Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
Int J Med Inform. 2019 Sep;129:260-266. doi: 10.1016/j.ijmedinf.2019.06.025. Epub 2019 Jun 25.
Electronic visits (e-visits) have the potential to expand patients' access to care and reduce healthcare costs. We aimed to describe trends in e-visit adoption among the U.S. office-based physicians and examine physician-and practice-level factors associated with e-visit adoption.
This was a retrospective observational study of 2011-2015 National Ambulatory Medical Care Survey. We used the Cochran-Armitage tests to evaluate trend changes in e-visit adoption among the U.S. office-based physicians. Multivariable logistic regression was used to calculate the odds of adopting e-visits adjusting for physician and practice characteristics.
Our sample included 10,767 respondents, representing 327,836 office-based physicians in the U.S. Our analysis indicated that, in 2015, 15.9% of physicians adopted e-visits, which is a minor increase of 2.2% in total utilization of 13.7% in 2011. The likelihood of adopting e-visits was 2.7 times higher for physicians who have fully implemented electronic health records systems compared (odds ratio, 2.66, [95% CI, 2.16-3.28]) to physicians who have not implemented EHRs. Other predictors of e-visit adoption included primary care rather than specialty care, capitated payment model, and having a secure messaging capability.
Our study demonstrates that overall e-visit adoption is low and has not been implemented as rapidly as other health information technologies. While use of secure information technology could be a facilitator for e-visit implementation, there are other barriers affecting widespread adoption. E-visits are a promising strategy for increasing patients' access to care. Future research is needed to explore implementation barriers that might be impeding e-visit adoption.
电子访视 (e-visit) 有扩大患者获得医疗服务的机会并降低医疗成本的潜力。我们旨在描述美国门诊医生采用电子访视的趋势，并研究与电子访视采用相关的医生和实践层面的因素。
这是一项对 2011-2015 年全国门诊医疗调查的回顾性观察性研究。我们使用 Cochran-Armitage 检验来评估美国门诊医生采用电子访视的趋势变化。多变量逻辑回归用于计算调整医生和实践特征后采用电子访视的可能性。
我们的样本包括 10767 名受访者，代表美国 327836 名门诊医生。我们的分析表明，2015 年有 15.9%的医生采用了电子访视，这比 2011 年总利用率 13.7%略有增加 2.2%。与未实施电子健康记录系统的医生相比，全面实施电子健康记录系统的医生采用电子访视的可能性高出 2.7 倍（优势比，2.66 [95%置信区间，2.16-3.28]）。采用电子访视的其他预测因素包括初级保健而非专科保健、人头付费模式以及具有安全消息传递功能。
我们的研究表明，总体而言，电子访视的采用率较低，并且没有像其他健康信息技术那样迅速实施。虽然使用安全信息技术可能是电子访视实施的促进因素，但还有其他影响广泛采用的障碍。电子访视是增加患者获得医疗服务机会的有前途的策略。需要进一步研究以探索可能阻碍电子访视采用的实施障碍。
