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评估新冠疫情后医疗保健中患者对远程医疗的偏好。

Assessment of Patient Preferences for Telehealth in Post-COVID-19 Pandemic Health Care.

机构信息

RAND Corporation, Boston, Massachusetts.

RAND Corporation, Santa Monica, California.

出版信息

JAMA Netw Open. 2021 Dec 1;4(12):e2136405. doi: 10.1001/jamanetworkopen.2021.36405.


DOI:10.1001/jamanetworkopen.2021.36405
PMID:34851400
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8637257/
Abstract

IMPORTANCE: Telehealth use greatly increased in 2020 during the first year of the COVID-19 pandemic. Patient preferences for telehealth or in-person care are an important factor in defining the role of telehealth in the postpandemic world. OBJECTIVE: To ascertain patient preferences for video visits after the ongoing COVID-19 public health emergency and to identify patient perceptions of the value of video visits and the role of out-of-pocket cost in changing patient preference for each visit modality. DESIGN, SETTING, AND PARTICIPANTS: This survey study was conducted using a nationally representative sample of adult members of the RAND American Life Panel. The data were obtained from the American Life Panel Omnibus Survey, which was fielded between March 8 and 19, 2021. MAIN OUTCOMES AND MEASURES: Preferences for video visits vs in-person care were analyzed in the survey. The first question was about participants' baseline preference for an in-person or a video visit for a nonemergency health issue. The second question entailed choosing between the preferred visit modality with a cost of $30 and another modality with a cost of $10. Questions also involved demographic characteristics, experience with video visits, willingness to use video visits, and preferences for the amount of telehealth use after the COVID-19 pandemic. RESULTS: A total of 2080 of 3391 sampled panel members completed the survey (participation rate, 61.3%). Participants in the weighted sample had a mean (SE) age of 51.1 (0.67) years and were primarily women (1079 [51.9%]). Most participants (66.5%) preferred at least some video visits in the future, but when faced with a choice between an in-person or a video visit for a health care encounter that could be conducted either way, more than half of respondents (53.0%) preferred an in-person visit. Among those who initially preferred an in-person visit when out-of-pocket costs were not a factor, 49.8% still preferred in-person care and 23.5% switched to a video visit when confronted with higher relative costs for in-person care. In contrast, among those who initially preferred a video visit, only 18.9% still preferred a video visit and 61.7% switched to in-person visit when confronted with higher relative costs for video visits. CONCLUSIONS AND RELEVANCE: This survey study found that participants were generally willing to use video visits but preferred in-person care, and those who preferred video visits were more sensitive to paying out-of-pocket cost. These results suggest that understanding patient preferences will help identify telehealth's role in future health care delivery.

摘要

重要性:在 COVID-19 大流行的第一年,2020 年远程医疗的使用大大增加。患者对远程医疗或面对面护理的偏好是定义远程医疗在后大流行时代作用的一个重要因素。 目的:确定患者在持续的 COVID-19 公共卫生紧急情况后对视频访问的偏好,并确定患者对视频访问的价值以及自付费用在改变每种访问方式的患者偏好方面的作用的看法。 设计、地点和参与者:这项调查研究使用了 RAND 美国生活小组的全国性成年成员的代表性样本。数据来自于美国生活小组综合调查,该调查于 2021 年 3 月 8 日至 19 日进行。 主要结果和措施:在调查中分析了对视频访问与面对面护理的偏好。第一个问题是关于参与者对非紧急健康问题的面对面或视频访问的基线偏好。第二个问题涉及在自付费用为 30 美元的首选访问方式和另一种自付费用为 10 美元的访问方式之间进行选择。问题还涉及人口统计学特征、视频访问经验、愿意使用视频访问以及对 COVID-19 大流行后使用远程医疗的偏好。 结果:在 3391 名抽样小组成员中,共有 2080 名完成了调查(参与率为 61.3%)。加权样本中的参与者平均(SE)年龄为 51.1(0.67)岁,主要是女性(1079[51.9%])。大多数参与者(66.5%)至少在未来希望进行一些视频访问,但当面临可以通过任何一种方式进行的医疗保健访问的面对面或视频访问选择时,超过一半的受访者(53.0%)更喜欢面对面访问。在没有自付费用因素的情况下,最初更喜欢面对面访问的人中,仍有 49.8%的人更喜欢面对面护理,而 23.5%的人在面对面护理的相对费用增加时转向视频访问。相比之下,在最初更喜欢视频访问的人中,只有 18.9%的人仍然更喜欢视频访问,而 61.7%的人在视频访问的相对费用增加时转向面对面访问。 结论和相关性:这项调查研究发现,参与者普遍愿意使用视频访问,但更喜欢面对面护理,而那些更喜欢视频访问的人对自付费用更加敏感。这些结果表明,了解患者的偏好将有助于确定远程医疗在未来医疗保健中的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e511/8637257/1e3743b80f09/jamanetwopen-e2136405-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e511/8637257/1e3743b80f09/jamanetwopen-e2136405-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e511/8637257/1e3743b80f09/jamanetwopen-e2136405-g001.jpg

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本文引用的文献

[1]
Strategies for Digital Care of Vulnerable Patients in a COVID-19 World-Keeping in Touch.

JAMA Health Forum. 2020-6-1

[2]
Who Is (and Is Not) Receiving Telemedicine Care During the COVID-19 Pandemic.

Am J Prev Med. 2021-9

[3]
Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic.

Telemed J E Health. 2021-12

[4]
A Qualitative Study of Primary Care Physicians' Experiences With Telemedicine During COVID-19.

J Am Board Fam Med. 2021-2

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MMWR Morb Mortal Wkly Rep. 2021-2-19

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The Transition to Telehealth during the First Months of the COVID-19 Pandemic: Evidence from a National Sample of Patients.

J Gen Intern Med. 2021-3

[7]
Use of Telehealth During the COVID-19 Pandemic: Scoping Review.

J Med Internet Res. 2020-12-1

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MMWR Morb Mortal Wkly Rep. 2020-10-30

[9]
Prevalence and Characteristics of Telehealth Utilization in the United States.

JAMA Netw Open. 2020-10-1

[10]
"I'm Not Feeling Like I'm Part of the Conversation" Patients' Perspectives on Communicating in Clinical Video Telehealth Visits.

J Gen Intern Med. 2020-6

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