The future of telemedicine visits after COVID-19: perceptions of primary care pediatricians.
The future of telemedicine visits after COVID-19: perceptions of primary care pediatricians.
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DOI：
10.1186/s13584-020-00414-0
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发表时间：
2020-10-20
影响因子：
4.5
通讯作者：
Ashkenazi S
中科院分区：
文献类型：
--
作者：
Grossman Z;Chodick G;Reingold SM;Chapnick G;Ashkenazi S
面对 COVID-19 的全球健康危机，卫生系统越来越多地支持在门诊护理环境中使用远程医疗。目前尚不清楚疫情结束后远程医疗的使用是否会持续增加。这项研究的目的是评估以色列儿科医生在大流行的第一个封锁阶段之前和期间对远程医疗的使用情况，并阐明他们如何预见远程医疗作为大流行后时代的医疗实践媒介。 2020 年 5 月，在第一次封锁宣布结束后不久，向以色列儿科医生分发了一项基于网络的调查。该调查使用两种假设的临床场景，评估了远程医疗的使用频率及其在第一次 COVID-19 封锁之前和期间对临床决策的影响。同样的场景也被用来评估儿科医生如何预见大流行后时期的远程医疗。此外，还检索并分析了马卡比在第一次封锁之前、期间和之后远程医疗使用情况的管理数据。 169 名儿科医生参与了调查（回复率 = 40%）。每天使用短信、图片和视频会议的受访者比例分别从 COVID-19 之前的 24%、15% 和 1% 增加到封锁期间的 40%、40% 和 12%（p < 0.05）。疫情结束后，预计使用短信和图片/视频剪辑的受访者比例预计将分别下降至 27% 和 26% (p < 0.05)，但图片/视频剪辑的受访者比例预计将从之前的 15% 增加到之后的 26% (p < 0.05)。据报道，通过远程医疗治疗疑似肺炎或为疑似中耳炎开抗生素的可能性很高，预计将从 COVID-19 封锁期间的 20% 受访者减少到封锁后的 6%% (p < 0.05)，从封锁期间的 14% 减少到封锁后的 3%。 （p < 0.05）。马卡比管理数据显示，与封锁前的使用水平相比，在封锁期间，电话访问量有所增加，而亲自访问量则有所减少。第一次封锁结束一个月后，现场探访部分恢复到基线水平，电话探访持续增加。第一次封锁前，电话就诊占儿科医生就诊的比例为 0%，封锁期间为 17%，封锁放松后 1 个月为 19%。研究表明，在第一次 COVID-19 封锁期间，初级保健儿科医生对远程医疗技术的使用大幅增加。该研究还发现，儿科医生预计大流行后使用水平将会下降。随着大流行的持续和发展，继续监测远程医疗的使用水平以及对大流行后使用水平的预期非常重要。
Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era. A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed. One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation. The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.
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