Hamline Michelle Y, Xing Guibo, Kravitz Richard L, Miller Marykate, Melnikow Joy
Department of Pediatrics, University of California Davis, Sacramento, CA, United States.
Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, United States.
JMIR Form Res. 2024 Jul 17;8:e50751. doi: 10.2196/50751.
Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability.
This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response.
We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse.
Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice.
Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.
在新冠疫情期间，远程医疗迅速发展，关键政策变化、财政支持以及疫情引发的恐惧使天平向基于互联网的医疗倾斜。尽管获得了更多支持，且对患者和临床医生都有益处，但远程医疗的采用情况在临床医生和医疗机构中存在差异。对于造成这种差异的医生和机构特征，我们知之甚少。
本研究旨在评估在疫情早期应对阶段影响一线医生采用远程医疗的因素。
2020年6月或7月，我们从美国医学协会医生专业数据中抽取了一个全国分层样本，对一线临床医生进行了调查。该调查询问了疫情期间远程医疗使用的第一个月和最近一个月（2020年6月）的情况；样本数据包括临床医生的性别、专业、人口普查区域以及从业年限。根据调查回复时各县的新冠疫情数据估算当地的疫情状况。数据采用加权逻辑回归进行分析，控制各县特定的疫情数据，并进行加权以考虑调查数据分层和无回应情况。
在疫情的前3 - 4个月，报告在超过30%的就诊中使用远程医疗的医生比例从29.2%（70/239）增至35.7%（85/238）。与初级保健相比，在疫情第一个月以及2020年6月大量使用远程医疗（>30%）的几率在传染病和重症监护医生中增加，而在住院医生和急诊医生中降低。至少在疫情前有最低限度的远程医疗使用（优势比[OR] 11.41，95%置信区间1.34 - 97.04）以及当地新冠病例的两周移动平均值较高（OR 10.16，95%置信区间2.07 - 49.97）也与2020年6月大量使用远程医疗相关。根据临床医生性别、人口普查区域或从业年限，未发现显著差异。
疫情前的远程医疗使用、当地新冠病例数较高以及临床医生专业与疫情早期应对阶段较高水平的大量远程医疗使用相关。这些结果表明，面对疫情时远程医疗的采用可能受到感知威胁程度和可用于实施的资源的严重影响。这种认识对于减少职业倦怠以及为未来公共卫生紧急情况做准备具有重要意义。
