Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2022 Jun 3;17(6):e0269435. doi: 10.1371/journal.pone.0269435. eCollection 2022.
Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered.
To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics.
Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively.
Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001).
Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities.
PROSPERO registration no: CRD42021241791.
大多数高收入国家的卫生政策越来越多地建议通过远程（视频和/或电话）预约提供常规门诊服务，尤其是由于大流行。这被认为可以改善获得医疗服务的机会，并在资源有限的卫生服务中提高效率。关于在提供远程门诊服务时，对卫生服务的邀请和利用方面现存不平等现象的影响，证据有限。
系统审查关于在二级和三级保健中提供和/或利用实时远程门诊咨询的证据，根据关键社会人口特征进行评估。
检索了 7 个电子书目数据库，以查找报告任何慢性疾病患者按 PROGRESS Plus 标准具有关键特征的患者中，被提供和/或接受实时远程门诊咨询的比例的研究。对照组包括常规护理（面对面）、另一种干预措施或在可比时间段内的提供/接受。研究过程由两人进行。数据以叙述方式报告。
共纳入 29 项研究。视频咨询的使用率从 5%到 78%不等，电话咨询的使用率从 12%到 78%不等。年龄在 65 岁以上、受教育程度较低、家庭收入较低、英语不是第一语言的患者远程就诊的可能性最低。女性通常比男性更有可能进行远程咨询，但在进行远程咨询的非白人种族中，他们更有可能选择电话预约而不是视频预约（p<0.001）。
提供远程咨询可能会使获得医疗保健的机会不平等状况持续存在或加剧。需要更多研究当前社会人口特征方面的健康差异，并探讨哪些方法对不同患者群体有效以及为什么如此，以便可以设计流程来缓解这些健康差异。
PROSPERO 注册编号：CRD42021241791。
