Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, United States.
Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Diego, San Diego, United States.
BMC Health Serv Res. 2023 Jun 22;23(1):680. doi: 10.1186/s12913-023-09634-x.
Adolescents and young adults are a diverse patient population with unique healthcare needs including sensitive and confidential services. Many clinics serving this population began offering telemedicine during the Covid-19 pandemic. Little is known regarding patient and parent experiences accessing these services via telemedicine.
To assess for trends and disparities in telemedicine utilization in the first year of the pandemic, we used the electronic health record to obtain patient demographic data from an adolescent and young adult medicine clinic in a large urban academic institution. Characteristics of patients who had accessed telemedicine were compared to those who were only seen in person. Mean age was compared using t-test, while other demographic variables were compared using chi-squared test or Fisher's exact test. We performed qualitative semi-structured interviews with patients and parents of patients in order to characterize their experiences and preferences related to accessing adolescent medicine services via telemedicine compared to in-person care.
Patients that identified as female, white race, Hispanic/Latinx ethnicity were more likely to have utilized telemedicine. Telemedicine use was also more prevalent among patients who were privately insured and who live farther from the clinic. Although interview participants acknowledged the convenience of telemedicine and its ability to improve access to care for people with geographic or transportation barriers, many expressed preferences for in-person visits. This was based on desire for face-to-face interactions with their providers, and perception of decreased patient and parent engagement in telemedicine visits compared to in-person visits. Participants also expressed concern that telemedicine does not afford as much confidentiality for patients.
More work is needed to address patient and parent preferences for telemedicine as an adjunct modality to in-person adolescent and young adult medicine services. Optimizing quality and access to telemedicine for this patient population can improve overall healthcare for this patient population.
青少年和年轻人是一个多样化的患者群体，他们有独特的医疗保健需求，包括敏感和保密的服务。许多为这一人群服务的诊所都在新冠疫情期间开始提供远程医疗服务。对于通过远程医疗获取这些服务的患者和家长的体验，知之甚少。
为了评估在疫情第一年远程医疗利用的趋势和差异，我们使用电子健康记录从一家大型城市学术机构的青少年和青年医学诊所获得患者人口统计学数据。比较了使用远程医疗的患者特征与仅进行面对面就诊的患者特征。使用 t 检验比较平均年龄，而其他人口统计学变量则使用卡方检验或 Fisher 确切检验进行比较。我们对患者及其家长进行了定性半结构化访谈，以描述他们在通过远程医疗与面对面护理获取青少年医学服务方面的体验和偏好。
自认为是女性、白人、西班牙裔/拉丁裔的患者更有可能使用远程医疗。私人保险和居住距离诊所较远的患者也更倾向于使用远程医疗。尽管访谈参与者承认远程医疗的便利性及其能够改善地理或交通障碍人群的医疗保健获取，但许多人表示更喜欢面对面就诊。这是基于他们希望与提供者进行面对面交流，以及他们认为与面对面就诊相比，远程医疗就诊患者和家长的参与度较低。参与者还表示担心远程医疗对患者的保密性不如面对面就诊。
需要做更多的工作来满足患者和家长对远程医疗作为青少年和青年医学服务的辅助模式的偏好。优化这一患者群体的远程医疗质量和可及性，可以改善这一患者群体的整体医疗保健。
