远程医疗的使用与 COVID-19 期间全科医生特征之间的关联：来自澳大利亚医生全国代表性调查的结果。
Association between telehealth use and general practitioner characteristics during COVID-19: findings from a nationally representative survey of Australian doctors.
机构信息
Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Melbourne, Victoria, Australia.
Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Melbourne, Victoria, Australia
出版信息
BMJ Open. 2021 Mar 24;11(3):e046857. doi: 10.1136/bmjopen-2020-046857.
OBJECTIVE
To investigate factors associated with the use of telehealth by general practitioners (GPs) during COVID-19.
DESIGN
A nationally representative longitudinal survey study of Australian doctors analysed using regression analysis.
SETTING
General practice in Australia during the COVID-19 pandemic.
PARTICIPANTS
448 GPs who completed both the 11th wave (2018-2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) Survey and the MABEL COVID-19 Special Online Survey (May 2020).
OUTCOME MEASURES
Proportion of all consultations delivered via telephone (audio) or video (audiovisual); proportion of telehealth consultations delivered via video.
RESULTS
46.1% of GP services were provided using telehealth in early May 2020, with 6.4% of all telehealth consultations delivered via video. Higher proportions of telehealth consultations were observed in GPs in larger practices compared with solo GPs: between +0.21 (95% CI +0.07 to +0.35) and +0.28 (95% CI +0.13 to +0.44). Greater proportions of telehealth consultations were delivered through video for GPs with appropriate infrastructure and for GPs with more complex patients: +0.10 (95% CI +0.04 to +0.16) and +0.04 (95% CI +0.00 to +0.08), respectively. Lower proportions of telehealth consultations were delivered via video for GPs over 55 years old compared with GPs under 35 years old: between -0.08 (95% CI -0.02 to -0.15) and -0.15 (95% CI -0.07 to -0.22), and for GPs in postcodes with a higher proportion of patients over 65 years old: -0.005 (95% CI -0.001 to -0.008) for each percentage point increase in the population over 65 years old.
CONCLUSIONS
GP characteristics are strongly associated with patterns of telehealth use in clinical work. Infrastructure support and relative pricing of different consultation modes may be useful policy instruments to encourage GPs to deliver care by the most appropriate method.
目的
调查在 COVID-19 期间全科医生（GP）使用远程医疗的相关因素。
设计
对澳大利亚医生进行的一项具有全国代表性的纵向调查研究，使用回归分析进行分析。
地点
澳大利亚 COVID-19 大流行期间的全科医疗。
参与者
完成了第 11 波（2018-2019 年）医学在澳大利亚：平衡就业和生活（MABEL）调查和 MABEL COVID-19 特别在线调查（2020 年 5 月）的 448 名 GP。
结果测量
通过电话（音频）或视频（视听）提供的所有咨询的比例；远程医疗咨询的视频比例。
结果
2020 年 5 月初，46.1%的 GP 服务通过远程医疗提供，其中 6.4%的远程医疗咨询通过视频提供。与 solo GP 相比，在较大实践中的 GP 观察到更高比例的远程医疗咨询：分别为+0.21（95%CI+0.07 至+0.35）和+0.28（95%CI+0.13 至+0.44）。对于具有适当基础设施的 GP 和具有更复杂患者的 GP，通过视频提供的远程医疗咨询比例更高：+0.10（95%CI+0.04 至+0.16）和+0.04（95%CI+0.00 至+0.08）。与 35 岁以下的 GP 相比，55 岁以上的 GP 通过视频提供的远程医疗咨询比例较低：分别为-0.08（95%CI-0.02 至-0.15）和-0.15（95%CI-0.07 至-0.22），并且在老年人比例较高的邮政编码中的 GP 中：每增加 1%的 65 岁以上人口，比例减少 0.005（95%CI-0.001 至-0.008）。
结论
GP 特征与临床工作中远程医疗使用模式密切相关。基础设施支持和不同咨询模式的相对定价可能是鼓励 GP 通过最合适的方法提供护理的有用政策工具。
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