Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts), New York, NY; Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel.
Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel.
Acad Pediatr. 2021 Nov-Dec;21(8):1414-1419. doi: 10.1016/j.acap.2021.07.012. Epub 2021 Jul 18.
The use of a nation-wide, pediatricians online (PO) after-hours telemedicine service has been offered in Israel for more than a decade. We sought to compare PO visits with those to the primary care pediatrician (PCP).
This is a retrospective cross-sectional study using Israel's largest health care provider database. We included children aged 0 to 18 years using either PO or PCP between 2015 and 2018. We compared the baseline characteristics, matching by socioeconomic status, chronic illness, and diagnosis, and compared their admission rates, laboratory testing, and medication prescription.
During this study period there were 262,541 PO visits and a random 10% sample of PCP visits which yielded 1,813,103 visits. Users of PO were more likely to have a higher socioeconomic status (43% vs 28.9%), fever (13.3% vs 4.4%) and less likely to have acute respiratory conditions (8.8% vs 16.7%). Users of PO had higher rates of emergency department admissions (2.9% vs 0.4%), hospital admissions (0.9% vs 0.2%), and lower rates of laboratory testing (3.7% vs 7.4%) and medication prescription (42.0% vs 52.0%) within 24 hours. All differences were statistically significant (P < .005).
Our pediatric telemedicine service operating after-hours has been found to be feasible, and widely used, for a myriad of clinical conditions. Significant differences exist between PO and PCP visit characteristics and outcomes. However, it remained unclear whether these differences reflect the difference in the patient population or whether they are the result of the different clinical services. Further research is warranted to clarify this matter.
在以色列，儿科医生在线（PO）的夜间远程医疗服务已经提供了十多年。我们旨在比较 PO 就诊与初级保健儿科医生（PCP）就诊。
这是一项使用以色列最大的医疗保健提供者数据库的回顾性横断面研究。我们纳入了 2015 年至 2018 年间使用 PO 或 PCP 的 0 至 18 岁儿童。我们比较了基本特征，按社会经济地位、慢性病和诊断进行匹配，并比较了他们的住院率、实验室检查和药物处方。
在这项研究期间，有 262541 次 PO 就诊和随机抽取的 10%的 PCP 就诊，共获得 1813103 次就诊。PO 的使用者更有可能具有较高的社会经济地位（43%比 28.9%）、发热（13.3%比 4.4%），而急性呼吸道疾病的可能性较小（8.8%比 16.7%）。PO 使用者的急诊就诊率（2.9%比 0.4%）、住院率（0.9%比 0.2%）和 24 小时内实验室检查率（3.7%比 7.4%）和药物处方率（42.0%比 52.0%）均较高，所有差异均具有统计学意义（P<0.005）。
我们发现，我们的儿科远程医疗服务在夜间运行是可行的，并且广泛用于各种临床情况。PO 和 PCP 就诊特征和结果存在显著差异。然而，尚不清楚这些差异是反映患者人群的差异，还是由于不同的临床服务造成的。需要进一步的研究来澄清这一问题。
