Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Maccabi Healthcare Services, Jerusalem and Shfela District, Modi'in-Maccabim-Re'ut, Israel.
PLoS One. 2019 May 2;14(5):e0216365. doi: 10.1371/journal.pone.0216365. eCollection 2019.
To characterize breast cancer patients who received telephone-based consultations of oncology nurse navigator via telemedical care (TMC patients) and analyze their healthcare utilization (HCU) one year before and after receiving this service.
A retrospective study among Maccabi Healthcare Services enrollees that were newly diagnosed during 2016 (n = 1035). HCU, demographic characteristics and comorbidities were obtained from computerized database. Multivariable ordered logit model was specified for the determinants of HCU by quarters. Independent variables included: annual number of telephone-based consultations, gap between diagnosis and first consultation, age, socio-economic status, eligibility for disability and income security benefits, and comorbidities.
Twenty-two percent of our cohort were TMC patients. Compared to others, these patients were younger and had a lower prevalence of hypertension. A higher proportion of these patients received disability benefits, and a lower proportion received income security benefits. The total average annual HCU of TMC patients (n = 107) before first consultation was $8857 and increased to $44130 in the first year following it (p<0.001), predominantly due to a significant increase in outpatient visits ($20380 vs. $3502, p<0.001) and medication costs ($19339 vs. $1758, p<0.001). The multivariable model revealed that each additional telephone-based consultation decreased the likelihood to be in the lowest quarter of the HCU distribution by 1.1 percentage points (p = 0.015), and increased the likelihood to be in the upper quarter of the HCU distribution by 1.1 percentage points (p = 0.016).
There was a significant increase in outpatient care and medications usage following first consultation. Moreover, a more intense use of this service was associated with elevated HCU. This result may stem from the proactive nature of the telemedical care.
通过远程医疗（TMC）对接受肿瘤护士导航员电话咨询的乳腺癌患者进行特征描述，并分析他们在接受该服务前后一年的医疗保健利用情况（HCU）。
这是一项对 Maccabi 医疗保健服务的参保者进行的回顾性研究，这些参保者在 2016 年期间被新诊断为乳腺癌（n=1035）。HCU、人口统计学特征和合并症均从计算机数据库中获取。采用四分位多变量有序逻辑模型来确定 HCU 的季度决定因素。自变量包括：每年电话咨询次数、诊断与首次咨询之间的时间间隔、年龄、社会经济地位、残疾资格和收入保障福利，以及合并症。
在我们的队列中，有 22%的患者是 TMC 患者。与其他人相比，这些患者更年轻，高血压的患病率更低。这些患者中获得残疾福利的比例更高，获得收入保障福利的比例更低。在首次咨询前，TMC 患者（n=107）的年平均 HCU 总额为 8857 美元，在首次咨询后的第一年增加到 44130 美元（p<0.001），主要是由于门诊就诊（从 20380 美元增加到 3502 美元，p<0.001）和药物费用（从 19339 美元增加到 1758 美元，p<0.001）显著增加。多变量模型显示，每次额外的电话咨询可使 HCU 分布的最低四分位数的可能性降低 1.1 个百分点（p=0.015），并使 HCU 分布的最高四分位数的可能性增加 1.1 个百分点（p=0.016）。
首次咨询后，门诊护理和药物使用量显著增加。此外，更频繁地使用该服务与更高的 HCU 相关。这一结果可能源于远程医疗的主动性质。
