Finn Michael T M, Brown Hannah R, Friedman Emily R, Kelly A Grace, Hansen Kathryn
Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Adult Congenital Heart Disease Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan.
Glob Adv Health Med. 2021 Feb 21;10:2164956121997361. doi: 10.1177/2164956121997361. eCollection 2021.
Integrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain conditions. The COVID-19 pandemic prompted rapid implementation of telehealth services.
We present outcomes of a complete and rapid transition to telehealth visits at an outpatient integrative medicine center in the Southeastern United States.
Patients and administrative staff took surveys comparing telehealth to in-person visits within four weeks of our clinic's transition to telehealth and three months later. Beginning four weeks after the clinic's telehealth conversion in March 2020, patients who had a telehealth visit at the center completed a survey about their telehealth experience and another survey three months later.
Patient quality judgements significantly favored telehealth at baseline, B = .77 [0.29 - 1.25], SE = .25, (712) = 3.15, p = .002, and increased at three months, B = .27 [-0.03 - 0.57], SE = .15, (712) = 1.76, p = .079. Telehealth technology usability and distance from the center predicted patient ratings of telehealth favorability. Providers favored in-person visits more than patients, B = -1.00 [-1.56 - -0.44], SE = .29, (799) = -3.48, p < .001, though did not favor either in-person or telehealth more than the other. Patient discrete choice between telehealth and in-person visits was split at baseline (in-person: n = 86 [54%]; telehealth: n = 73 [46%]), but favored telehealth at three months (in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete choice favored telehealth at follow-up across providers and patients, OR = 2.69 [.1.18 - 6.14], z = 2.36, p = .018. Major qualitative themes highlight telehealth as acceptable and convenient, with some challenges including technological issues. Some felt a loss of interpersonal connection during telehealth visits, while others felt the opposite.
We report converging mixed-method data on the successful and sustained implementation of telehealth with associated policy and clinical implications during and beyond the COVID-19 pandemic.
整合医学是治疗慢性疾病，尤其是慢性疼痛疾病的关键框架。新冠疫情促使远程医疗服务迅速得到实施。
我们展示了美国东南部一家门诊整合医学中心向远程医疗就诊全面且快速转型的成果。
患者和行政人员在我们诊所向远程医疗转型后的四周内以及三个月后进行了调查，比较远程医疗和面对面就诊的情况。从2020年3月诊所转为远程医疗四周后开始，在该中心进行过远程医疗就诊的患者完成了一份关于其远程医疗体验的调查，并在三个月后又完成了一份调查。
在基线时患者对远程医疗的质量判断显著更倾向于远程医疗，B = 0.77 [0.29 - 1.25]，标准误 = 0.25，（712）= 3.15，p = 0.002，且在三个月时有所增加，B = 0.27 [-0.03 - 0.57]，标准误 = 0.15，（712）= 1.76，p = 0.079。远程医疗技术的可用性以及与中心的距离预测了患者对远程医疗的好感度评分。与患者相比，医护人员更倾向于面对面就诊，B = -1.00 [-1.56 - -0.44]，标准误 = 0.29，（799）= -3.48，p < 0.001，不过他们对面对面就诊或远程医疗的偏好程度并无明显差异。在基线时患者在远程医疗和面对面就诊之间的离散选择是有分歧的（面对面：n = 86 [54%]；远程医疗：n = 73 [46%]），但在三个月时更倾向于远程医疗（面对面：n = 17 [40%]；远程医疗：n = 26 [60%]）。总体而言，在随访中，医护人员和患者的离散选择都更倾向于远程医疗，比值比 = 2.69 [1.18 - 6.14]，z = 2.36，p = 0.018。主要的定性主题强调远程医疗是可接受且方便的，但也存在一些挑战，包括技术问题。一些人在远程医疗就诊时感觉失去了人际联系，而另一些人则有相反的感受。
我们报告了关于在新冠疫情期间及之后成功且持续实施远程医疗的综合混合方法数据，以及相关的政策和临床意义。
