Nachum Sapir, Gogia Kriti, Clark Sunday, Hsu Hanson, Sharma Rahul, Greenwald Peter W
Department of Medicine and Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
Telemed J E Health. 2021 Feb;27(2):178-183. doi: 10.1089/tmj.2019.0318. Epub 2020 Jun 24.
Evaluation of direct-to-consumer (DTC) telemedicine programs has focused on care delivery via personal electronic devices. Telemedicine kiosks for the delivery of virtual urgent care services have not been systematically described. Our institution has placed kiosks for DTC urgent care in pharmacies. These kiosks can be used without a personal electronic device. Retrospective review of adult patients using pharmacy-based kiosks (kiosk) or personal electronic devices (app) for DTC evaluation. Data for patient characteristics, wait time, technical quality, visit duration diagnosis codes, follow-up recommendations, and whether the patient was traveling were compared. Results were interpreted using the National Quality Forum framework for telemedicine service evaluation, focused on access, experience, and effectiveness. Comparisons were made using chi-square test, Student's t-test, and Wilcoxon rank-sum tests. Over 1 year there were 1,996 DTC visits; 238 (12%) initiated from kiosks. Kiosk patients were slightly older (mean age 38 ± 13 vs. 35 ± 11; p < 0.001), more likely to be male (52% vs. 39%; p < 0.001), more likely to be remote from home (25% vs. 3%; p < 0.001), and had less technical difficulty (10% vs. 19%; p = 0.003). Referral for urgent in-person evaluation was low in both groups (10% kiosk vs. 16%; app p = 0.017). Kiosks may increase access to care and improve technical experience. Low urgent referral rates suggest effective care for both types of visit. Despite their potential advantages, kiosk visits accounted for a minority of overall visits for our DTC telemedicine service line, and daily use of each kiosk location was low.
对直接面向消费者（DTC）的远程医疗项目的评估主要集中在通过个人电子设备提供医疗服务。用于提供虚拟紧急护理服务的远程医疗信息亭尚未得到系统描述。我们机构在药店设置了用于DTC紧急护理的信息亭。这些信息亭无需个人电子设备即可使用。对使用基于药店的信息亭（信息亭）或个人电子设备（应用程序）进行DTC评估的成年患者进行回顾性研究。比较了患者特征、等待时间、技术质量、就诊时长、诊断代码、随访建议以及患者是否在出行等数据。使用美国国家质量论坛远程医疗服务评估框架对结果进行解读，重点关注可及性、体验和有效性。采用卡方检验、学生t检验和威尔科克森秩和检验进行比较。在1年多的时间里，共有1996次DTC就诊；其中238次（12%）是通过信息亭发起的。使用信息亭的患者年龄稍大（平均年龄38±13岁 vs. 35±11岁；p<0.001），男性比例更高（52% vs. 39%；p<0.001），离家较远的可能性更大（25% vs. 3%；p<0.001），技术困难较少（10% vs. 19%；p = 0.003）。两组中紧急面对面评估的转诊率都较低（信息亭组为10%，应用程序组为16%；p = 0.017）。信息亭可能会增加医疗服务的可及性并改善技术体验。较低的紧急转诊率表明两种就诊方式的医疗服务都有效。尽管信息亭有潜在优势，但在我们DTC远程医疗服务线路的总就诊次数中，通过信息亭就诊的占少数，而且每个信息亭地点的每日使用量都很低。
