Johns Hopkins University School of Nursing, Baltimore, MD, United States.
Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
J Med Internet Res. 2024 May 10;26:e52124. doi: 10.2196/52124.
Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic.
This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion.
We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ≥18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards.
We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits.
Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity.
在 COVID-19 大流行期间，远程医疗得到了扩展，尽管使用情况因年龄、性别、种族或民族、教育程度、收入和地点而异。目前尚不清楚在大流行后期是否仍有大量使用远程医疗或存在不平等现象。
本研究旨在评估远程医疗扩展一年后远程医疗就诊的流行程度、不平等现象和主要原因。
我们使用了 2022 年健康信息国家趋势调查（HINTS 6）的横断面数据，这是第一个包含远程医疗数据的周期。共有 4830 名美国成年英语和西班牙语使用者（年龄≥18 岁）参与了本研究。主要结局指标为 2022 年 3 月 7 日至 11 月 8 日之前的 12 个月内远程医疗就诊次数和最近一次远程医疗就诊的主要原因。我们通过泊松回归评估了社会人口统计学和临床预测因素与远程医疗就诊次数和最近一次远程医疗就诊的主要原因之间的关系。分析根据 HINTS 6 标准进行加权。
我们纳入了 4830 名参与者（平均年龄 48.3 岁，标准差 17.5 岁；50.28%为女性；65.21%为白人）。在美国成年人中，38.78%报告在过去一年中有过远程医疗就诊。远程医疗就诊率在年龄、种族或民族、收入以及城市与农村地区之间相似。然而，有远程医疗就诊的个体更不可能居住在中西部地区（调整后患病率比 [aPR] 0.65，95%置信区间 [CI] 0.54-0.77），而更可能是女性（aPR 1.21，95% CI 1.06-1.38）、大学毕业或研究生毕业（aPR 1.24，95% CI 1.05-1.46）、有医疗保险（aPR 1.56，95% CI 1.08-2.26）和已婚或同居（aPR 1.17，95% CI 1.03-1.32），调整了社会人口统计学特征、医疗保健就诊频率和合并症。在过去一年中有远程医疗就诊的参与者中，最近一次就诊的主要原因是轻微或急性疾病（32.15%）、慢性病管理（21%）、心理健康或药物滥用（16.94%）和年度体检（16.22%）。老年人更有可能报告最近一次远程医疗就诊的主要原因是慢性病管理（aPR 2.08，95% CI 1.33-3.23），但不太可能报告心理健康或药物滥用问题（aPR 0.19，95% CI 0.10-0.35），调整了社会人口统计学特征和医疗保健就诊频率。
在美国成年人中，远程医疗就诊率在远程医疗扩展一年后仍然很高，且不受年龄、种族或民族、收入或城乡位置的影响。在 COVID-19 之后，远程医疗可以继续被利用，以改善获得医疗保健的机会和健康公平。
