Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Medicine, University of Washington School of Medicine, Seattle, WA; and.
J Acquir Immune Defic Syndr. 2023 Mar 1;92(3):223-230. doi: 10.1097/QAI.0000000000003124.
Telemedicine use for the care of people with HIV (PWH) significantly expanded during the COVID-19 pandemic. During 2021, vaccine uptake increased and patients were encouraged to resume in-person care, resulting in a mixture of in-person and telemedicine visits. We studied how different patient populations used telemedicine in this hybrid-care environment.
Using observational data from patients enrolled in the Johns Hopkins HIV Clinical Cohort, we analyzed all in-person and telemedicine HIV primary care visits completed in an HIV clinic from January 1st, 2021, to December 31st, 2021. We used log-binomial regression to investigate the association between patient characteristics and the probability of completing a telemedicine versus in-person visit and the probability of completing a video versus telephone visit.
A total of 5518 visits were completed by 1884 patients; 4282 (77.6%) visits were in-person, 800 (14.5%) by phone, and 436 (7.9%) by video. The relative risk (RR) of completing telemedicine vs. in-person visits was 0.65 (95% Confidence Interval (CI): 0.47, 0.91) for patients age 65 years or older vs. age 20-39 years; 0.84 (95% CI: 0.72, 0.98) for male patients vs. female patients; 0.81 (95% CI: 0.66, 0.99) for Black vs. White patients; 0.62 (95% CI: 0.49, 0.79) for patients in the highest vs. lowest quartile of Area Deprivation Index; and 1.52 (95% CI: 1.26, 1.84) for patients >15 miles vs. <5 miles from clinic.
In the second year of the pandemic, overall in-person care was used more than telemedicine and significant differences persist across subgroups in telemedicine uptake.
在 COVID-19 大流行期间，远程医疗在艾滋病毒感染者（PWH）护理中的使用显著扩大。2021 年，疫苗接种率上升，鼓励患者恢复面对面护理，导致面对面和远程医疗就诊混合。我们研究了在这种混合护理环境中不同患者群体如何使用远程医疗。
使用来自约翰霍普金斯艾滋病毒临床队列中登记的患者的观察数据，我们分析了 2021 年 1 月 1 日至 2021 年 12 月 31 日在艾滋病毒诊所完成的所有面对面和远程医疗艾滋病毒初级保健就诊。我们使用对数二项式回归来研究患者特征与完成远程医疗与面对面就诊的概率以及完成视频与电话就诊的概率之间的关系。
共有 1884 名患者完成了 5518 次就诊；4282 次（77.6%）就诊为面对面，800 次（14.5%）为电话，436 次（7.9%）为视频。与 20-39 岁年龄组相比，65 岁或以上患者完成远程医疗与面对面就诊的相对风险（RR）为 0.65（95%置信区间（CI）：0.47，0.91）；男性患者比女性患者的 RR 为 0.84（95% CI：0.72，0.98）；黑人患者比白人患者的 RR 为 0.81（95% CI：0.66，0.99）；与处于地区贫困指数最低四分位数的患者相比，处于最高四分位数的患者的 RR 为 0.62（95% CI：0.49，0.79）；与距离诊所<5 英里的患者相比，距离诊所>15 英里的患者的 RR 为 1.52（95% CI：1.26，1.84）。
在大流行的第二年，总体上面对面护理的使用多于远程医疗，并且在远程医疗使用率方面，各亚组之间仍然存在显著差异。
