一项关于与头痛患者使用远程通讯相关的临床因素、就诊模式和人口统计学因素的回顾性队列研究。

A retrospective cohort study of clinical factors, visit patterns, and demographic factors associated with use of remote communications in patients with headache.

机构信息

Center for Headache and Facial Pain, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

出版信息

Headache. 2021 Nov;61(10):1521-1528. doi: 10.1111/head.14226. Epub 2021 Oct 29.

DOI:10.1111/head.14226

PMID:34713896

Abstract

OBJECTIVE

To identify the characteristics associated with high utilization of remote communications (RCs) in patients with headache.

BACKGROUND

Patients with headache frequently communicate with their providers using secure portal messaging and telephone calls. However, clinical and demographic factors as well as visit patterns associated with RC utilization remain poorly characterized.

METHODS

We retrospectively analyzed data from patients with headache who were evaluated in the ambulatory neurology faculty practice at the Icahn School of Medicine at Mount Sinai in New York between January 1 and June 30, 2019. We extracted clinical and demographic characteristics, total office visits, secure MyChart portal messages, and telephone encounters from our institutional data warehouse. We defined high RC and MyChart utilization as the top tertile of RC and MyChart message volume, respectively, and assessed the relationship between patient characteristics and high RC (primary outcome), as well as high MyChart utilization (secondary outcome). We characterized the relationship between clinicodemographic characteristics and the ratio of MyChart messages to total RCs (secondary outcome).

RESULTS

We identified 1390 patients, of whom 477 (34.3%) were high RC utilizers and 321 (23.1%) were high MyChart utilizers. High RC utilizers generated 3306/3921 (84.3%) RCs. The presence of chronic headache (aOR 2.31, 95% CI 1.75-3.03, p < 0.0001), cluster headache (aOR 18.3, 95% CI 5.0-71.7, p = 0.001), and migraine (aOR 3.82, 95% CI 1.93-9.3, p = 0.011) was associated with high RC utilization. Patients ≥65 years of age were less likely to engage in MyChart messaging as a proportion of RC (191/680, 28.1%) compared with patients 18-30 years of age (243/620, 39.2%, p = 0.049) and 30-64 years of age (1172/2721, 43.1%, p < 0.0001).

CONCLUSIONS

A minority of patients with headache (477/1390; 34.3%) generated the majority (3306/3921; 84.3%) of RCs. Our findings should be validated in external patient cohorts with the objective of developing strategies to optimize RC utilization.

摘要

目的

确定与头痛患者远程通讯（RC）高利用率相关的特征。

背景

头痛患者经常通过安全门户消息传递和电话与医务人员进行沟通。然而，与 RC 利用相关的临床和人口统计学因素以及就诊模式仍未得到很好的描述。

方法

我们回顾性分析了 2019 年 1 月 1 日至 6 月 30 日期间在纽约西奈山伊坎医学院门诊神经病学医师实践中接受评估的头痛患者的数据。我们从我们的机构数据仓库中提取了临床和人口统计学特征、总就诊次数、安全 MyChart 门户消息和电话访问。我们将 RC 和 MyChart 的高利用率分别定义为 RC 和 MyChart 消息量的前三分位数，并评估了患者特征与高 RC（主要结局）以及高 MyChart 利用率（次要结局）之间的关系。我们描述了诊所人口统计学特征与 MyChart 消息与总 RC 之比的关系（次要结局）。

结果

我们确定了 1390 名患者，其中 477 名（34.3%）是高 RC 使用者，321 名（23.1%）是高 MyChart 使用者。高 RC 使用者生成了 3306/3921（84.3%）条 RC。慢性头痛（优势比 2.31，95%置信区间 1.75-3.03，p<0.0001）、丛集性头痛（优势比 18.3，95%置信区间 5.0-71.7，p=0.001）和偏头痛（优势比 3.82，95%置信区间 1.93-9.3，p=0.011）与高 RC 利用率相关。与 18-30 岁（243/620，39.2%，p=0.049）和 30-64 岁（1172/2721，43.1%，p<0.0001）的患者相比，≥65 岁的患者使用 MyChart 消息作为 RC 比例较低（191/680，28.1%）。