Health Management Center, Cheng Hsin General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Med Internet Res. 2022 Aug 12;24(8):e40288. doi: 10.2196/40288.
Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear.
This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan.
We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients' demographic characteristics, disease type, physicians' features, and specialties/departments were collected, and physicians' opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics.
Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician's positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient's age, the physician's age, and the physician's sex were not associated with the utilization of virtual clinics in our study.
Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient's sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician's attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.
尽管 COVID-19 大流行加速了全球远程医疗和虚拟咨询的采用，但影响虚拟诊所使用的复杂因素仍不清楚。
本研究旨在确定与虚拟诊所服务在台湾实施经验中虚拟诊所使用相关的因素。
我们回顾性分析了 2021 年 5 月 19 日至 7 月 31 日期间，由于 COVID-19 大流行，台北市一家大型综合医院迅速实施虚拟门诊后，总共 187742 人次（176815 人次为面对面就诊，10927 人次为虚拟就诊）的门诊就诊数据。收集了患者的人口统计学特征、疾病类型、医生特征和专科/科室信息，并使用 5 点李克特量表调查和评估医生对虚拟诊所的意见。采用多水平分析确定与虚拟诊所使用相关的因素。
患者/就诊、医生和科室层面的因素分别占虚拟诊所使用总方差的 67.5%、11.1%和 21.4%。女性（比值比 [OR] 1.27，95%置信区间 [CI] 1.22-1.33，P<.001）；距离医院较远（OR 2.36，95%CI 2.15-2.58，如果距离>50 公里，P<.001；OR 3.95，95%CI 3.11-5.02，如果需要长途旅行，P<.001）；由全民健康保险（NHI）报销（OR 7.29，95%CI 5.71-9.30，P<.001）；因重大慢性疾病就诊（OR 1.33，95%CI 1.24-1.42，P<.001）；医生对虚拟诊所的积极态度（OR 1.50，95%CI 1.16-1.93，P=.002）；以及在某些科室就诊，包括心脏中心、精神科和内科（OR 2.55，95%CI 1.46-4.46，P=.004），与虚拟诊所的使用呈正相关。患者的年龄、医生的年龄和医生的性别与我们的研究中虚拟诊所的使用无关。
我们的研究结果表明，除了先前证明的可能影响远程医疗使用的患者水平因素，包括患者的性别和距离医院的远近外，就诊水平（保险类型、疾病类型）、医生水平（医生对虚拟诊所的态度）和科室水平等因素也有助于虚拟诊所的使用。尽管在大流行期间虚拟就诊的数量与大流行前相比增加了 300 多倍，但在研究期间，大多数（176815/187742，94.2%）门诊就诊仍为面对面就诊。因此，了解影响虚拟诊所使用的因素对于加速远程医疗的实施非常重要。我们的研究结果可能有助于指导扩大虚拟诊所使用的决策，特别是在发展和推广远程医疗虚拟诊所服务方面面临困难的国家。
