Dekker Paige K, Bhardwaj Priya, Singh Tanvee, Bekeny Jenna C, Kim Kevin G, Steinberg John S, Evans Karen K, Song David H, Attinger Christopher E, Fan Kenneth L
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Georgetown University School of Medicine, Washington, D.C.
Plast Reconstr Surg Glob Open. 2020 Dec 15;9(1):e3228. doi: 10.1097/GOX.0000000000003228. eCollection 2021 Jan.
The COVID-19 pandemic has brought seismic shifts in healthcare delivery. The objective of this study was to examine the impact of telemedicine in the disadvantaged population.
All consecutive patients with outpatient appointments amongst 5 providers in the Plastic and Reconstructive Surgery Department between March 2, 2020, and April 10, 2020, were retrospectively reviewed. Appointment and patient characteristics collected include visit modality, reason for visit, new or established patient, history of recorded procedure, age, sex, race, insurance provider, urban/rural designation of residence, Social Vulnerability Index, and income. The primary outcome of interest was whether or not a patient missed their appointment (show versus no-show).
During the study period, there were a total of 784 patient appointments. Before the COVID-19 pandemic, patients with a higher Social Vulnerability Index were more likely to have a no-show appointment (0.49 versus 0.39, = 0.007). Multivariate regression modeling showed that every 0.1 increase in Social Vulnerability Index results in 1.32 greater odds of loss to follow-up ( = 0.045). These associations no longer held true after the lockdown.
This study indicates a reduction in disparity and an increase in access following the dramatically increased use of telemedicine in the wake of the COVID-19 pandemic. Although drawbacks to telemedicine exist and remain to be addressed, the vast majority of literature points to an overwhelming benefit-both for patient experience and outcomes-of utilizing telemedicine. Future studies should focus on improving access, reducing technological barriers, and policy reform to improve the spread of telemedicine.
新冠疫情给医疗服务带来了巨大变革。本研究的目的是考察远程医疗对弱势群体的影响。
回顾性分析2020年3月2日至2020年4月10日期间整形外科5家医疗机构中所有连续预约门诊的患者。收集的预约和患者特征包括就诊方式、就诊原因、新患者或老患者、既往手术记录、年龄、性别、种族、保险提供商、居住的城乡指定、社会脆弱性指数和收入。主要关注的结果是患者是否错过预约（就诊与未就诊）。
在研究期间，共有784例患者预约。在新冠疫情之前，社会脆弱性指数较高的患者更有可能未就诊（0.49对0.39，P = 0.007）。多变量回归模型显示，社会脆弱性指数每增加0.1，失访几率就会增加1.32倍（P = 0.045）。封锁后这些关联不再成立。
本研究表明，在新冠疫情后远程医疗使用大幅增加之后，差距有所缩小，可及性有所提高。尽管远程医疗存在缺点且有待解决，但绝大多数文献指出，利用远程医疗对患者体验和结局都有压倒性的益处。未来的研究应侧重于改善可及性、减少技术障碍和政策改革，以促进远程医疗的推广。
