Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic.
Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2020.31640
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Adusumalli S
中科院分区：
文献类型：
--
作者：
Eberly LA;Kallan MJ;Julien HM;Haynes N;Khatana SAM;Nathan AS;Snider C;Chokshi NP;Eneanya ND;Takvorian SU;Anastos-Wallen R;Chaiyachati K;Ambrose M;O'Quinn R;Seigerman M;Goldberg LR;Leri D;Choi K;Gitelman Y;Kolansky DM;Cappola TP;Ferrari VA;Hanson CW;Deleener ME;Adusumalli S
在2019冠状病毒病（COVID-19）大流行期间，哪些社会人口因素与远程医疗的使用率较高以及使用视频（与电话）进行远程医疗门诊护理相关？在这项队列研究中，148402名患者在COVID-19大流行的早期阶段计划在大型学术卫生系统进行初级保健和医学专业门诊远程医疗访问，年龄较大，亚洲种族，非英语作为患者的首选语言，以及医疗补助与完成的远程医疗访问较少独立相关。年龄较大、女性、黑人、拉丁裔和较低的家庭收入与远程医疗视频的使用率较低有关。这项研究确定了在获得远程医疗的初级保健和专科门诊护理方面存在的种族/民族、性别、年龄、语言和社会经济差异;如果不加以解决，这些差异可能会加剧弱势群体在护理方面存在的不平等。2019冠状病毒病（COVID-19）大流行要求医疗保健提供平台发生转变，需要重新依赖远程医疗。评估COVID-19大流行期间远程医疗使用和远程医疗就诊视频使用是否存在不公平。在这项队列研究中，对2020年3月16日至5月11日期间计划在大型学术卫生系统的初级保健和专科门诊进行远程医疗访问的所有患者进行了回顾性病历审查。年龄、种族/民族、性别、语言、家庭收入中位数和保险类型均从电子病历中确定。成功完成远程医疗就诊和远程医疗就诊的视频（与电话）就诊。多变量模型用于评估社会人口因素（包括性别、种族/民族、社会经济地位和语言）与远程医疗就诊以及视频使用之间的关联。在研究期间，共有148402例患者（86055例女性[58.0%];平均[SD]年龄，56.5 [17.7]岁）计划进行远程医疗访视; 80780例患者（54.4%）完成了访视。在78539例完成访视并指定访视方式的患者中，35824例（45.6%）通过视频进行访视，而24025例（56.9%）通过电话访视。在多变量模型中，（55-64岁组的校正比值比[aOR]为0.85 [95%CI，0.83-0.88]; 65-74岁组的aOR为0.75 [95%CI，0.72-0.78];年龄≥75岁的受试者的aOR，0.67 [95% CI，0.64-0.70]），亚洲人种（aOR，0.69 [95% CI，0.66-0.73]），非英语语言为患者首选语言（aOR，0.84 [95%CI，0.78-0.90]）和医疗补助保险（aOR，0.93 [95%CI，0.89-0.97]）与完成的远程医疗就诊次数较少独立相关。年龄较大55-64岁组aOR为0.79 [95% CI为0.76-0.82]，65-74岁组aOR为0.78 [95% CI为0.74-0.83];年龄≥75岁的受试者的aOR为0.49 [95% CI为0.46-0.53]），女性（aOR，0.92 [95% CI，0.90-0.95]），黑人（aOR，0.65 [95% CI，0.62-0.68]），拉丁裔（aOR，0.90 [95%CI，0.83-0.97]），以及家庭收入较低（收入<50 000美元的aOR为0.57 [95% CI，0.54-0.60];收入为50 000- 100 000美元的aOR为0.89 [95% CI，0.85-0.92]）与远程医疗就诊中较少使用视频相关。这些结果在医学专业中相似。在这项队列研究中，在COVID-19大流行的早期阶段，计划在大型学术卫生系统进行初级保健和医学专业门诊远程医疗访问的患者中，老年患者，亚洲患者和非英语患者的远程医疗使用率较低，而老年患者，女性患者，黑人，拉丁裔和贫困患者的视频使用较少。在获得远程医疗护理方面存在不公平现象，值得进一步关注。这项队列研究评估了在2019年冠状病毒病大流行期间，远程医疗使用和远程医疗视频访问使用是否存在不公平现象。
What sociodemographic factors are associated with higher use of telemedicine and the use of video (vs telephone) for telemedicine visits for ambulatory care during the coronavirus disease 2019 (COVID-19) pandemic? In this cohort study of 148 402 patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older age, Asian race, non-English language as the patient’s preferred language, and Medicaid were independently associated with fewer completed telemedicine visits. Older age, female sex, Black race, Latinx ethnicity, and lower household income were associated with lower use of video for telemedicine care. This study identified racial/ethnic, sex, age, language, and socioeconomic differences in accessing telemedicine for primary care and specialty ambulatory care; if not addressed, these differences may compound existing inequities in care among vulnerable populations. The coronavirus disease 2019 (COVID-19) pandemic has required a shift in health care delivery platforms, necessitating a new reliance on telemedicine. To evaluate whether inequities are present in telemedicine use and video visit use for telemedicine visits during the COVID-19 pandemic. In this cohort study, a retrospective medical record review was conducted from March 16 to May 11, 2020, of all patients scheduled for telemedicine visits in primary care and specialty ambulatory clinics at a large academic health system. Age, race/ethnicity, sex, language, median household income, and insurance type were all identified from the electronic medical record. A successfully completed telemedicine visit and video (vs telephone) visit for a telemedicine encounter. Multivariable models were used to assess the association between sociodemographic factors, including sex, race/ethnicity, socioeconomic status, and language, and the use of telemedicine visits, as well as video use specifically. A total of 148 402 unique patients (86 055 women [58.0%]; mean [SD] age, 56.5 [17.7] years) had scheduled telemedicine visits during the study period; 80 780 patients (54.4%) completed visits. Of 78 539 patients with completed visits in which visit modality was specified, 35 824 (45.6%) were conducted via video, whereas 24 025 (56.9%) had a telephone visit. In multivariable models, older age (adjusted odds ratio [aOR], 0.85 [95% CI, 0.83-0.88] for those aged 55-64 years; aOR, 0.75 [95% CI, 0.72-0.78] for those aged 65-74 years; aOR, 0.67 [95% CI, 0.64-0.70] for those aged ≥75 years), Asian race (aOR, 0.69 [95% CI, 0.66-0.73]), non-English language as the patient’s preferred language (aOR, 0.84 [95% CI, 0.78-0.90]), and Medicaid insurance (aOR, 0.93 [95% CI, 0.89-0.97]) were independently associated with fewer completed telemedicine visits. Older age (aOR, 0.79 [95% CI, 0.76-0.82] for those aged 55-64 years; aOR, 0.78 [95% CI, 0.74-0.83] for those aged 65-74 years; aOR, 0.49 [95% CI, 0.46-0.53] for those aged ≥75 years), female sex (aOR, 0.92 [95% CI, 0.90-0.95]), Black race (aOR, 0.65 [95% CI, 0.62-0.68]), Latinx ethnicity (aOR, 0.90 [95% CI, 0.83-0.97]), and lower household income (aOR, 0.57 [95% CI, 0.54-0.60] for income <$50 000; aOR, 0.89 [95% CI, 0.85-0.92], for $50 000-$100 000) were associated with less video use for telemedicine visits. These results were similar across medical specialties. In this cohort study of patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older patients, Asian patients, and non–English-speaking patients had lower rates of telemedicine use, while older patients, female patients, Black, Latinx, and poorer patients had less video use. Inequities in accessing telemedicine care are present, which warrant further attention. This cohort study evaluates whether inequities are present in telemedicine use and video visit use for telemedicine visits during the coronavirus disease 2019 pandemic.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
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作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
影响因子：
9.7
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Lim, Paulina S.
DOI：
10.1111/j.1532-5415.2010.02959.x
发表时间：
2010-08-01
影响因子：
6.3
作者：
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影响因子：
5.7
作者：
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Phillips, RS
DOI：
10.1016/0021-9681(87)90171-8
发表时间：
1987-01-01
期刊：
JOURNAL OF CHRONIC DISEASES
影响因子：
--
作者：
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通讯作者：
MACKENZIE, CR