Mueller Bridget R, Lawrence Steven, Benn Emma, Nirenberg Sharon, Kummer Benjamin, Jette Nathalie, George Mary-Catherine, Robinson-Papp Jessica
Departments of Neurology and.
Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Pain Rep. 2022 Apr 14;7(3):e1001. doi: 10.1097/PR9.0000000000001001. eCollection 2022 May-Jun.
The shift from in-person visits to telehealth visits during the COVID-19 pandemic presented unique challenges for patients with pain. Disparities in health care access already existed, and the impact of telehealth on these inequities has not been studied.
To identify sociodemographic characteristics of patients with pain obtaining care through video, telephone, and in-person visits as social distancing restrictions evolved during the COVID-19 pandemic.
Using our institutional clinical data warehouse, we identified 3314 patients with pain receiving care at a large academic institution in New York City during a baseline period (September 23, 2019-March 22, 2020) and counted telephone, video, and in-person visits during the following conditions: a shutdown period (March 23, 2020-May 23, 2020), when nonessential in-person visits were strictly limited, and a reopening period (May 23, 2020-September 23, 2020), when restrictions were relaxed and in-person visits were available. Patients were categorized into 4 groups based on the technology used to complete a visit: (1) video, (2) telephone, (3) in-person, and (4) no visit.
Patients who were older, publicly insured, and identified as Black or Hispanic were overrepresented in the telephone visit group during shutdown and the in-person group during reopening. A video visit during shutdown increased the likelihood of continued video visit use during reopening despite the return of in-person visits.
Results show differences in how patients with pain accessed clinical care in a socially distanced world and that flexibility in method of health care delivery may reduce barriers to access. Future research will identify factors (eg, Internet access, digital literacy, provider-patient relationships) driving heterogeneity in telehealth use in patients with pain.
在新冠疫情期间，从面对面就诊转向远程医疗就诊给疼痛患者带来了独特的挑战。医疗保健获取方面的差距已然存在，而远程医疗对这些不平等现象的影响尚未得到研究。
确定在新冠疫情期间随着社交距离限制的演变，通过视频、电话和面对面就诊获得护理的疼痛患者的社会人口学特征。
利用我们机构的临床数据仓库，我们确定了在基线期（2019年9月23日至2020年3月22日）在纽约市一家大型学术机构接受护理的3314名疼痛患者，并统计了在以下情况下的电话、视频和面对面就诊次数：关闭期（2020年3月23日至2020年5月23日），此时非必要的面对面就诊受到严格限制；以及重新开放期（2020年5月23日至2020年9月23日），此时限制放宽且可进行面对面就诊。根据完成就诊所使用的技术，将患者分为4组：（1）视频组，（2）电话组，（3）面对面组，（4）未就诊组。
年龄较大、有公共保险且被认定为黑人或西班牙裔的患者在关闭期的电话就诊组和重新开放期的面对面就诊组中占比过高。在关闭期进行视频就诊增加了在重新开放期继续使用视频就诊的可能性，尽管面对面就诊已恢复。
结果显示了在社交距离环境下疼痛患者获取临床护理的方式存在差异，并且医疗服务提供方式的灵活性可能会减少获取障碍。未来的研究将确定驱动疼痛患者远程医疗使用异质性的因素（例如，互联网接入、数字素养、医患关系）。
