Department of Rheumatology, Bolton One Health Centre, Bolton NHS FT, Moor Lane, Bolton, BL3 5BN, UK.
School of Biological Sciences, University of Manchester, Manchester, UK.
Rheumatol Int. 2022 Jun;42(6):999-1007. doi: 10.1007/s00296-022-05112-5. Epub 2022 Apr 11.
Since the COVID-19 pandemic started, there have been changes in clinical practice to limit transmission, such as switching from face-to-face to remote consultations. We aimed to study the influence of technical factors on remote consultations in our experience during the pandemic. 12 clinicians completed data collection forms after consultations, recording the technology used (video vs phone); technical problems encountered; discharge or subsequent appointment status; and technical aspects of the consultation process using 0-10 numerical rating scales (NRS) (Time Adequate; Relevant History; Physical Exam; Management Plan; and Communication Quality). Data were collated on an MS Access 2016 database and transferred to SPSS version 25 for statistics. Of 285 forms valid for analysis, 48 (16.8%) had video consultations. Of 259 forms with technical problems data recorded, 48 (18.5%) had a technical problem. Video patients were significantly younger (mean 49.3 vs 61.3 years, p < 0.001), had higher scores on Physical Exam scale (mean 4.0 vs 2.6, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). Those with technical problems were more common among video consultations (33.3% vs 15.4%, p = 0.005), had lower scores on Time Adequate scale (7.7 vs 8.7, p < 0.001) and Communication Quality scale (7.1 vs 8.4, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). The strongest correlation of Management Plan scale was with Communication Quality scale (Rho = 0.64). Of the NRS, a 1-point reduction in scores on Management Plan scale was the strongest predictor of subsequent face-to-face appointment (Odds Ratio 1.88, 95% CI 1.58-2.24), and this remained an independent predictor in multivariate analysis (adjusted OR 1.90, 1.57-2.31). Having a technical problem was inversely associated with the outcome of a subsequent face-to-face appointment (OR 0.17, 0.04-0.74), and this remained significant after adjustment for Management Plan in multivariate analysis (adjusted OR 0.09, 0.12-0.54). Video patients were younger suggesting a preference for video amongst younger patients. Although technical problems were more common with video, having a video consultation or a technical problem had no significant impact on management plan. Scoring lower on the Management Plan scale was the strongest predictor of, and independently associated with, requesting a subsequent face-to-face appointment. The inverse relationship of technical problems with subsequent face-to-face appointment request will need validation in further studies.
自 COVID-19 大流行以来，为了限制传播，临床实践发生了变化，例如从面对面咨询转为远程咨询。我们旨在研究技术因素对我们在大流行期间经验中的远程咨询的影响。12 名临床医生在咨询后填写了数据收集表，记录所使用的技术（视频与电话）；遇到的技术问题；出院或随后的预约情况；以及使用 0-10 数字评分量表（NRS）（时间充足；相关病史；体格检查；管理计划；沟通质量）评估咨询过程的技术方面。数据在 MS Access 2016 数据库中进行整理，并转移到 SPSS 版本 25 进行统计分析。在 285 份可用于分析的有效表格中，有 48 份（16.8%）为视频咨询。在记录了技术问题数据的 259 份表格中，有 48 份（18.5%）存在技术问题。视频患者明显更年轻（平均 49.3 岁对 61.3 岁，p<0.001），体格检查量表评分更高（平均 4.0 对 2.6，p<0.001），但管理计划量表评分无显著差异（7.3 对 7.2）。视频咨询中技术问题更常见（33.3%对 15.4%，p=0.005），时间充足量表评分较低（7.7 对 8.7，p<0.001）和沟通质量量表评分较低（7.1 对 8.4，p<0.001），但管理计划量表评分无显著差异（7.3 对 7.2）。管理计划量表与沟通质量量表的相关性最强（Rho=0.64）。在 NRS 中，管理计划量表评分降低 1 分是后续面对面预约的最强预测因素（优势比 1.88，95%CI 1.58-2.24），并且在多变量分析中仍然是一个独立的预测因素（调整后的优势比 1.90，1.57-2.31）。存在技术问题与后续面对面预约呈负相关（OR 0.17，0.04-0.74），并且在多变量分析中调整管理计划后仍然具有统计学意义（调整后的 OR 0.09，0.12-0.54）。视频患者更年轻，这表明年轻患者更喜欢视频。尽管视频中技术问题更常见，但视频咨询或技术问题对管理计划没有显著影响。管理计划量表评分较低是后续面对面预约的最强预测因素，并且与预约独立相关。技术问题与后续面对面预约请求之间的反比关系需要在进一步的研究中进行验证。
