Henson Jacqueline B, Patel Yuval A, Wall April H, Muir Andrew J
Department of Medicine, Division of Gastroenterology, School of Medicine, Duke University, Durham, NC.
J Clin Gastroenterol. 2025 Apr 1;59(4):354-360. doi: 10.1097/MCG.0000000000002023.
To evaluate order completion after telehealth compared with in-person encounters.
Completion of ordered testing, including laboratories and imaging, is an important aspect of successful outpatient care of patients with liver disease. Whether the completion of orders from telehealth encounters differs from in-person visits is unknown.
Completion of ordered laboratories and imaging from hepatology encounters at our center from 2021 to 2022 were evaluated and compared between video telehealth and in-person visits. Laboratory completion was evaluated at 14 days, 30 days, and 90 days, and imaging completion was assessed at 1 year.
Telehealth encounters were significantly less likely to have laboratories completed at all evaluated time points (14 d: 40.7% vs 90.9%; 30 d: 50.9% vs 92.2%; 90 d: 63.9% vs 94.3%, P < 0.001 for all). Among telehealth encounters, encounters in patients more remote from the center were less likely to have laboratories completed. Imaging ordered at telehealth encounters was also less likely to be completed within 1 year (62.5% vs 70.1%, P < 0.001), including liver ultrasounds (59.1% vs 67.6%, P = 0.001), which persisted when limited to encounters for cirrhosis (55.8% vs 66.4%, P = 0.01).
Telehealth encounters were significantly less likely to have ordered laboratories and imaging completed compared with in-person visits, which has important clinical implications for effective outpatient care of patients with liver disease. Further research is needed to better understand the barriers to order completion for telehealth visits and ways to optimize this to improve the effectiveness of this visit modality.
评估远程医疗与面对面会诊后的医嘱完成情况。
完成所开的检查，包括实验室检查和影像学检查，是肝病患者成功门诊治疗的一个重要方面。远程医疗会诊所开医嘱的完成情况与面对面就诊是否不同尚不清楚。
对2021年至2022年我们中心肝病会诊所开的实验室检查和影像学检查的完成情况进行评估，并在视频远程医疗和面对面就诊之间进行比较。在14天、30天和90天评估实验室检查的完成情况，在1年时评估影像学检查的完成情况。
在所有评估时间点，远程医疗会诊完成实验室检查的可能性显著更低（14天：40.7%对90.9%；30天：50.9%对92.2%；90天：63.9%对94.3%，所有P<0.001）。在远程医疗会诊中，距离中心较远的患者的会诊完成实验室检查的可能性更低。远程医疗会诊所开的影像学检查在1年内完成的可能性也更低（62.5%对70.1%，P<0.001），包括肝脏超声检查（59.1%对67.6%，P = 0.001），当仅限于肝硬化会诊时这种情况仍然存在（55.8%对66.4%，P = 0.01）。
与面对面就诊相比，远程医疗会诊完成所开实验室检查和影像学检查的可能性显著更低，这对肝病患者的有效门诊治疗具有重要的临床意义。需要进一步研究以更好地了解远程医疗会诊医嘱完成的障碍以及优化方法，以提高这种就诊方式的有效性。
