Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.
Columbia University, New York, NY, United States.
J Med Internet Res. 2023 Jul 26;25:e47670. doi: 10.2196/47670.
Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics.
The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens.
Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation.
We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population.
Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered.
在社会经济地位较低的多元化环境中，基于视频的远程医疗（与仅音频相比）的使用频率较低。很少有研究评估远程医疗模式（即视频与仅音频访问）对临床质量指标的影响。
本研究旨在通过实施科学的视角，评估远程医疗的采用情况以及访问模式（门诊、视频和电话访问）对不同、社会经济地位较低环境中的初级保健质量指标的影响。
根据 RE-AIM（覆盖范围、有效性、采用、实施和维持）框架，我们评估了远程医疗的采用情况，按访问模式评估了目标初级保健质量指标，并描述了提供者对远程医疗实施的障碍和促进因素的定性反馈。
我们发现门诊护理的质量指标（即血压和抑郁筛查）略优于视频和电话访问；在我们的人群中，远程医疗在 2 年内被放弃。
在 COVID-19 大流行期间广泛实施远程医疗之后，应该考虑访问模式对质量结果、提供者和患者偏好以及历史上处于边缘地位的环境中的技术障碍的影响。
