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大流行引发的医疗资源匮乏社区远程医疗的采用:关停前后趋势的描述性研究。

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends.

机构信息

Department of Systems and Technology, Auburn University, Auburn, AL, United States.

Department of Information Systems, Statistics, and Management Science, University of Alabama, Tuscaloosa, AL, United States.

出版信息

J Med Internet Res. 2022 Jul 15;24(7):e38602. doi: 10.2196/38602.


DOI:10.2196/38602
PMID:35786564
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9290332/
Abstract

BACKGROUND: The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic-related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services. OBJECTIVE: Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities. METHODS: We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination. RESULTS: The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination. CONCLUSIONS: The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.

摘要

背景:远程医疗服务在农村社区的采用一直是一个挑战。这种技术驱动服务采用缓慢的原因可归因于社会规范、医疗保健政策以及缺乏基础设施来支持服务的提供。然而,由于 COVID-19 大流行导致的面对面医疗服务关闭,远程医疗服务的使用成为了一种必要而非选择。大流行还加速了一些必要的立法,允许为远程检查和医疗保健服务报销医疗费用。随着服务恢复正常,重要的是要检查在关闭期间使用远程医疗服务是否改变了人们对远程医疗作为传统面对面医疗服务可靠替代的接受趋势。 目的:我们的目的是探讨临时转向远程医疗服务是否改变了农村社区对技术支持的医疗服务使用的态度。 方法:我们检查了 2019 年 3 月至 2021 年 6 月期间阿拉巴马州的医疗补助报销数据。选择远程医疗服务代码,我们探讨了 COVID-19 关闭的三个阶段的采用率:大流行前、大规模疫苗接种前和大规模疫苗接种后。 结果:在三个时期,远程医疗索赔的趋势与非远程医疗索赔的趋势相反。在三个时期,使用远程医疗的患者的各种特征(年龄组、性别、种族、农村程度和服务提供商类型)的分布不同。行为和心理健康相关的索赔在大流行开始后远程医疗使用率最高。大规模疫苗接种后,远程医疗使用率仍保持在较高水平。 结论:目前的趋势表明,远程医疗服务的采用很可能在大流行后增加,并且消费者(患者)、服务提供商、医疗保健机构、保险公司以及州和地方政策已经改变了他们对远程医疗的态度。远程医疗使用的增加可以帮助地方和联邦政府解决服务不足社区医疗设施和服务提供商短缺的问题,患者可以及时有效地获得所需的护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/36af8de5abd5/jmir_v24i7e38602_fig8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/0b5b3fffdc38/jmir_v24i7e38602_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/c0fcb487df80/jmir_v24i7e38602_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/ebfa8c64dbf1/jmir_v24i7e38602_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/158b837370a4/jmir_v24i7e38602_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/89bbfd304f81/jmir_v24i7e38602_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/cc0cdf666c09/jmir_v24i7e38602_fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/48223a38c48a/jmir_v24i7e38602_fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/36af8de5abd5/jmir_v24i7e38602_fig8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/0b5b3fffdc38/jmir_v24i7e38602_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/c0fcb487df80/jmir_v24i7e38602_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/ebfa8c64dbf1/jmir_v24i7e38602_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/158b837370a4/jmir_v24i7e38602_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/89bbfd304f81/jmir_v24i7e38602_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/cc0cdf666c09/jmir_v24i7e38602_fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/48223a38c48a/jmir_v24i7e38602_fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2427/9290332/36af8de5abd5/jmir_v24i7e38602_fig8.jpg

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本文引用的文献

[1]
Telemedicine Among Oral Medicine Practitioners During COVID-19 Pandemic and Its Future Impact on the Specialty.

Risk Manag Healthc Policy. 2021-10-21

[2]
Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic.

Healthc Policy. 2021-8

[3]
Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study.

JMIR Med Inform. 2021-8-27

[4]
Demographics associated with US healthcare disparities are exacerbated by the telemedicine surge during the COVID-19 pandemic.

J Telemed Telecare. 2024-1

[5]
Physicians' Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study.

JMIR Med Inform. 2021-6-1

[6]
Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study.

JMIR Hum Factors. 2021-4-22

[7]
Rural Telemedicine Use Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study.

J Med Internet Res. 2021-4-5

[8]
Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study.

J Med Internet Res. 2021-3-29

[9]
Racial and Socioeconomic Disparities in Utilization of Telehealth in Patients with Liver Disease During COVID-19.

Dig Dis Sci. 2022-1

[10]
Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study.

J Med Internet Res. 2020-12-18

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