Fisher Katie, Tapley Amanda, Ralston Anna, Davey Andrew, Fielding Alison, van Driel Mieke, Holliday Elizabeth, Ball Jean, Dizon Jason, Spike Neil, Clarke Lisa, Magin Parker
School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia.
Royal Australian College of General Practitioners GP Training Research Department, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia.
Fam Pract. 2024 Apr 15;41(2):198-202. doi: 10.1093/fampra/cmad115.
Remunerated telehealth consultations were introduced in Australia in 2020 in response to the COVID-19 pandemic. Videoconferencing has advantages over telephone-consulting, including improved diagnostic and decision-making accuracy. However, videoconferencing uptake in Australia has been low. This study aimed to establish prevalence and associations of video versus telephone consultations in Australian general practice (GP) registrars' practice.
A cross-sectional analysis of data from 2020 to 2021 (three 6-monthly data-collection rounds) from the Registrars Clinical Encounters in Training (ReCEnT) study. GP registrars record details of 60 consecutive consultations every 6-month term, for a total of 3 terms. Univariable and multivariable logistic regression were performed within the Generalized Estimating Equations framework with the outcome video versus telephone.
102,286 consultations were recorded by 1,168 registrars, with 21.4% of consultations performed via telehealth. Of these, telephone accounted for 96.6% (95% CI: 96.3-96.8%) and videoconferencing for 3.4% (95% CI: 3.2-3.7%). Statistically significant associations of using videoconferencing, compared to telephone, included longer consultation duration (OR 1.02, 95% CI: 1.01-1.03 per minute; and mean 14.9 versus 12.8 min), patients aged 0-14 years old (OR 1.29, 95% CI: 1.03-1.62, compared to age 15-34), patients new to the registrar (OR 1.19, 95% CI: 1.04-1.35), part-time registrars (OR 1.84, 95% CI: 1.08-3.15), and areas of less socioeconomic disadvantage (OR 1.27, 95% CI: 1.00-1.62 per decile).
Registrars' telehealth consultations were mostly performed via telephone. Telephone use being associated with socioeconomic disadvantage has health equity implications. Future research should explore barriers to videoconferencing use and strategies to increase its uptake.
为应对2019冠状病毒病疫情，澳大利亚于2020年引入了有偿远程医疗咨询服务。视频会议相较于电话咨询具有优势，包括提高诊断和决策准确性。然而，澳大利亚视频会议的使用率较低。本研究旨在确定澳大利亚全科医生（GP）注册实习生诊疗中视频咨询与电话咨询的普及率及相关性。
对注册实习生培训临床诊疗（ReCEnT）研究2020年至2021年（三轮每6个月收集一次数据）的数据进行横断面分析。GP注册实习生每6个月记录60次连续诊疗的详细信息，共记录3个6个月的数据。在广义估计方程框架内进行单变量和多变量逻辑回归分析，以视频咨询与电话咨询作为结果变量。
1168名注册实习生共记录了102286次诊疗，其中21.4%的诊疗通过远程医疗进行。在这些远程医疗诊疗中，电话咨询占96.6%（95%置信区间：96.3 - 96.8%），视频会议咨询占3.4%（95%置信区间：3.2 - 3.7%）。与电话咨询相比，使用视频会议咨询具有统计学显著相关性的因素包括：诊疗时间更长（比值比1.02，95%置信区间：每分钟1.01 - 1.03；平均时长分别为14.9分钟和12.8分钟）、0 - 14岁患者（与15 - 34岁患者相比，比值比1.29，95%置信区间：1.03 - 1.62）、首次找该注册实习生诊疗的患者（比值比1.19，95%置信区间：1.04 - 1.35）、兼职注册实习生（比值比1.84，95%置信区间：1.08 - 3.15）以及社会经济劣势程度较低的地区（每十分位数比值比1.27，95%置信区间：1.00 - 1.62）。
注册实习生的远程医疗咨询大多通过电话进行。电话咨询与社会经济劣势相关，这对健康公平性有影响。未来研究应探索视频会议咨询使用的障碍以及提高其使用率的策略。
