Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
J Med Internet Res. 2024 Nov 1;26:e64159. doi: 10.2196/64159.
Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown.
This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care.
In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan.
The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected.
Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption.
远程医疗（在线医疗）在全球范围内受到了广泛关注。然而，它在日本并未得到广泛应用，关于在线医疗的接收和提供情况以及其普及程度低的原因仍不清楚。
本研究旨在从患者接受和医疗专业人员提供在线医疗的角度调查日本在线医疗的现状和采用的限制因素。
共进行了 2 项全国性问卷调查。第一项调查针对患者和健康人群，从 1300 万人中筛选出约 4 万人。参与者的选择基于政府数据，以匹配日本人口的年龄分布，记录他们的在线医疗体验和医疗就诊情况。为了进一步调查在线医疗的使用和满意度，对筛选出的 4 万名参与者中的 15%（6000 人）进行了在线调查。第二项调查针对医疗专业人员，向每个地区随机选择的 4900 家医疗设施中的医生、护士和行政人员各发放一份问卷，询问他们的在线医疗实践和印象。此外，两次调查都调查了限制日本在线医疗扩张的因素。
筛选和主要调查中患者和健康人群的应答率分别为 92.5%（36998/40000）和＞80%（1312/1478，88.77%；1281/1522，84.17%；404/478，84.5%；2226/2522，88.26%，在 4 个调查组中）。对医疗专业人员的调查共收到 1552 份回复（n=618，39.82%为医生；n=428，27.58%为护士；n=506，32.6%为行政人员）。尽管医疗机构层面的回复率较低（794/4900，16.2%），但某些类别医疗机构的回复率相对较高。只有 5.29%（1956/36998）的患者和健康人群有在线医疗体验。当附近有更多的医院，且他们认为亲自看医生更麻烦时，他们更有可能使用在线医疗（附近医院更多：调整后的优势比[aOR]1.33，95%可信区间[CI]1.18-1.50；更麻烦：aOR 1.48，95%CI 1.35-1.63，每个调查应答点）。同样，这些因素与满意度密切相关（附近医院更多：aOR 1.40，95%CI 1.14-1.73；更麻烦：aOR 1.50，95%CI 1.27-1.76，每个调查应答点）。在两次调查中，选择限制在线医疗广泛使用的最常见因素是患者需要转为面对面医疗进行强制性检查和程序。对在线医疗的认识不足和教育不足也是经常被选择的原因。
我们的全国性调查提供了日本在线医疗现状的见解，同时也发现了一些与之相关的问题和挑战，这将有助于促进其更广泛的应用。
