Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
Department of Health Management and Policy, University of Texas School of Biomedical Informatics, Houston, TX, USA.
J Telemed Telecare. 2024 Sep;30(8):1285-1292. doi: 10.1177/1357633X221146810. Epub 2023 Jan 19.
SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature.
All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during 12 months before and after lockdown (March 1st, 2020). Logistic regression was utilized to examine the effects of the lockdown on inbox item rate post-COVID-19 lockdown as compared to the pre-lockdown period.
Before COVID-19 lockdown, 2.07 new inbox items per encounter were received, which increased to 2.83 items after lockdown. However, only patient-initiated electronic messages increased after lockdown and stabilized at a rate higher than the pre-COVID-19 period (aRR 1.27, -value < 0.001). In contrast, prescription refill requests and telephone calls quickly spiked, then returned to pre-lockdown levels.
Based on our observations, providers experienced a quick increase in all inbox items. However, only electronic messages had a sustained increase, exacerbating the workload of administrators, staff, and clinical providers. This study directly correlates healthcare technology adoption to a significant disruptive event but also shows additional challenges to the healthcare system that must be considered with these changes.
SARS-CoV-2 病毒（COVID-19）对美国的医疗保健实践产生了影响，技术被用于促进医疗保健的可及性并减少医源性传播。此后，患者向初级保健提供者发送的消息量增加。然而，封锁后电子通信的数量和趋势在文献中描述得很差。
从四家初级保健诊所的患者向提供者发送的所有收件箱项目（电话、续药请求和电子消息）都被收集。每个星期遇到的患者的收件箱项目率被计算为每个患者的项目数的比例。在封锁前 12 个月和封锁后（2020 年 3 月 1 日）评估收件箱率的趋势。逻辑回归用于检查封锁对 COVID-19 封锁后收件箱项目率的影响，与封锁前时期相比。
在 COVID-19 封锁之前，每个遭遇收到 2.07 个新的收件箱项目，封锁后增加到 2.83 个。然而，只有患者发起的电子消息在封锁后增加，并稳定在高于 COVID-19 前时期的水平（ARR1.27，-值<0.001）。相比之下，处方续药请求和电话很快飙升，然后回到封锁前的水平。
根据我们的观察，提供者经历了所有收件箱项目的快速增加。然而，只有电子消息持续增加，这增加了管理员、工作人员和临床提供者的工作量。本研究直接将医疗保健技术的采用与重大破坏性事件相关联，但也显示了医疗保健系统必须考虑这些变化的其他挑战。
