Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Health Forum. 2021 Oct 15;2(10):e213282. doi: 10.1001/jamahealthforum.2021.3282. eCollection 2021 Oct.
Little is known about how telemedicine use was evolving before the broad changes that occurred during the COVID-19 pandemic in 2020. Understanding prepandemic patterns of telemedicine use can inform ongoing debates on the future of telemedicine policy.
To describe trends in telemedicine utilization among Medicare fee-for-service beneficiaries before the COVID-19 pandemic and the specialties of clinicians providing telemedicine.
This was a cross-sectional study and descriptive analysis of telemedicine utilization by 10.4 million fee-for-service Medicare beneficiaries from 2010 to 2019. Data analysis was performed from June 6, 2019, to July 30, 2020.
Rates of telemedicine utilization, characteristics of beneficiaries who received telemedicine in 2010 to 2019, and specialties of clinicians delivering telemedicine.
Of 10.4 million rural Medicare beneficiaries, telemedicine was used by 91 483 individuals (age ≥65 years, 47 135 [51.5%]; women, 51 476 [56.3%]; and White, 76 467 [83.6%] individuals) in 2019. In 2010 to 2019, telemedicine visits grew by 23.1% annually. A total of 0.9% of all fee-for-service rural beneficiaries had a telemedicine visit in 2019 compared with 0.2% in 2010. In 2019, there were 257 979 telemedicine visits or 34.8 visits per 1000 rural beneficiaries and most (75.9%) of these visits were for mental health conditions. Patients with bipolar disorder or schizophrenia (3.0% of rural beneficiaries) received 40% of all telemedicine visits in 2019. Some traditionally disadvantaged and underserved groups comprised a larger share of telemedicine users than nonusers in 2019, such as those dually insured with Medicaid (56.9% of users vs 18.6% of nonusers; adjusted odd ratio, 3.83; 95% CI, 3.77-3.89). In 2010 to 2019, telemedicine for mental health conditions shifted away from psychiatrists (71.2% to 35.8% of all telemedicine visits) to nonphysician clinicians, eg, nurse practitioners, psychologists, and social workers (21.4% to 57.2%). There was wide variation in telemedicine utilization in 2019 across counties: median (IQR), 16.0 (2.5-51.4) telemedicine users per 1000 beneficiaries). In 891 counties (29% of all US counties), at least 10% of beneficiaries with bipolar disorder or schizophrenia used a telemedicine service in 2019.
In this cross-sectional study of telemedicine utilization before the COVID-19 pandemic, there was sustained growth in telemedicine visits among rural beneficiaries covered by the Medicare program, especially care delivered by nurse practitioners and other nonphysician clinicians. The prepandemic model of telemedicine provided in local health care settings may be a viable modality to maintain in rural communities.
在 2020 年 COVID-19 大流行期间发生的广泛变化之前，人们对远程医疗使用的演变情况知之甚少。了解远程医疗使用的大流行前模式可以为正在进行的关于远程医疗政策未来的辩论提供信息。
描述 2020 年 COVID-19 大流行之前医疗保险按服务收费受益人中远程医疗使用的趋势和提供远程医疗服务的临床医生的专业。
设计、设置和参与者：这是一项横断面研究和 2010 年至 2019 年 1040 万医疗保险按服务收费受益人的远程医疗使用情况描述性分析。数据分析于 2019 年 6 月 6 日至 2020 年 7 月 30 日进行。
远程医疗使用率、2010 年至 2019 年接受远程医疗的受益人的特征以及提供远程医疗的临床医生的专业。
在 1040 万农村医疗保险受益人中，2019 年有 91483 人（年龄≥65 岁，47135[51.5%]；女性，51476[56.3%]；白人，76467[83.6%]）使用了远程医疗。2010 年至 2019 年，远程医疗就诊量每年增长 23.1%。2019 年，只有 0.9%的农村医疗保险全部受益人有一次远程医疗就诊，而 2010 年这一比例为 0.2%。2019 年，有 257979 次远程医疗就诊，或每 1000 名农村受益人的 34.8 次就诊，其中大多数（75.9%）就诊是为了治疗心理健康问题。患有双相情感障碍或精神分裂症的患者（农村受益人的 3.0%）在 2019 年接受了所有远程医疗就诊的 40%。与非使用者相比，2019 年一些传统上处于不利地位和服务不足的群体在远程医疗使用者中的比例更大，例如同时有医疗补助和医疗保险的人（使用者的 56.9%，非使用者的 18.6%；调整后的优势比，3.83；95%CI，3.77-3.89）。2010 年至 2019 年，心理健康问题的远程医疗治疗从精神科医生（所有远程医疗就诊的 71.2%至 35.8%）转向非医师临床医生，例如护士从业人员、心理学家和社会工作者（21.4%至 57.2%）。2019 年各县之间的远程医疗使用情况存在很大差异：中位数（IQR），每 1000 名受益人中有 16.0（2.5-51.4）名远程医疗使用者）。在 891 个县（占美国所有县的 29%）中，至少有 10%的患有双相情感障碍或精神分裂症的受益人在 2019 年使用了远程医疗服务。
在这项对 COVID-19 大流行前远程医疗使用情况的横断面研究中，医疗保险计划覆盖的农村受益人的远程医疗就诊量持续增长，尤其是由护士从业人员和其他非医师临床医生提供的护理。大流行前的远程医疗模式可能是维持农村社区的一种可行模式。
