Appireddy Ramana, Khan Sana, Leaver Chad, Martin Cally, Jin Albert, Durafourt Bryce A, Archer Stephen L
Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada.
Canada Health Infoway, Toronto, ON, Canada.
J Med Internet Res. 2019 Oct 7;21(10):e13734. doi: 10.2196/13734.
Timely, in-person access to health care is a challenge for people living with conditions such as stroke that result in frailty, loss of independence, restrictions in driving and mobility, and physical and cognitive decline. In Southeastern Ontario, access is further complicated by rurality and the long travel distances to visit physician clinics. There is a need to make health care more accessible and convenient. Home virtual visits (electronic visits, eVisits) can conveniently connect physicians to patients. Physicians use a secure personal videoconferencing tool to connect to patients in their homes. Patients use their device of choice (smartphone, tablet, laptop, or desktop) for the visit.
This study aimed to assess the feasibility and logistics of implementing eVisits in a stroke prevention clinic for seniors.
A 6-month eVisit pilot study was initiated in the Kingston Health Sciences Centre stroke prevention clinic in August 2018. eVisits were used only for follow-up patient encounters. An integrated evaluation was used to test the impact of the program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by telephone interviews, using a brief questionnaire. Access and patient satisfaction metrics were compared with concurrent standard of care (patients' prior personal experience with in-person visits). Values are presented as median (interquartile range).
There were 75 subjects in the pilot. The patients were aged 65 (56-73.5) years, and 39% (29/75) resided in rural areas. There was a shorter wait for an appointment by eVisit versus in-person (mean 59.98 [SD 48.36] days vs mean 78.36 [SD 50.54] days; P<.001). The eVisit was also shorter, taking on an average of only 10 min to deliver follow-up care with a high degree of patient satisfaction versus 90 (60-112) min for in-person care. The total time saved by patients per eVisit was 80 (50-102) min, 44 (21-69) min of which was travel time. Travel distance avoided by the patients was 30.1 km (11.2-82.2). The estimated total out-of-pocket cost savings for patients per eVisit was Can $52.83 (31.26-94.53). The estimated savings (opportunity cost for in-person outpatient care) for our eVisit pilot project was Can $23,832-$28,584. The patient satisfaction with eVisits was very good compared with their prior personal experience with in-person outpatient care.
The eVisit program was well received by patients, deemed to be safe by physicians, and avoided unnecessary patient travel and expense. It also has the potential to reduce health care costs. We plan to scale the project within the department and the institution.
对于患有中风等疾病的人来说，及时获得面对面的医疗服务是一项挑战，这些疾病会导致身体虚弱、失去独立性、驾驶和行动受限以及身体和认知能力下降。在安大略省东南部，农村地区以及前往医生诊所的路途遥远使获得医疗服务变得更加复杂。有必要使医疗服务更容易获得且更便捷。家庭虚拟就诊（电子就诊，eVisits）可以方便地将医生与患者联系起来。医生使用安全的个人视频会议工具与家中的患者进行连接。患者使用他们选择的设备（智能手机、平板电脑、笔记本电脑或台式电脑）进行就诊。
本研究旨在评估在老年中风预防诊所实施电子就诊的可行性和后勤保障。
2018年8月在金斯顿健康科学中心中风预防诊所启动了一项为期6个月的电子就诊试点研究。电子就诊仅用于患者的随访。采用综合评估来测试该项目对诊所工作流程和患者满意度的影响。通过电话访谈，使用简短问卷对患者满意度进行评估。将就诊机会和患者满意度指标与同期的标准护理（患者之前面对面就诊的个人经历）进行比较。数据以中位数（四分位间距）表示。
试点中有75名受试者。患者年龄为65（56 - 73.5）岁，39%（29/75）居住在农村地区。与面对面就诊相比，电子就诊的预约等待时间更短（平均59.98 [标准差48.36]天对平均78.36 [标准差50.54]天；P <.001）。电子就诊时间也更短，提供随访护理平均仅需10分钟，患者满意度高，而面对面护理则需要90（60 - 112）分钟。每次电子就诊患者节省的总时间为80（50 - ！02）分钟，其中44（21 - 69）分钟是出行时间。患者避免的出行距离为30.1公里（11.2 - 82.2）。估计每次电子就诊患者自付费用节省的总额为52.83加元（31.26 - 94.53）。我们的电子就诊试点项目估计节省的费用（面对面门诊护理的机会成本）为23,832 - 28,584加元。与他们之前面对面门诊护理的个人经历相比，患者对电子就诊的满意度非常高。
电子就诊项目受到患者的好评，医生认为其安全，避免了患者不必要的出行和费用。它还有降低医疗成本的潜力。我们计划在部门和机构内扩大该项目规模。
