Wood Sarah M, Pickel Julia, Phillips Alexis W, Baber Kari, Chuo John, Maleki Pegah, Faust Haley L, Petsis Danielle, Apple Danielle E, Dowshen Nadia, Schwartz Lisa A
Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
JMIR Pediatr Parent. 2021 Nov 15;4(4):e32708. doi: 10.2196/32708.
Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking.
The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality.
Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses.
Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing.
Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.
青少年及青年（AYA）及其父母和照料者（照料者）对远程医疗的可接受性、可行性和质量方面的数据尚缺。
本研究的目的是通过比较远程医疗与面对面就诊在效率、有效性、公平性、以患者为中心和保密性方面的可接受性，评估远程医疗的非劣效性。
2020年5月至7月，在青少年医学亚专科诊所进行视频就诊后，向照料者和AYA发送基于网络的横断面调查。使用卡方检验比较将远程医疗评为非劣效的AYA和照料者的比例。通过测量技术困难的项目评估可行性。使用医学研究所医疗质量维度进行演绎主题分析，对开放式问题的回答进行编码。
AYA的调查回复率为20.5%（55/268），照料者的回复率为21.8%（123/563）。大多数受访者是白人顺性别女性。大多数AYA和照料者认为远程医疗在保密性、沟通、药物管理和精神卫生保健方面不劣于面对面就诊。与照料者相比，更高比例的AYA认为远程医疗在保密性方面较差（11/51，22%对3/118，2.5%，P<0.001）。四分之一（14/55）的AYA患者和31.7%（39/123）的照料者报告有技术困难。定性数据中的主要主题包括远程医疗在医疗服务效率和公平性方面的优势。然而，受访者的担忧包括由于缺乏亲自检查、生命体征采集和实验室检测，护理的安全性和有效性降低，尤其是对饮食失调患者。
远程医疗在AYA和照料者中高度可接受。未来的优化应包括改善隐私、缓解技术困难以及规范在家获取患者数据的方法，以确保患者安全。
