Oregon Health and Science University School of Medicine, Portland, Oregon, USA.
Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA.
Telemed J E Health. 2024 Feb;30(2):415-421. doi: 10.1089/tmj.2023.0126. Epub 2023 Jul 19.
The telemedicine expansion (TE) that accompanied the COVID-19 pandemic presents a novel opportunity to increase access to care for rural-residing children with type 1 diabetes (T1D) who may live a great distance from their provider. The study objective was to compare trends in visit frequency among the pediatric T1D population at a single academic center in Oregon before and after TE by those living <100 miles versus ≥100 miles from clinic (MFC) and those residing in urban versus rural areas. We evaluated electronic health record data from 790 children receiving care between July 2018 and December 2021. We estimated differences in likelihood of adequately timed monitoring care (ATMC) over time by patient residence using Generalized Estimating Equations. Just before TE, 37.3% of children were receiving ATMC and those living ≥100 MFC were 20.6% less likely to receive ATMC compared with those living <100 MFC (relative risk [RR] 0.79; confidence interval [95% CI]: 0.57-1.11). Following TE, decreases in ATMC for those living ≥100 MFC were less than for those living <100 MFC (RR of interaction: 1.17; 95% CI: 0.68-2.00). Just before TE, those living in rural areas were as likely to receive ATMC compared with those living in urban areas (RR 1.00; 95% CI: 0.61-1.63). Following TE, decreases in ATMC were greater for those living in rural areas versus urban areas (RR of interaction: 0.79; 95% CI: 0.31-2.01). Between July 2020 and December 2021, the likelihood of ATMC decreased across the entire pediatric T1D population. Decreases in ATMC during this period were more substantial for those living <100 MFC and/or in rural areas, however, these discrepancies were not statistically significant.
远程医疗在 COVID-19 大流行期间得到了扩展，为居住在距离医疗机构较远的农村地区的 1 型糖尿病 (T1D) 儿童提供了更多获得医疗服务的机会。本研究的目的是比较俄勒冈州一家学术中心的儿科 T1D 人群在远程医疗前后，根据患者居住距离诊所 (MFC) 小于 100 英里与大于或等于 100 英里以及居住在城市与农村地区，就诊频率的变化趋势。我们评估了 2018 年 7 月至 2021 年 12 月期间接受治疗的 790 名儿童的电子健康记录数据。我们使用广义估计方程估计了不同患者居住地随时间推移获得充分及时监测护理 (ATMC) 的可能性差异。在远程医疗之前，37.3%的儿童接受 ATMC，与居住距离诊所小于 100 英里的儿童相比，居住距离诊所大于或等于 100 英里的儿童接受 ATMC 的可能性低 20.6%（相对风险 [RR] 0.79；95%CI：0.57-1.11）。在远程医疗之后，对于居住距离诊所大于 100 英里的儿童，ATMC 的减少幅度小于居住距离诊所小于 100 英里的儿童（交互作用 RR：1.17；95%CI：0.68-2.00）。在远程医疗之前，居住在农村地区的儿童与居住在城市地区的儿童获得 ATMC 的可能性相当（RR 1.00；95%CI：0.61-1.63）。在远程医疗之后，居住在农村地区的儿童 ATMC 的减少幅度大于居住在城市地区的儿童（交互作用 RR：0.79；95%CI：0.31-2.01）。在 2020 年 7 月至 2021 年 12 月期间，整个儿科 T1D 人群获得 ATMC 的可能性降低。然而，对于居住距离诊所小于 100 英里和/或居住在农村地区的儿童，在此期间 ATMC 的减少幅度更大，但这些差异没有统计学意义。
