Centre for Health Systems and Safety Research, Australian Institute of Health Innovation Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
College of Medicine & Public Health, Flinders University.
J Telemed Telecare. 2024 Jun;30(5):834-841. doi: 10.1177/1357633X221094406. Epub 2022 May 11.
Our earlier analysis during the COVID-19 surges in 2020 showed a reduction in general practitioner (GP) in-person visits to residential aged care facilities (RACFs) and increased use of telehealth. This study assessed how sociodemographic characteristics affected telehealth utilisation.
This retrospective cohort consists of 27,980 RACF residents aged 65 years and over, identified from general practice electronic health records in Victoria and New South Wales during March 2020-August 2021. Residents' demographic characteristics, including age, sex, region, and pension status, were analysed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the associations with telehealth utilisation (telephone/video vs. in-person consultations) and with video versus telephone consultations, in mixed-effects multiple level regression models.
Of 32,330 median monthly GP consultations among 21,987 residents identified in 2020, telehealth visits accounted for 17% of GP consultations, of which 93% were telephone consults. In 2021, of 32,229 median monthly GP consultations among 22,712 residents, telehealth visits accounted for 11% of GP consultations (97% by telephone). Pension holders (OR: 1.14; 95% CI: 1.10, 1.17) and those residing in rural areas (OR: 1.72; 95% CI: 1.57, 1.90) were more likely to use telehealth. However, residents in rural areas were less likely to use video than telephone in GP consultations (OR: 0.41; 95% CI: 0.29, 0.57). Results were similar in separate analyses for each COVID surge.
Telephone was primarily used in telehealth consultations among pension holders and rural residents in RACFs. Along with the limited use of video in virtual care in rural RACFs, the digital divide may imply potential healthcare disparities in socially disadvantaged patients.
我们在 2020 年 COVID-19 疫情高峰期的早期分析表明，全科医生（GP）对养老院的现场访问减少，而远程医疗的使用增加。本研究评估了社会人口特征如何影响远程医疗的使用。
本回顾性队列包括 2020 年 3 月至 2021 年 8 月期间从维多利亚州和新南威尔士州的全科医生电子健康记录中确定的 27980 名 65 岁及以上的养老院居民。分析居民的人口统计学特征，包括年龄、性别、地区和养老金状况，以使用混合效应多水平回归模型估计与远程医疗使用（电话/视频与现场咨询）以及视频与电话咨询相关的优势比（OR）和 95%置信区间（CI）。
在 2020 年确定的 21987 名居民中，每月有 32330 次 GP 中位数咨询，其中远程医疗就诊占 GP 咨询的 17%，其中 93%为电话咨询。在 2021 年，在 22712 名居民中，每月有 32229 次 GP 中位数咨询，远程医疗就诊占 GP 咨询的 11%（97%为电话）。养老金领取者（OR：1.14；95%CI：1.10，1.17）和居住在农村地区的居民（OR：1.72；95%CI：1.57，1.90）更有可能使用远程医疗。然而，农村地区的居民在 GP 咨询中使用视频的可能性低于电话（OR：0.41；95%CI：0.29，0.57）。在每个 COVID 高峰期的单独分析中，结果相似。
在养老院的养老金领取者和农村居民中，电话主要用于远程医疗咨询。在农村养老院虚拟护理中视频的使用有限的情况下，数字鸿沟可能意味着社会弱势群体患者存在潜在的医疗保健差距。
