在VHA的远程医疗接入和替代
Jessica Lum1, Izabela Sadej2,3, Steven D Pizer2,3
1VA Boston Healthcare System, Boston, MA, USA. jessica.lum2@va.gov.
Journal of general internal medicine
|February 23, 2024
概括
退伍军人卫生管理局 (VHA) 扩大了精神卫生 (MH) 服务的远程医疗,患者的偏好推动了使用. 虽然远程医疗增加了获得机会,但面对面的护理仍然很重要,特别是对于老年人和农村退伍军人来说.
科学领域:
- 医疗保健提供 医疗保健提供
- 心理健康服务 心理健康服务
- 远程医学研究 远程医学研究
背景情况:
- 退伍军人卫生管理局 (VHA) 在应对COVID-19时显著扩大了远程医疗服务.
- 这项研究考察了在VHA内从面对面的心理健康 (MH) 护理转向远程医疗的转变.
- 关注的重点领域包括设施,提供者和患者利用模式以及获得护理.
研究的目的:
- 评估远程医疗在VHA中多大程度上取代了面对面的心理健康护理.
- 调查患者偏好在推动远程医疗采用的作用.
- 为了比较通过等待时间来衡量远程医疗与面对面预约的护理机会.
主要方法:
- 对门诊精神卫生预约的VHA电子健康记录的分析 (2019年1月-2023年2月).
- 根据设施,提供者和患者随着时间的推移计算远程医疗比例.
- 检查患者偏好,提供者的行为,以及不同预约方式的等待时间,根据患者人口统计学 (年龄,城市/农村) 分层.
主要成果:
- 心理健康的远程医疗在COVID-19后急剧增长,所有设施都提供服务,大多数提供商都在使用它.
- 患者利用率两极分化:56%的患者完全使用远程医疗,36%的患者完全使用面对面的护理.
- 患者的偏好,而不是提供者的偏好,驱使了专门的远程医疗使用;视频更喜欢通过电话.
- 面对面和视频预约的等待时间相似 (差距小于1天),表明可比性访问.
- 年轻和城市患者更多地使用远程医疗;老年和农村患者更倾向于亲自护理.
结论:
- VHA成功扩展了远程医疗,为许多退伍军人提供了更好的服务.
- 护理的混合方法仍然存在,承认不同的方式可以满足不同的需求和偏好.
- 患者的偏好是专门使用远程医疗的关键驱动因素.
- 像连接和数字素养这样的障碍可能会影响老年农村人口的个人护理偏好.
- 需要进一步的研究来优化患者满意度,质量和效率的模式组合.
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