Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Hepatology. 2020 Aug;72(2):723-728. doi: 10.1002/hep.31276.
Evidence strongly supports that access to specialty gastroenterology or hepatology care in cirrhosis is associated with higher adherence to guideline-recommended care and improves clinical outcomes. Presently, only about one half of acute care hospitalizations for cirrhosis-related complications result in inpatient specialty care, and the current hepatology workforce cannot meet the demand of patients with liver disease nationwide, particularly in less densely populated areas and in community-based practices not affiliated with academic centers. Telemedicine, defined as the delivery of health care services at a distance using electronic means for diagnosis and treatment, holds tremendous promise to increase access to broadly specialty care. The technology is cheap and easy to use, although it is presently limited in scale by interstate licensing restrictions and reimbursement barriers. The outbreak of severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 has, in the short term, accelerated the growth of telemedicine delivery as a public health and social distancing measure. Herein, we examine whether this public health crisis can accelerate the national conversation about broader adoption of telemedicine for routine medical care in non-crisis situations, using a case series from our telehepatology program as a pragmatic example.
有充分证据表明，在肝硬化患者中获得专业的胃肠病学或肝脏病学治疗与更高的遵医嘱护理率相关，并能改善临床结局。目前，只有大约一半的肝硬化相关并发症急性住院治疗会导致住院接受专业治疗，而当前的肝脏病学劳动力无法满足全国范围内肝病患者的需求，尤其是在人口密度较低的地区和未与学术中心相关联的社区实践中。远程医疗是指使用电子手段进行诊断和治疗，以远程方式提供医疗服务，它在增加广泛的专业医疗服务方面具有巨大的潜力。该技术价格低廉且易于使用，但目前受到州际许可限制和报销障碍的规模限制。严重急性呼吸综合征冠状病毒 2 和 2019 年冠状病毒病的爆发在短期内加速了远程医疗作为公共卫生和社会隔离措施的发展。在此，我们通过我们的远程肝脏病学计划的一个实际案例来探讨这场公共卫生危机是否能够加速关于在非危机情况下更广泛采用远程医疗进行常规医疗的全国性对话。
