Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD.
Kaiser Permanente, Institute for Health Research, Denver, CO.
Med Care. 2023 Apr 1;61(Suppl 1):S30-S38. doi: 10.1097/MLR.0000000000001833. Epub 2023 Mar 9.
BACKGROUND/OBJECTIVE: In recent years, 2 circumstances have changed provider-patient interactions in ambulatory care: (1) the replacement of virtual for in-person visits and (2) the COVID-19 pandemic. We studied the potential impact of each event on provider practice and patient adherence by comparing the frequency of the association of provider orders, and patient fulfillment of those orders, by visit mode and pandemic period, for incident neck or back pain (NBP) visits in ambulatory care.
Data were extracted from the electronic health records of 3 Kaiser Permanente regions (Colorado, Georgia, and Mid-Atlantic States) from January 2017 to June 2021. Incident NBP visits were defined from ICD-10 coded as primary or first listed diagnoses on adult, family medicine, or urgent care visits separated by at least 180 days. Visit modes were classified as virtual or in-person. Periods were classified as prepandemic (before April 2020 or the beginning of the national emergency) or recovery (after June 2020). Percentages of provider orders for, and patient fulfillment of orders, were measured for 5 service classes and compared on: virtual versus in-person visits, and prepandemic versus recovery periods. Comparisons were balanced on patient case-mix using inverse probability of treatment weighting.
Ancillary services in all 5 categories at each of the 3 Kaiser Permanente regions were substantially ordered less frequently on virtual compared with in-person visits in both the prepandemic and recovery periods (both P ≤ 0.001). Conditional on an order, patient fulfillment within 30 days was high (typically ≥70%) and not likely meaningfully different between visit modes or pandemic periods.
Ancillary services for incident NBP visits were ordered less frequently during virtual than in-person visits in both prepandemic and recovery periods. Patient fulfillment of orders was high, and not significantly different by mode or period.
背景/目的：近年来，有 2 种情况改变了门诊护理中的医患互动：（1）虚拟就诊取代了面对面就诊，（2）新冠疫情。我们通过比较虚拟和面对面就诊模式以及疫情期间的就诊模式，研究了这两种情况对提供者实践和患者依从性的潜在影响，对门诊新出现的颈部或背部疼痛（NBP）就诊中提供者医嘱的关联性及其患者的执行情况进行了研究。
数据来自 2017 年 1 月至 2021 年 6 月科罗拉多州、佐治亚州和大西洋中部地区的 3 个 Kaiser Permanente 地区的电子健康记录。新出现的 NBP 就诊是根据 ICD-10 编码确定的，主要或首次列出的诊断为成人、家庭医学或紧急护理就诊，间隔至少 180 天。就诊模式分为虚拟或面对面。时期分为疫情前（2020 年 4 月之前或国家紧急状态开始之前）或恢复期（2020 年 6 月之后）。在以下方面测量了 5 种服务类别中提供者的医嘱比例和患者的医嘱执行比例：虚拟与面对面就诊，以及疫情前与恢复期。使用治疗反概率加权法对患者病例组合进行平衡比较。
在 3 个 Kaiser Permanente 地区的所有 5 个类别中，在疫情前和恢复期，与面对面就诊相比，虚拟就诊时所有 5 类辅助服务的医嘱均明显减少（均 P ≤ 0.001）。在有医嘱的情况下，30 天内的患者执行率较高（通常≥70%），且在就诊模式或疫情期间无明显差异。
在疫情前和恢复期，与面对面就诊相比，虚拟就诊时新出现的 NBP 就诊的辅助服务医嘱减少。患者对医嘱的执行率较高，且就诊模式或疫情期间无显著差异。
