Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
AGEIS, Université Grenoble Alpes, Grenoble, France.
J Med Internet Res. 2023 Jan 27;25:e40912. doi: 10.2196/40912.
Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. A previous study revealed that physicians' willingness to use TM and actual use of TM are closely connected to their knowledge of TM. However, it remains unclear which factors are associated with patients' motivation to use TM.
This study aims to identify the factors that determine patients' willingness to try TM (TM try) and their wish that their rheumatologists offer TM services (TM wish).
We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with rheumatic and musculoskeletal disease (RMD). Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM try and TM wish. The predictor variables (covariates) studied individually included sociodemographic factors (eg, age and sex) and health characteristics (eg, disease type and health status). All the variables positively or negatively associated with TM try or TM wish in the univariate analyses were then considered for the Bayesian model averaging analysis after a selection based on the variance inflation factor (≤2.5). All the analyses were stratified by sex.
Of the total 102 variables, 59 (57.8%) and 45 (44.1%) variables were found to be positively or negatively associated (region of practical equivalence ≤5%) with TM try and TM wish, respectively. A total of 16 and 8 determinant factors were identified for TM try and TM wish, respectively. Wishing that TM services were offered by rheumatologists, having internet access at home, residing 5 to 10 km away from the general practitioner's office, owning an electronic device, and being aged 40 to 60 years were among the factors positively associated with TM try and TM wish. By contrast, not yet being diagnosed with an RMD, having no prior knowledge of TM, having a bad health status, living in a rural area, not documenting one's health status, not owning an electronic device, and being aged 60 to 80 years were negatively associated with TM try and TM wish.
Our results suggest that health status, knowledge, age, and access to technical equipment and infrastructure influence the motivation of patients with RMD to use telehealth services. In particular, older patients with RMD living in rural areas, who could likely benefit from using TM, are currently not motivated to use TM and seem to need additional TM support.
先前的研究表明，远程医疗（TM）是补充风湿病学护理和解决劳动力短缺的有效工具。随着 COVID-19 大流行的爆发，TM 经历了大规模的增长。先前的一项研究表明，医生使用 TM 的意愿和实际使用 TM 与他们对 TM 的了解密切相关。然而，目前尚不清楚哪些因素与患者使用 TM 的动机有关。
本研究旨在确定决定患者尝试 TM（TM try）和希望风湿病医生提供 TM 服务（TM wish）的因素。
我们对德国全国性横断面调查中患有风湿和肌肉骨骼疾病（RMD）的患者进行了二次数据分析。对数据进行了贝叶斯单变量和多变量逻辑回归分析，以确定哪些因素与 TM try 和 TM wish 相关。研究的预测变量（协变量）单独包括社会人口统计学因素（例如年龄和性别）和健康特征（例如疾病类型和健康状况）。在单变量分析中与 TM try 或 TM wish 呈正相关或负相关的所有变量，在基于方差膨胀因子（≤2.5）进行选择后，均被考虑用于贝叶斯模型平均分析。所有分析均按性别分层。
在总共 102 个变量中，有 59 个（57.8%）和 45 个（44.1%）变量与 TM try 和 TM wish 呈正相关或负相关（实用等价区域≤5%）。分别确定了 16 个和 8 个决定因素与 TM try 和 TM wish 相关。希望风湿病医生提供 TM 服务、在家中可以上网、距离全科医生办公室 5 至 10 公里、拥有电子设备以及年龄在 40 至 60 岁之间是与 TM try 和 TM wish 呈正相关的因素。相比之下，尚未被诊断出患有 RMD、对 TM 一无所知、健康状况不佳、居住在农村地区、不记录自己的健康状况、没有电子设备以及年龄在 60 至 80 岁之间与 TM try 和 TM wish 呈负相关。
我们的结果表明，健康状况、知识、年龄以及获得技术设备和基础设施的机会会影响 RMD 患者使用远程医疗服务的动机。特别是，居住在农村地区、可能受益于 TM 的年龄较大的 RMD 患者目前没有动力使用 TM，似乎需要额外的 TM 支持。
