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从床边到“网络端”的差距:产科远程医疗实现公平性的障碍。

Disparities from bedside to "webside": barriers to achieving equity in telemedicine in obstetrics.

作者信息

Udegbe Beverly C, Clapp Mark A, Bryant Allison S

机构信息

Tufts University, Boston, MA (Ms Udegbe).

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Drs Clapp and Bryant).

出版信息

AJOG Glob Rep. 2023 Feb;3(1):100159. doi: 10.1016/j.xagr.2022.100159. Epub 2023 Jan 3.

Abstract

Given the urgency of the COVID-19 pandemic, telehealth was swiftly implemented in the United States and shifted from an optional to an essential modality of care. This was important in both maintaining continuity of care, especially for those with chronic illnesses, and in evaluating individuals presenting with illness or acute needs. One of the primary benefits of telemedicine is convenience; however, this is juxtaposed with the various downsides that result from a lack of physical appointments and accessible technology. Notably, there are large barriers to achieving equity for certain communities, of which the most apparent is the "digital divide" that results from a lack of adequate broadband infrastructure and lower technology literacy among members of certain communities and those in rural areas. Without attention to factors that can improve availability, uptake, and experience, disparities will increase with telemedicine. As this technology becomes common practice, it will be important to provide equal reimbursement for in-person and telehealth visits, center patient design and cultural competency in telemedicine programs, and improve broadband and technology access, ensuring that the highest-quality care is delivered to all patients.

摘要

鉴于新冠疫情的紧迫性,远程医疗在美国迅速得到实施,并从一种可选的医疗模式转变为一种基本的医疗模式。这对于维持医疗服务的连续性(尤其是对慢性病患者而言)以及评估患病或有紧急需求的个体都很重要。远程医疗的主要好处之一是便利性;然而,这与因缺乏面对面预约和可及技术而产生的各种不利因素形成了对比。值得注意的是,某些社区在实现公平方面存在巨大障碍,其中最明显的是“数字鸿沟”,这是由于某些社区成员和农村地区居民缺乏足够的宽带基础设施以及较低的技术素养造成的。如果不关注那些能够提高可及性、使用率和体验的因素,远程医疗中的差距将会加大。随着这项技术成为常规做法,为面对面就诊和远程医疗就诊提供同等报销、在远程医疗项目中以患者为中心进行设计并提高文化能力,以及改善宽带和技术接入,确保为所有患者提供最高质量的医疗服务,将变得至关重要。

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