School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States.
Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States.
Appl Clin Inform. 2023 Jan;14(1):172-184. doi: 10.1055/s-0043-1762595. Epub 2023 Mar 1.
The COVID-19 (coronavirus disease 2019) pandemic rapidly expanded telemedicine scale and scope. As telemedicine becomes routine, understanding how specialty and diagnosis combine with demographics to impact telemedicine use will aid in addressing its current limitations.
To analyze the relationship between medical specialty, diagnosis, and telemedicine use, and their interplay with patient demographics in determining telemedicine usage patterns.
We extracted encounter and patient data of all adults who scheduled outpatient visits from June 1, 2020 to June 30, 2021 from the electronic health record of an integrated academic health system encompassing a broad range of subspecialties. Extracted variables included medical specialty, primary visit diagnosis, visit modality (video, audio, or in-person), and patient age, sex, self-reported race/ethnicity and 2013 rural-urban continuum code. Six specialties (General Surgery, Family Medicine, Gastroenterology, Oncology, General Internal Medicine, and Psychiatry) ranging from the lowest to the highest quartile of telemedicine use (video and audio) were chosen for analysis. Relative proportions of video, audio, and in-person modalities were compared. We examined diagnoses associated with the most and least frequent telemedicine use within each specialty. Finally, we analyzed associations between patient characteristics and telemedicine modality (video vs. audio/in-person, and video/audio vs. in-person) using a mixed-effects logistic regression model.
A total of 2,494,296 encounters occurred during the study period, representing 420,876 unique patients (mean age: 44 years, standard deviation: 24 years, 54% female). Medical diagnoses requiring physical examination or minor procedures were more likely to be conducted in-person. Rural patients were more likely than urban patients to use video telemedicine in General Surgery and Gastroenterology and less likely to use video for all other specialties. Within most specialties, male patients and patients of nonwhite race were overall less likely to use video modality and video/audio telemedicine. In Psychiatry, members of several demographic groups used video telemedicine more commonly than expected, while in other specialties, members of these groups tended to use less telemedicine overall.
Medical diagnoses requiring physical examination or minor procedures are more likely to be conducted in-person. Patient characteristics (age, sex, rural vs. urban, race/ethnicity) affect video and video/audio telemedicine use differently depending on medical specialty. These factors contribute to a unique clinical scenario which impacts perceived usefulness and accessibility of telemedicine to providers and patients, and are likely to impact rates of telemedicine adoption.
COVID-19（冠状病毒病 2019）大流行迅速扩大了远程医疗的规模和范围。随着远程医疗变得常规化，了解专业和诊断如何与人口统计学因素相结合，以影响远程医疗的使用，将有助于解决其当前的局限性。
分析医疗专业、诊断和远程医疗使用之间的关系，以及它们与患者人口统计学因素的相互作用，以确定远程医疗使用模式。
我们从一家综合性学术医疗系统的电子健康记录中提取了 2020 年 6 月 1 日至 2021 年 6 月 30 日期间所有预约门诊的成年患者的就诊和患者数据。提取的变量包括医疗专业、首诊诊断、就诊方式（视频、音频或面对面）以及患者年龄、性别、自我报告的种族/族裔和 2013 年城乡连续体代码。选择了六个专业（普通外科、家庭医学、胃肠病学、肿瘤学、普通内科和精神病学），它们的远程医疗使用（视频和音频）从最低到最高四分位数进行分析。比较了视频、音频和面对面方式的相对比例。我们检查了每个专业中与最频繁和最不频繁的远程医疗使用相关的诊断。最后，我们使用混合效应逻辑回归模型分析了患者特征与远程医疗方式（视频与音频/面对面，视频/音频与面对面）之间的关联。
在研究期间共发生了 2,494,296 次就诊，代表了 420,876 名独特的患者（平均年龄：44 岁，标准差：24 岁，54%为女性）。需要体格检查或小手术的医疗诊断更有可能进行面对面就诊。农村患者比城市患者更有可能在普通外科和胃肠病学中使用视频远程医疗，而在其他专业中则不太可能使用视频。在大多数专业中，男性患者和非白人种族的患者总体上不太可能使用视频模式和视频/音频远程医疗。在精神病学中，一些人群群体比预期更频繁地使用视频远程医疗，而在其他专业中，这些群体总体上更倾向于使用较少的远程医疗。
需要体格检查或小手术的医疗诊断更有可能进行面对面就诊。患者特征（年龄、性别、农村与城市、种族/族裔）根据医疗专业的不同，对视频和视频/音频远程医疗的使用有不同的影响。这些因素促成了一个独特的临床情况，影响了提供者和患者对远程医疗的实用性和可及性的看法，并且可能会影响远程医疗的采用率。
