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加拿大安大略省虚拟上门诊所就诊患者的特征和医疗保健利用情况:横断面分析。

Characteristics and Health Care Use of Patients Attending Virtual Walk-in Clinics in Ontario, Canada: Cross-sectional Analysis.

机构信息

Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, ON, Canada.

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

出版信息

J Med Internet Res. 2023 Jan 12;25:e40267. doi: 10.2196/40267.

Abstract

BACKGROUND

Funding changes in response to the COVID-19 pandemic supported the growth of direct-to-consumer virtual walk-in clinics in several countries. Little is known about patients who attend virtual walk-in clinics or how these clinics contribute to care continuity and subsequent health care use.

OBJECTIVE

The objective of the present study was to describe the characteristics and measure the health care use of patients who attended virtual walk-in clinics compared to the general population and a subset that received any virtual family physician visit.

METHODS

This was a retrospective, cross-sectional study in Ontario, Canada. Patients who had received a family physician visit at 1 of 13 selected virtual walk-in clinics from April 1 to December 31, 2020, were compared to Ontario residents who had any virtual family physician visit. The main outcome was postvisit health care use.

RESULTS

Virtual walk-in patients (n=132,168) had fewer comorbidities and lower previous health care use than Ontarians with any virtual family physician visit. Virtual walk-in patients were also less likely to have a subsequent in-person visit with the same physician (309/132,168, 0.2% vs 704,759/6,412,304, 11%; standardized mean difference [SMD] 0.48), more likely to have a subsequent virtual visit (40,030/132,168, 30.3% vs 1,403,778/6,412,304, 21.9%; SMD 0.19), and twice as likely to have an emergency department visit within 30 days (11,003/132,168, 8.3% vs 262,509/6,412,304, 4.1%; SMD 0.18), an effect that persisted after adjustment and across urban/rural resident groups.

CONCLUSIONS

Compared to Ontarians attending any family physician virtual visit, virtual walk-in patients were less likely to have a subsequent in-person physician visit and were more likely to visit the emergency department. These findings will inform policy makers aiming to ensure the integration of virtual visits with longitudinal primary care.

摘要

背景

为应对 COVID-19 大流行而进行的资金调整,支持了多个国家直接面向消费者的虚拟上门诊所的发展。对于前往虚拟上门诊所的患者,以及这些诊所如何有助于保持连续性护理和后续的医疗保健使用,我们知之甚少。

目的

本研究旨在描述与一般人群以及接受任何虚拟家庭医生就诊的亚组相比,前往虚拟上门诊所就诊的患者的特征,并衡量他们的医疗保健使用情况。

方法

这是一项在加拿大安大略省进行的回顾性、横断面研究。2020 年 4 月 1 日至 12 月 31 日期间,在 13 家选定的虚拟上门诊所中接受过家庭医生就诊的患者与在安大略省接受过任何虚拟家庭医生就诊的患者进行了比较。主要结局是就诊后的医疗保健使用情况。

结果

与安大略省接受任何虚拟家庭医生就诊的患者相比,虚拟上门患者(n=132168)的合并症和先前的医疗保健使用较少。虚拟上门患者也不太可能与同一名医生进行后续的当面就诊(309/132168,0.2%对 704759/6412304,11%;标准化均差[SMD]0.48),更有可能进行后续的虚拟就诊(40030/132168,30.3%对 1403778/6412304,21.9%;SMD 0.19),并且在 30 天内急诊就诊的可能性增加一倍(11003/132168,8.3%对 262509/6412304,4.1%;SMD 0.18),这种效应在调整后和城乡居民群体中都持续存在。

结论

与安大略省接受任何家庭医生虚拟就诊的患者相比,虚拟上门患者不太可能进行后续的当面就诊,而更有可能就诊急诊。这些发现将为旨在确保虚拟就诊与纵向初级保健相整合的政策制定者提供信息。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7e8/9880810/dc5529db56c4/jmir_v25i1e40267_fig1.jpg

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