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提高服务不足地区老年人的远程医疗可及性:一种4M框架方法。

Enhancing Telehealth Accessibility for Older Adults in Underserved Areas: A 4M Framework Approach.

作者信息

Lee Soohyoung Rain, Maxi Andrea, Kim Laurie, Kim Yihyun, Choe Ian, Hong Chelin, Kim Pearl, Reed Peter S, Kim Yonsu, Shen Jay, Yoo Ji Won

机构信息

Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA.

Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.

出版信息

Gerontol Geriatr Med. 2024 Sep 15;10:23337214241277045. doi: 10.1177/23337214241277045. eCollection 2024 Jan-Dec.

DOI:10.1177/23337214241277045
PMID:39286401
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11403561/
Abstract

Telehealth has emerged as a vital alternative to traditional healthcare delivery, particularly for rural and underserved populations. While efforts to enhance telehealth accessibility have primarily focused on technological solutions, the effectiveness of its telehealth and the role of physician training in bridging racial and ethnic disparities in telehealth usage remains underexplored. This study evaluates the impact of a trained-physician-delivered, age-friendly telehealth model on healthcare accessibility and outcomes. A retrospective analysis was conducted on 214 older patients (60+) at an urban primary care facility in Nevada, USA. Patients received telehealth services from either trained or non-trained physicians, with the trained group utilizing a 4M-based telehealth model focusing on Medication, Mentation, Mobility, and What Matters. Findings revealed lower exposure to both general and 4M-based telehealth among Hispanic and Asian patients compared to their white counterparts. Telehealth usage did not significantly reduce hospital or emergency department visits overall. However, certain types of 4M-based telehealth, such as What Matters and Medications, reduced hospital and ED visits. The development and implementation of telehealth education curricula for healthcare providers could make telehealth more accessible to minority patients, potentially reducing unnecessary emergency department visits and addressing disparities in telehealth access.

摘要

远程医疗已成为传统医疗服务的重要替代方式,尤其对于农村和服务不足的人群而言。虽然提高远程医疗可及性的努力主要集中在技术解决方案上,但远程医疗的有效性以及医生培训在弥合远程医疗使用中的种族和族裔差异方面的作用仍未得到充分探索。本研究评估了由经过培训的医生提供的、适合老年人的远程医疗模式对医疗可及性和医疗结果的影响。对美国内华达州一家城市初级保健机构的214名老年患者(60岁以上)进行了回顾性分析。患者接受来自经过培训或未经培训的医生的远程医疗服务,经过培训的组采用基于4M的远程医疗模式,重点关注用药、心理状态、行动能力和重要事项。研究结果显示,与白人患者相比,西班牙裔和亚裔患者接受一般远程医疗和基于4M的远程医疗的比例较低。总体而言,远程医疗的使用并未显著减少住院或急诊就诊次数。然而,某些类型的基于4M的远程医疗,如重要事项和用药方面的远程医疗,减少了住院和急诊就诊次数。为医疗服务提供者制定和实施远程医疗教育课程,可以使少数族裔患者更容易获得远程医疗服务,有可能减少不必要的急诊就诊次数,并解决远程医疗可及性方面的差异问题。

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本文引用的文献

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Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department.门诊患者门诊随访方式(现场或远程)与再次就诊率的关联。
JAMA Netw Open. 2022 Oct 3;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783.
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Strategies for Digital Care of Vulnerable Patients in a COVID-19 World-Keeping in Touch.新冠疫情下弱势患者的数字照护策略——保持联系
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Telehealth for geriatric post-emergency department visits to promote age-friendly care.
老年急诊后访视的远程医疗促进友善老年照护
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Perspectives on Telehealth for older adults during the COVID-19 pandemic using the quadruple aim: interviews with 48 physicians.《COVID-19 大流行期间使用四重目标视角看待老年人远程医疗:对 48 名医生的访谈》
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Using telehealth consultations for healthcare provision to patients from non-Indigenous racial/ethnic minorities: a systematic review.利用远程医疗咨询为非原住民少数族裔患者提供医疗服务:系统评价。
J Am Med Inform Assoc. 2022 Apr 13;29(5):970-982. doi: 10.1093/jamia/ocac015.
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The Design Blueprint for a Large-Scale Telehealth Platform.一个大规模远程医疗平台的设计蓝图。
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Associations of telemedicine vs. in-person ambulatory visits and cancellation rates and 30-day follow-up hospitalizations and emergency department visits.远程医疗与面对面门诊就诊的关联以及取消率、30天随访住院率和急诊就诊率。
Prev Med Rep. 2021 Nov 5;24:101629. doi: 10.1016/j.pmedr.2021.101629. eCollection 2021 Dec.
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"Can you see my screen?" Addressing Racial and Ethnic Disparities in Telehealth.“你能看到我的屏幕吗?”解决远程医疗中的种族和民族差异问题。
Curr Cardiovasc Risk Rep. 2021;15(12):23. doi: 10.1007/s12170-021-00685-5. Epub 2021 Dec 6.
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Telehealth-based diagnostic testing in general practice during the COVID-19 pandemic: an observational study.COVID-19大流行期间基层医疗中基于远程医疗的诊断测试:一项观察性研究。
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