Grossman Zachi, Chodick Gabriel, Reingold Stephen M, Chapnick Gil, Ashkenazi Shai
Adelson School of Medicine, Ariel University, Ariel, Israel.
Pediatric Clinic, Maccabi Healthcare Services, 26 Rofe Hamachtarot, 69372, Tel Aviv, Israel.
Isr J Health Policy Res. 2020 Oct 20;9(1):53. doi: 10.1186/s13584-020-00414-0.
Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era.
A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed.
One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation.
The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.
面对新冠疫情这一全球健康危机，卫生系统越来越支持在门诊护理环境中使用远程医疗。尚不清楚在疫情结束后，远程医疗使用的增加是否会持续。本研究的目的是评估以色列儿科医生在疫情首次封锁阶段之前和期间对远程医疗的使用情况，并阐明他们如何预见远程医疗在疫情后时代作为一种医疗实践媒介的作用。
2020年5月，在首次封锁结束后不久，对以色列儿科医生进行了一项基于网络的调查。该调查使用两个假设的临床场景，评估了在首次新冠疫情封锁之前和期间远程医疗的使用频率及其对临床决策的影响。同样的场景也用于评估儿科医生对疫情后远程医疗的预见。此外，还检索并分析了Maccabi关于首次封锁之前、期间和之后远程医疗使用的行政数据。
169名儿科医生回复了调查（回复率 = 40%）。报告每天使用短信、图片和视频会议的受访者比例从新冠疫情之前的24%、15%和1%分别增至封锁期间的40%、40%和12%（p < 0.05）。疫情后，预计短信和图片/视频剪辑的使用比例将分别降至27%和26%的受访者（p < 0.05），但图片/视频剪辑预计将从之前15%的受访者增至之后26%的受访者（p < 0.05）。报告通过远程医疗治疗疑似肺炎或为疑似中耳炎开抗生素的高可能性预计将从新冠疫情封锁期间20%的受访者降至之后6%的受访者（p < 0.05），分别从封锁期间14%的受访者降至之后3%的受访者（p < 0.05）。Maccabi行政数据表明，与封锁前的使用水平相比，封锁期间电话问诊增加，面对面问诊减少。首次封锁结束后一个月，面对面问诊部分恢复到基线水平，电话问诊持续增加。电话问诊在首次封锁前占儿科医生问诊的0%，封锁期间占17%，封锁解除后1个月占19%。
该研究表明，在首次新冠疫情封锁期间，基层医疗儿科医生对远程医疗技术的使用大幅增加。该研究还发现，儿科医生预计疫情后使用水平将下降。随着疫情的持续和演变，持续监测远程医疗的使用水平以及对疫情后使用水平的预期将很重要。
