Stanford University, School of Medicine, Palo Alto, CA.
Clin J Pain. 2023 Aug 1;39(8):408-413. doi: 10.1097/AJP.0000000000001132.
To evaluate subsequent shifts to patient access to tertiary pain management care following shelter-in-place (SIP) and increased telehealth during the COVID-19 pandemic.
Retrospective naturalistic design was used. Data for this study were extracted from a retrospective review of the Pediatric-Collaborative Health Outcomes Information Registry, with additional demographic information collected using chart review. Participants were 906 youth who received an initial evaluation either in-person (n=472) within the 18 months before SIP or through telehealth (n=434) within the 18 months after SIP during the COVID-19 pandemic. Patient variables to assess access included geographic distance from the clinic, ethnic and racial diversity, and patient's insurance type. Descriptive characteristics for each group were analyzed using χ 2 test, percentage change, and t -test analyses.
Data indicated that transitioning to telehealth resulted in maintained access rates between groups as measured by race and ethnic diversity as well as distance traveled from the clinic. A trend toward increase in government-funded insurance was found, though no statistically significant differences were identified between telehealth and in-person visits. Though the majority of participants (in-person: 52.75%; telehealth 55.81%) lived within 50 miles of the clinic, results indicated that telehealth allowed for a statistically significant increase in evaluation access for families living further from the clinic within a 50-mile radius.
Overall, accessibility to pediatric pain management through telehealth during SIP was maintained despite significant declines in overall access to health care, with some trends in increased accessibility for patients with government insurance.
评估在 COVID-19 大流行期间实行就地避难（SIP）和增加远程医疗后，患者获得三级疼痛管理护理的后续转变。
采用回顾性自然设计。本研究的数据来自儿科合作健康结果信息注册处的回顾性审查，使用图表审查收集了更多人口统计学信息。参与者为 906 名青年，他们在 SIP 之前的 18 个月内通过面对面（n=472）或 SIP 之后的 18 个月内通过远程医疗（n=434）接受了初始评估。评估访问的患者变量包括与诊所的地理距离、种族和民族多样性以及患者的保险类型。使用卡方检验、百分比变化和 t 检验分析对每个组的描述性特征进行分析。
数据表明，向远程医疗的转变保持了组间的访问率，这是通过种族和民族多样性以及从诊所的旅行距离来衡量的。发现政府资助的保险呈增加趋势，但在远程医疗和面对面访问之间未发现统计学上的显著差异。尽管大多数参与者（面对面：52.75%；远程医疗：55.81%）居住在离诊所 50 英里以内，但结果表明，远程医疗允许居住在 50 英里半径内更远距离的家庭在评估方面具有统计学意义的增加。
总体而言，尽管总体医疗保健的获得率显著下降，但通过 SIP 期间的远程医疗实现了儿科疼痛管理的可及性，对于具有政府保险的患者，可及性呈增加趋势。
