Mitchell Emily S, Andrea Sarah, Guttmann-Bauman Ines
Oregon Health and Science University, School of Medicine, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
Oregon Health and Science University - Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR 97201, USA.
J Clin Transl Endocrinol. 2024 Mar 19;36:100338. doi: 10.1016/j.jcte.2024.100338. eCollection 2024 Jun.
Children with type 1 diabetes require close monitoring with visits every 3-4 months. COVID-19-induced telemedicine expansion may alleviate the challenge of high visit frequency that children with type 1 diabetes face. However, telemedicine's impact on access to care may be limited if patients lack adequate support for telemedicine. The purpose of this study was to evaluate the impact of telemedicine care coordination services on visit frequency in an urban medical center without care coordination services versus a rural outreach program with established care coordination services serviced by the same providers.
We evaluated EHR data from 790 children receiving care between July 2018 and December 2021 at a single academic center in Oregon. We estimated differences in likelihood of adequately timed monitoring care over time by patient care coordination services status using Generalized Estimating Equations.
Just prior to telemedicine expansion, patients receiving care coordination services were 25.6 % less likely to receive adequately timed monitoring care (95 % CI: 51.6 %, 114 %). Following telemedicine expansion, likelihood of adequately timed monitoring care increased from 28.8 % to 58.2 % among those receiving care coordination services and decreased from 38.7 % to 22.0 % among those not receiving care coordination services; increases in adequately timed monitoring care were 3.55 times greater in patients receiving care coordination services relative to those not (95 % CI: 2.10, 6.01).
For pediatric patients with type 1 diabetes, telemedicine care coordination may be an important factor for increasing visit adherence and may increase the number of patients meeting goal visit frequency beyond levels seen prior to widespread telemedicine availability.
1型糖尿病患儿需要每3 - 4个月进行一次密切监测并就诊。由新冠疫情引发的远程医疗扩张可能会缓解1型糖尿病患儿面临的高就诊频率挑战。然而，如果患者缺乏对远程医疗的充分支持，那么远程医疗对获得医疗服务的影响可能会受到限制。本研究的目的是评估远程医疗护理协调服务对城市医疗中心（无护理协调服务）与农村外展项目（有由相同提供者提供的既定护理协调服务）就诊频率的影响。
我们评估了2018年7月至2021年12月期间在俄勒冈州一个单一学术中心接受治疗的790名儿童的电子健康记录（EHR）数据。我们使用广义估计方程，根据患者护理协调服务状况，估计随时间推移获得适时监测护理的可能性差异。
就在远程医疗扩张之前，接受护理协调服务的患者获得适时监测护理的可能性低25.6%（95%置信区间：51.6%，114%）。远程医疗扩张后，接受护理协调服务的患者中，适时监测护理的可能性从28.8%增至58.2%，而未接受护理协调服务的患者中，这一比例从38.7%降至22.0%；接受护理协调服务的患者适时监测护理的增加幅度是未接受服务患者的3.55倍（95%置信区间：2.10，6.01）。
对于1型糖尿病儿科患者，远程医疗护理协调可能是提高就诊依从性的一个重要因素，并且可能使达到目标就诊频率的患者数量增加，超过广泛应用远程医疗之前的水平。
