划视频与电话访问的比例，并比较了每个诊断组内的药物，抗生素，实验室和成像研究的医生订单。其中包括273，301次会面，86，676次（41.5%）视频访问和122，051次（58.5%）电话访问。在诊断组中，皮肤软组织疾病的视频就诊比例最高（59.7%），而心理健康疾病的电话就诊比例最高（71.1%）。调整协变量后，视频访视期间药物医嘱（46.6% vs. 44.5%）、影像学医嘱（17.3% vs. 14.9%）、实验室医嘱（19.5% vs. 17.2%）和抗生素医嘱（7.5% vs. 5.2%）的总体发生率高于电话访视（p < 0.05）。诊断组内最大的差异是皮肤和软组织疾病，其中药物订单的比例比视频访视期间高9.1%，比电话访视高9.1%（45.5%对36.5%，p < 0.05）。我们观察到，在常见的初级保健条件下，远程医疗遇到的访问类型的临床医生订单的统计学显着差异。我们的研究结果表明，在某些情况下，视频访问期间传达的视觉信息可能会促进临床检查和治疗。在线版本包含补充材料，可通过10.1186/s12911-022-02040-z获得。
Telemedicine is increasingly relied upon for care delivery in primary care, but the impact of visit type on clinical ordering behavior is uncertain. Within Kaiser Permanente Northern California, we identified patients who self-scheduled and completed telemedicine encounters with their personal primary care provider or another available primary care provider in the same medical group, between April 1st, 2020, and October 31st, 2020, while physical distancing restrictions for COVID-19 were in place. We collected patient sociodemographic and clinical characteristics, measures of technology access, and categorized the most common primary encounter diagnoses. We measured proportions of patient-scheduled video versus telephone visits for each of eight diagnosis groups (Skin & Soft Tissue, Musculoskeletal Pain, Back Pain, General Gastrointestinal, Hypertension & Diabetes, Mental Health, Upper Respiratory, and Abdominal Pain), and compared physician orders for medications, antibiotics, lab and imaging studies by visit type within each diagnosis group. There were 273,301 included encounters, with 86,676 (41.5%) video visits and 122,051 (58.5%) telephone visits. Of the diagnosis groups, Skin & Soft Tissue conditions had the highest proportion of video visits (59.7%), while Mental Health conditions had the highest proportion of telephone visits (71.1%). After adjusting for covariates, the overall rates of medication orders (46.6% vs. 44.5%), imaging orders (17.3% vs. 14.9%), lab orders (19.5% vs. 17.2%), and antibiotic orders (7.5% vs. 5.2%) were higher during video visits as compared to telephone visits (p < 0.05). The largest difference within diagnosis groups was for Skin & Soft Tissue conditions, where the rate of medication orders was 9.1% higher than during video visits than telephone visits (45.5% vs. 36.5%, p < 0.05). We observed statistically significant differences in clinician orders by visit type during telemedicine encounters for common primary care conditions. Our findings suggest that, for certain conditions, visual information conveyed during video visits may promote clinical work-up and treatment. The online version contains supplementary material available at 10.1186/s12911-022-02040-z.
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影响因子：
10.9
作者：
Resneck, Jack S.;Abrouk, Michael;Edison, Karen E.
通讯作者：
Edison, Karen E.
DOI：
10.1093/jamia/ocaa072
发表时间：
2020-07-01
影响因子：
6.4
作者：
Mann, Devin M.;Chen, Ji;Nov, Oded
通讯作者：
Nov, Oded
影响因子：
39
作者：
Schoenfeld AJ;Davies JM;Marafino BJ;Dean M;DeJong C;Bardach NS;Kazi DS;Boscardin WJ;Lin GA;Duseja R;Mei YJ;Mehrotra A;Dudley RA
通讯作者：
Dudley RA
影响因子：
8
作者：
Ray, Kristin N.;Shi, Zhuo;Mehrotra, Ateev
通讯作者：
Mehrotra, Ateev
影响因子：
2.1
作者：
Tenforde, Adam S.;Iaccarino, Mary A.;Borg-Stein, Joanne
通讯作者：
Borg-Stein, Joanne