访问和访问之间的互动频率 在COVID-19之前和之后 远程医疗实施
Sarah Nouri1, Courtney R Lyles2,3,4, Elizabeth B Sherwin4
1Division of Palliative Medicine, Department of Medicine, University of California San Francisco.
JAMA network open
|September 15, 2023
概括
在COVID-19公共卫生紧急情况 (PHE) 期间的远程医疗增加了患者接触,主要是通过访问之间的互动,而不仅仅是收费访问. 这些相互作用的差异在不同患者群体中持续存在,突出显示了在护理获取方面的潜在不平等.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 数字健康数字健康
- 健康 公平 卫生 公平
背景情况:
- COVID-19公共卫生紧急情况 (PHE) 迅速加速了远程医疗的采用,大大改变了患者与临床团队的互动.
- 之前的研究主要集中在收费的患者和临床医生的访问上,可能会忽视其他关键的护理服务组件,如与非收费团队成员的互动或访问之间的通信.
研究的目的:
- 分析随着时间的推移,面对面访问,远程医疗访问和访问之间的互动 (例如,电话,患者门户信息) 的变化.
- 在PHE期间,检查这些变化与患者的关键特征相关,包括年龄,种族/种族,语言和社会经济地位.
主要方法:
- 一项回顾性队列研究分析了2019年4月至2021年3月的糖尿病成人患者在两个城市学术和安全网医疗保健系统中的遭遇.
- 用中断时间序列分析来评估总体接触的趋势,与任何医疗保健团队成员的访问,收费的临床医生访问和访问之间的相互作用,跨越三个时期:PHE前,严格的庇护所和混合PHE.
主要成果:
- 在混合PHE期间,总体患者接触量增加,主要是由于访问间互动的增加,而访问率保持稳定.
- 在混合PHE期间,与PHE前相比,在患者特征之间观察到访问利用的差异较少.
- 然而,访问之间互动的现有差异仍然存在,某些种族/族裔和语言群体 (例如,SFHN的亚洲/华语患者) 与白人/英语患者相比,互动较少.
结论:
- 在PHE期间患者与临床医生接触的增长是由访问间的互动维持的,超出了传统的收费访问.
- 在不同患者群体之间观察到的访问间互动的持续差异表明在护理获取和沟通方面存在潜在的不平等.
- 需要进一步的研究,以了解这些不断变化的护理利用模式,特别是访问之间的互动,对患者结果和医疗保健团队工作负担的影响.
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