Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
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DOI：
10.1007/s40618-022-01814-6
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发表时间：
2022-09
影响因子：
5.4
通讯作者：
Ye, S.
中科院分区：
文献类型：
--
作者：
Grauer, A.;Duran, A. T.;Liyanage-Don, N. A.;Torres-Deas, L. M.;Metser, G.;Moise, N.;Kronish, I. M.;Ye, S.
我们的研究探讨了远程医疗在初级保健中的使用是否与糖尿病患者的风险因素评估和控制相关。这是一项于2020年2月至2020年12月在基层医疗网络进行的回顾性1：1倾向评分匹配队列研究。参与者包括18至75岁的糖尿病患者。感兴趣的暴露是任何远程医疗访视。我们确定是否对每位患者的血红蛋白A1 c（HbA 1c）、血压（BP）和低密度脂蛋白胆固醇（LDL-C）进行评估。对于每个风险因素，我们还确定了在评估时风险因素是否得到控制（即，最后HbA 1c <8.0%，BP < 130/80 mmHg，LDL-C < 100 mg/dL）。经过1：1的倾向评分匹配，我们在研究期间确定了1，824例糖尿病患者。远程医疗的使用与所有三个风险因素评估的患者比例较低相关（162/912 [18%]与408/912 [45%]，p < 0.001）。然而，在评估个体风险因素时，远程医疗的使用并没有影响风险因素的控制。与仅接受现场访视的患者相比，接受任何远程医疗访视的患者HbA 1c < 8%的比值比（OR）为1.04（95%CI 0.74至1.46，p = 0.23）。类似地，BP < 130/80 mmHg的OR为1.08（95% CI 0.85-1.36 p = 0.53），LDL-C < 100 mg/dL的OR为1.14（95% CI 0.76-1.72，p = 0.52）。在COVID-19大流行期间，远程医疗的使用与糖尿病患者风险因素评估的差距有关，但对风险因素是否得到控制的影响有限。在线版本包含补充材料，可通过10.1007/s40618-022-01814-6获得。
Our study examined whether telemedicine use in primary care is associated with risk factor assessment and control for patients with diabetes mellitus. This was a retrospective, 1:1 propensity score matched cohort study conducted in a primary care network between February 2020 and December 2020. Participants included patients with diabetes mellitus, ages 18 to 75. Exposure of interest was any telemedicine visit. We determined whether hemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) were assessed for each patient. For each risk factor, we also determined whether the risk factor was controlled when they were assessed (i.e., last HbA1c < 8.0%, BP < 130/80 mmHg, LDL-C < 100 mg/dL). After 1:1 propensity score matching, we identified 1,824 patients with diabetes during the study period. Telemedicine use was associated with a lower proportion of patients with all three risk factors assessed (162/912 [18%], versus 408/912 [45%], p < 0.001). However, when individual risk factors were assessed, telemedicine use did not impact risk factor control. When compared with patients with in-person visit only, the odds ratio (OR) for HbA1c < 8% was 1.04 (95% CI 0.74 to 1.46, p = 0.23) for patients with any telemedicine visit. Similarly, the OR for BP < 130/80 mmHg was 1.08 (95% CI 0.85–1.36 p = 0.53), and the OR for LDL-C < 100 mg/dL was 1.14 (95% CI 0.76–1.72, p = 0.52). Telemedicine use was associated with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic, but had limited impact on whether risk factors were controlled. The online version contains supplementary material available at 10.1007/s40618-022-01814-6.
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