Ishikawa Tomoki, Sato Jumpei, Hattori Junko, Goda Kazuo, Kitsuregawa Masaru, Mitsutake Naohiro
Institute for Health Economics and Policy, Minato-ku, Tokyo, Japan.
Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
Interact J Med Res. 2022 Jul 12;11(2):e39181. doi: 10.2196/39181.
Telehealth using telephones or online communication is being promoted as a policy initiative in several countries. However, there is a lack of research on telehealth utilization in a country such as Japan that offers free access to medical care and regulates telehealth provision-particularly with respect to COVID-19.
The present study aimed to clarify telehealth utilization, the characteristics of patients and medical institutions using telehealth, and the changes to telehealth in Japan in order to support the formulation of policy strategies for telehealth provision.
Using a medical administrative claim database of the National Health Insurance and Advanced Elderly Medical Service System in Mie Prefecture, we investigated patients who used telehealth from January 2017 to September 2021. We examined telehealth utilization with respect to both patients and medical institutions, and we determined their characteristics. Using April 2020 as the reference time point for COVID-19, we conducted an interrupted time-series analysis (ITSA) to assess changes in the monthly proportion of telehealth users to beneficiaries.
The number of telehealth users before the reference time point was 13,618, and after the reference time point, it was 28,853. Several diseases and conditions were associated with an increase in telehealth utilization. Telehealth consultations were mostly conducted by telephone and for prescriptions. The ITSA results showed a sharp increase in the proportion of telehealth use to beneficiaries after the reference time point (rate ratio 2.97; 95% CI 2.14-2.31). However, no apparent change in the trend of increasing or decreasing telehealth use was evident after the reference time point (rate ratio 1.00; 95% CI 1.00-1.01).
We observed a sharp increase in telehealth utilization after April 2020, but no change in the trend of telehealth use was evident. We identified changes in the characteristics of patients and providers using telehealth.
在一些国家，使用电话或在线通信的远程医疗作为一项政策举措正在得到推广。然而，在像日本这样提供免费医疗服务且对远程医疗服务进行监管的国家，尤其是在新冠肺炎疫情方面，对远程医疗利用情况的研究却很缺乏。
本研究旨在阐明日本远程医疗的利用情况、使用远程医疗的患者和医疗机构的特征，以及远程医疗的变化情况，以支持远程医疗服务政策策略的制定。
利用三重县国民健康保险和老年高级医疗服务系统的医疗行政索赔数据库，我们调查了2017年1月至2021年9月期间使用远程医疗的患者。我们考察了患者和医疗机构的远程医疗利用情况，并确定了他们的特征。以2020年4月作为新冠肺炎疫情的参考时间点，我们进行了中断时间序列分析（ITSA），以评估远程医疗用户占受益人的月度比例变化。
参考时间点之前的远程医疗用户数量为13618人，之后为28853人。几种疾病和状况与远程医疗利用率的增加有关。远程医疗咨询大多通过电话进行，且用于开处方。ITSA结果显示，参考时间点之后，远程医疗用户占受益人的比例急剧增加（率比2.97；95%置信区间2.14 - 2.31）。然而，参考时间点之后，远程医疗使用增加或减少的趋势没有明显变化（率比1.00；95%置信区间1.00 - 1.01）。
我们观察到2020年4月之后远程医疗利用率急剧上升，但远程医疗使用趋势没有明显变化。我们确定了使用远程医疗的患者和提供者特征的变化。
