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全科医学受训者在 COVID-19 大流行期间使用远程医疗:一项横断面研究。

General practice trainees' telehealth use during the COVID-19 pandemic: a cross-sectional study.

机构信息

University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia.

GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, Australia.

出版信息

Fam Pract. 2023 Dec 22;40(5-6):638-647. doi: 10.1093/fampra/cmad022.

Abstract

BACKGROUND

Prompted by the COVID-19 pandemic, remuneration was introduced for Australian general practice telehealth consultations. General practitioner (GP) trainees' telehealth use is of clinical, educational, and policy importance. The aim of this study was to assess the prevalence and associations of telehealth versus face-to-face consultations amongst Australian GP registrars (vocational GP trainees).

METHODS

Cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, from 2020 to 2021 (three 6-month terms), including registrars in 3 of Australia's 9 Regional Training Organisations. In ReCEnT, GP registrars record details of 60 consecutive consultations, 6 monthly. The primary analysis used univariate and multivariable logistic regression, with outcome of whether the consultation was conducted via telehealth (phone and videoconference) or face-to-face.

RESULTS

1,168 registrars recorded details of 102,286 consultations, of which 21.4% (95% confidence interval [CI]: 21.1%-21.6%) were conducted via telehealth. Statistically significant associations of a telehealth consultation included shorter consultation duration (odds ratio [OR] 0.93, 95% CI: 0.93-0.94; and mean 12.9 versus 18.7 min); fewer problems addressed per consultation (OR 0.92, 95% CI: 0.87-0.97); being less likely to seek assistance from a supervisor (OR 0.86, 95% CI: 0.76-0.96) while being more likely to generate learning goals (OR 1.18, 95% CI: 1.02-1.37); and being more likely to arrange a follow-up consultation (OR 1.18, 95% CI: 1.02-1.35).

CONCLUSIONS

That telehealth consultations were shorter, with higher rates of follow-up, has GP workforce/workload implications. That telehealth consultations were less likely to involve in-consultation supervisor support, but more likely to generate learning goals, has educational implications.

摘要

背景

受 COVID-19 大流行的影响,澳大利亚的全科医生提供远程医疗咨询服务可获得报酬。全科医生(GP)受训者使用远程医疗具有临床、教育和政策重要性。本研究的目的是评估澳大利亚全科医生注册实习生(职业 GP 受训者)中远程医疗与面对面咨询的比例,并分析其相关因素。

方法

本研究是对 Registrar Clinical Encounters in Training(ReCEnT)研究 2020 年至 2021 年(三个 6 个月的任期)数据的横断面分析,研究对象来自澳大利亚 9 个区域培训组织中的 3 个。在 ReCEnT 中,GP 注册实习生记录了 60 次连续咨询的详细信息,每月记录 6 次。主要分析采用单变量和多变量逻辑回归,结局是咨询是否通过电话和视频会议进行远程医疗。

结果

1168 名注册实习生记录了 102286 次咨询的详细信息,其中 21.4%(95%置信区间[CI]:21.1%-21.6%)通过远程医疗进行。远程医疗咨询具有统计学意义的关联因素包括:咨询时间更短(比值比[OR]0.93,95%CI:0.93-0.94;平均 12.9 分钟与 18.7 分钟);每次咨询解决的问题更少(OR0.92,95%CI:0.87-0.97);不太可能寻求主管的帮助(OR0.86,95%CI:0.76-0.96),而更有可能生成学习目标(OR1.18,95%CI:1.02-1.37);更有可能安排后续咨询(OR1.18,95%CI:1.02-1.35)。

结论

远程医疗咨询时间更短,后续咨询的比例更高,这对全科医生的劳动力/工作量有影响。远程医疗咨询不太可能涉及咨询中的主管支持,但更有可能生成学习目标,这对教育有影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14fa/10745257/a2c5f60293b3/cmad022_fig1.jpg

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