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需要在城市学术性家庭医学中心进行后续面对面就诊的远程医疗问诊。

Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre.

作者信息

Arsenault Mylène, Long Stephanie, D'Souza Vinita, Ilie Alexandru, Todd Keith J

机构信息

Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada.

Department of Family Medicine, McGill University, Montreal, Canada.

出版信息

Fam Pract. 2024 Apr 15;41(2):105-113. doi: 10.1093/fampra/cmae008.

Abstract

BACKGROUND

With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic.

METHODS

We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days.

RESULTS

Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians.

CONCLUSION

In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.

摘要

背景

随着新冠疫情的爆发,远程医疗在全球医疗环境中迅速得到应用。为了解在我们城市的学术性家庭医学诊所环境中,哪些因素会影响远程医疗就诊的顺利完成,我们分析了疫情期间进行的远程医疗就诊情况。

方法

我们对一家家庭医学中心内两个临床科室的远程医疗就诊记录进行了回顾性分析。为了研究未完成就诊与各种因素(年龄、性别、就诊主诉、医生培训水平[住院医师或 staff]以及医患关系连续性)之间的关联,我们对 2020 年 8 月、2021 年 2 月和 2021 年 5 月的数据进行了多变量逻辑回归分析。未完成就诊是指需要在 3 天内与医生进行面对面随访的就诊。

结果

在我们调查的 2138 次远程医疗患者就诊中,9.6%为未完成就诊。出现肿块和凸起症状的患者(比值比:3.84,95%置信区间:1.44,10.5)以及由住院医师诊治的患者(比值比:1.77,95%置信区间:1.22,2.56)未完成就诊的几率增加。与社区诊所(地点 B)相比,在家庭医学诊所(地点 A)对注册患者进行的远程医疗就诊未完成就诊的几率较低(比值比:0.24,95%置信区间:0.15,0.39),社区诊所提供紧急/临时护理,患者与医生之间不存在关联的关系连续性。

结论

在我们的城市临床环境中,只有一小部分远程医疗就诊需要面对面随访就诊。这些信息可能有助于指导将患者分诊至远程医疗或标准面对面护理的方法。

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