Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Telemed J E Health. 2022 Oct;28(10):1458-1463. doi: 10.1089/tmj.2021.0310. Epub 2022 Mar 23.
The use of direct to patient (DTP) telemedicine for common acute conditions is widespread. It provides certain advantages over in-person visits, but has led to concerns about fragmentation of care. It is unknown whether use of DTP telemedicine decreases use of primary care services in a way that leads to missed preventive screenings and immunizations. Virtual urgent care (VUC) is a DTP telemedicine service to treat common acute conditions. All VUC encounters completed at an academic health system from July 2018 to December 2019 were evaluated and analyzed in 2020. Only patients established with primary care (at least one primary care visit in the same year as VUC encounter) were included. Specific preventive screenings (breast cancer, gonorrhea/chlamydia, and cervical cancer) and immunizations (tetanus and influenza) were characterized as up to date based on national guidelines. Chi-squares and multivariate logistic regressions were used to assess receipt of screenings and immunizations. Regressions included VUC and primary care utilization and demographic factors. Patients evaluated ( = 1025) were mostly 25-50 years old (69.7%), women (81.8%), and white (74.9%). More than half (56.5%) had only used VUC once. In multivariate analyses, VUC utilization was not negatively associated with any of the preventive services evaluated, whereas primary care utilization was associated with receipt of both immunizations and gonorrhea/chlamydia screening. Higher VUC utilization is not negatively associated with receipt of preventive services, as long as a primary care relationship is established. VUC may provide a useful method of encouraging receipt of preventive services, especially for younger patients.
直接面向患者（DTP）的远程医疗在常见急性病中的应用非常广泛。它相对于面对面就诊具有某些优势，但也引起了对护理碎片化的担忧。目前尚不清楚 DTP 远程医疗的使用是否会导致患者减少对初级保健服务的使用，从而导致预防筛查和免疫接种的遗漏。虚拟紧急护理（VUC）是一种用于治疗常见急性病的 DTP 远程医疗服务。2020 年对 2018 年 7 月至 2019 年 12 月期间在学术医疗系统中完成的所有 VUC 就诊进行了评估和分析。仅纳入与初级保健建立联系的患者（在 VUC 就诊的同一年至少有一次初级保健就诊）。根据国家指南，将特定的预防筛查（乳腺癌、淋病/衣原体和宫颈癌）和免疫接种（破伤风和流感）确定为最新。使用卡方检验和多变量逻辑回归评估筛查和免疫接种的情况。回归分析包括 VUC 和初级保健的使用情况以及人口统计学因素。评估的患者（ = 1025）大多为 25-50 岁（69.7%）、女性（81.8%）和白人（74.9%）。超过一半（56.5%）的患者仅使用过一次 VUC。在多变量分析中，VUC 的使用与评估的任何预防服务均无负相关，而初级保健的使用与免疫接种和淋病/衣原体筛查的接受情况均呈正相关。只要建立了初级保健关系，VUC 的高利用率与预防服务的接受情况并无负相关。VUC 可能是鼓励接受预防服务的一种有用方法，特别是对年轻患者而言。
