Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19.
Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19.
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DOI：
10.1001/jamanetworkopen.2023.47686
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发表时间：
2024-01-02
影响因子：
13.8
通讯作者：
Deleire, Thomas
中科院分区：
文献类型：
--
作者：
Tilhou, Alyssa Shell;Jain, Arjun;Deleire, Thomas
这项队列研究评估了远程保健和互联网速度与初级保健使用之间的关系，涉及健康的社会人口学决定因素。在新冠肺炎大流行期间，在获得初级保健远程保健服务方面出现了哪些差距，高速互联网的接入在多大程度上与远程保健利用方面的差距有关？在这项对172名 387威斯康星州医疗补助受益人的队列研究中，远程医疗扩展暴露了远程医疗服务利用方面的差距，即使在拥有高速互联网的受益人中也存在这种差距。这些发现表明，扩大远程医疗服务或接入高速互联网不太可能弥合初级保健服务利用方面的差距。初级保健(PC)收据与更好的健康结果相关。远程医疗的扩张和网速如何与个人电脑的使用相关联尚不清楚。通过健康的社会人口学决定因素，研究远程健康和互联网速度与个人电脑使用之间的联系。这项队列研究对18岁至岁的连续登记的非怀孕、非残疾威斯康星州医疗补助受益人在新冠肺炎突发公共卫生事件之前(2019年6月1日至2020年2月29日)与初始时期(2020年3月1日至2020年5月31日)和延长(2020年3月1日至2021年12月31日)突发公共卫生事件之间面对面和远程健康PC访问的变化进行了差异回归。对2022年3月至2023年3月的数据进行了分析。Phe诱导的远程医疗扩展。PC远程健康(使用当前程序术语代码)访问的变化：(1)计数；(2)远程健康完成的访问份额；(3)由远程健康抵消的由PHE引起的访问下降的百分比。高速互联网(HSI)，定义为居住在最大下载速度中值为940兆比特每秒或更高的人口普查区组中(2020年6月联邦通信委员会宽带数据)；其他被归类为低速互联网(LSI)的人口普查区组。在172名 387参与者中，女性102名 989(59.7%)，非西班牙裔白人103名 848(60.2%)，非西班牙裔黑人34名 258(19.9%)，西班牙裔15名 020(8.7%)，26~45岁的104名 239(60.5%)，居住在城市县的112名 355(66.0%)。其中 433例(82.6%)， 524例(42.1%)，慢性病72例。平均(SD)为每月0.138(0.261)次PHE前PC访问。在PHE前阶段，女性的就诊率显著高于男性参与者，非西班牙裔白人患者的就诊率显著高于非西班牙裔黑人个人，城市居民的就诊率高于农村居民，HSI患者的就诊率高于LSI患者，以及慢性病患者的就诊率高于非慢性病患者。在最初的PHE期间，女性参与者在远程医疗就诊方面的增幅高于男性参与者(43.1%；95%CI，37.02%-49.18%；P <； .001)、份额(2.20个百分点差异[PPD]；95%CI，1.06-3.33PPD；P <； .001)和偏移量(6.81PPD；95%CI，3.74-9.87PPD；P <； .001)。非西班牙裔黑人参与者的份额比非西班牙裔白人参与者更大(5.44PPD；95%CI，4.07-6.81PPD；P <； .001)和偏移量(15.22PPD；95%CI，10.69-19.75PPD；P <； .001)。与非西班牙裔白人参与者相比，西班牙裔参与者在远程医疗就诊方面的增幅更大(35.60%；95%CI，25.55%-45.64%；P <； .001)、份额(8.50PPD；95%CI，6.75-10.26PPD；P <； .001)和偏移量(12.93PPD；95%CI，6.25-19.60PPD；P <； .001)。城市参与者的远程医疗就诊增加(63.87%；95%CI，52.62%-75.11%；P <； .001)，份额(9.13 PPD；95%CI，7.84-10.42 PPD；P <； .001)和偏移量(13.31 PPD；95%CI；9.62-16.99 PPD；P <； .001)。有血缘关系的参与者远距离就诊的比例高于有血缘关系者(55.23%；95%CI，42.26%-68.20%；P <； .001)、份额(6.61 PPD；95%CI，5.00-8.23 PPD；P &l； .001)和偏移者(6.82 PPD；95%CI，2.15-11.49 PPD；P = .004)。有慢性病的参与者远距离就诊的增加幅度大于无慢性病患者(188.07%；95%CI，175.27%-200.86%；P <； .001)、份额(4.50PPD；95%CI，3.58-5.42 PPD；P <； .001)和偏移量(9.03 PPD；95%CI，6.01-12.04 PPD；P <； .001)。延长的Phe差异是相似的。在患有HSI的人中，差异仍然存在。在这项对威斯康星州医疗补助受益人的队列研究中，除了西班牙裔和非西班牙裔黑人个人尽管初级保健前利用率较低，但远程健康接受率在初级保健前使用率较高的群体中出现了更大的远程健康吸收。HSI并没有缩小差距。这些发现表明，远程医疗和HSI可能会增加PC的接收，但通常不会缩小利用率差距。
This cohort study evaluates the association of telehealth and internet speed with primary care use across sociodemographic determinants of health. What disparities emerged in access to primary care telehealth services during the COVID-19 pandemic, and to what degree is access to high-speed internet associated with disparities in telehealth utilization? In this cohort study of 172 387 Wisconsin Medicaid beneficiaries, telehealth expansion exposed disparities in utilization of telehealth services that persisted even among beneficiaries with high-speed internet. These findings suggest that expansion of telehealth service or access to high-speed internet is unlikely to close gaps in utilization of primary care services. Primary care (PC) receipt is associated with better health outcomes. How telehealth expansion and internet speed are associated with PC use is unclear. To examine the association of telehealth and internet speed with PC use across sociodemographic determinants of health. This cohort study performed difference-in-differences regression of the change in in-person and telehealth PC visits between pre–COVID-19 public health emergency (PHE) (June 1, 2019, to February 29, 2020) and an initial (March 1, 2020, to May 31, 2020) and prolonged (March 1, 2020, to December 31, 2021) PHE period among continuously enrolled nonpregnant, nondisabled Wisconsin Medicaid beneficiaries aged 18 to 64 years. Data were analyzed from March 2022 to March 2023. PHE-induced telehealth expansion. Change in PC telehealth (using Current Procedural Terminology codes) visits: (1) count; (2) visit share completed by telehealth; (3) percentage of PHE-induced visit decline offset by telehealth. High-speed internet (HSI) defined as living in a census block group with a median block maximum download speed of 940 megabits per second or greater (June 2020 Federal Communications Commission broadband data); other census block groups classified as low-speed internet (LSI). In the total cohort of 172 387 participants, 102 989 (59.7%) were female, 103 848 (60.2%) were non-Hispanic White, 34 258 (19.9%) were non-Hispanic Black, 15 020 (8.7%) were Hispanic, 104 239 (60.5%) were aged 26 to 45 years, and 112 355 (66.0%) lived in urban counties. A total of 142 433 (82.6%) had access to HSI; 72 524 (42.1%) had a chronic condition. There was a mean (SD) of 0.138 (0.261) pre-PHE PC visits per month. In the pre-PHE period, visit rates were significantly higher for female than male participants, non-Hispanic White than non-Hispanic Black individuals, urban than rural residents, those with HSI than LSI, and patients with chronic disease than patients without. In the initial PHE period, female participants had a greater increase in telehealth visits than male participants (43.1%; 95% CI, 37.02%-49.18%; P < .001), share (2.20 percentage point difference [PPD]; 95% CI, 1.06-3.33 PPD; P < .001) and offset (6.81 PPD; 95% CI, 3.74-9.87 PPD; P < .001). Non-Hispanic Black participants had a greater increase in share than non-Hispanic White participants (5.44 PPD; 95% CI, 4.07-6.81 PPD; P < .001) and offset (15.22 PPD; 95% CI, 10.69-19.75 PPD; P < .001). Hispanic participants had a greater increase in telehealth visits than Non-Hispanic White participants (35.60%; 95% CI, 25.55%-45.64%; P < .001), share (8.50 PPD; 95% CI, 6.75-10.26 PPD; P < .001) and offset (12.93 PPD; 95% CI, 6.25-19.60 PPD; P < .001). Urban participants had a greater increase in telehealth visits than rural participants (63.87%; 95% CI, 52.62%-75.11%; P < .001), share (9.13 PPD; 95% CI, 7.84-10.42 PPD; P < .001), and offset (13.31 PPD; 95% CI; 9.62-16.99 PPD; P < .001). Participants with HSI had a greater increase in telehealth visits than those with LSI (55.23%; 95% CI, 42.26%-68.20%; P < .001), share (6.61 PPD; 95% CI, 5.00-8.23 PPD; P < .001), and offset (6.82 PPD; 95% CI, 2.15-11.49 PPD; P = .004). Participants with chronic disease had a greater increase in telehealth visits than those with none (188.07%; 95% CI, 175.27%-200.86%; P < .001), share (4.50 PPD; 95% CI, 3.58-5.42 PPD; P < .001), and offset (9.03 PPD; 95% CI, 6.01-12.04 PPD; P < .001). Prolonged PHE differences were similar. Differences persisted among those with HSI. In this cohort study of Wisconsin Medicaid beneficiaries, greater telehealth uptake occurred in groups with higher pre-PHE utilization, except for high uptake among Hispanic and non-Hispanic Black individuals despite low pre-PHE utilization. HSI did not moderate disparities. These findings suggest telehealth and HSI may boost PC receipt, but will generally not close utilization gaps.
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影响因子：
13.8
作者：
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通讯作者：
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影响因子：
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