Wu Elaine I, Reed Mary, Frueh Bradley, Wu Weilu, Kim H Jane
Department of Ophthalmology, The Permanente Medical Group, 3553 Whipple Road Building B, Union City, CA, 94587, USA.
Division of Research, Kaiser Permanente, Northern California, USA.
Heliyon. 2024 Nov 5;10(22):e39982. doi: 10.1016/j.heliyon.2024.e39982. eCollection 2024 Nov 30.
To compare the outcome of telemedicine versus in-person visit in a large health care system.
Retrospective cohort study.
174,245 patients with a telemedicine or in-person visit from September 2020 to June 2021 in the Kaiser Permanente Northern California Health Care System were included. Main outcome measures were whether an initial telemedicine or in-person visit required a subsequent in-person visit and patient characteristics that differed between telemedicine and in-person groups. Charts of selected televisits with return in-person visits were reviewed for diagnostic accuracy of telemedicine.
27 % of patients who had telemedicine visit had a subsequent in-person visit compared to 13 % of patients who had initial in-person visit. Telemedicine visit was associated with higher risk of needing a subsequent in-person visit compared to an initial in-person visit (RR 2.35, CI 2.30-2.40). Patient characteristics associated with higher risk of telemedicine visit compared to in-person visit included female gender (RR 1.07, CI 1.05-1.08), Asian/Black/Hispanic/other race (RR 1.06, CI 1.04-1.08; RR 1.07, CI 1.04-1.11; RR 1.03, CI 1.02-1.05; RR 1.04, CI 1.03-1.06), and English language preference (RR 1.08, CI 1.04-1.11). Age had bimodal distribution with patients younger than 18 and 65 and older associated with less usage of telemedicine. Diagnostic accuracy of telemedicine was 93 %.
Although telemedicine visit was associated with higher risk of needing return in-person visits, telemedicine was able to address ophthalmic needs in majority of patients with high diagnostic accuracy. This large health care system study supports the continued used of telemedicine in ophthalmology in post pandemic setting.
在一个大型医疗系统中比较远程医疗与面对面就诊的结果。
回顾性队列研究。
纳入了2020年9月至2021年6月在凯撒永久北加州医疗系统中进行远程医疗或面对面就诊的174,245名患者。主要结局指标为初次远程医疗或面对面就诊后是否需要后续的面对面就诊，以及远程医疗组和面对面就诊组之间不同的患者特征。对选定的有后续面对面复诊的远程就诊病历进行审查，以评估远程医疗的诊断准确性。
进行远程医疗就诊的患者中有27%随后进行了面对面就诊，而初次进行面对面就诊的患者中这一比例为13%。与初次面对面就诊相比，远程医疗就诊后需要后续面对面就诊的风险更高（相对风险2.35，置信区间2.30 - 2.40）。与面对面就诊相比，远程医疗就诊风险较高的患者特征包括女性（相对风险1.07，置信区间1.05 - 1.08）、亚洲/黑人/西班牙裔/其他种族（相对风险1.06，置信区间1.04 - 1.08；相对风险1.07，置信区间1.04 - 1.11；相对风险1.03，置信区间1.02 - 1.05；相对风险1.04，置信区间1.03 - 1.06）以及偏好英语（相对风险1.08，置信区间1.04 - 1.11）。年龄呈双峰分布，18岁以下和65岁及以上的患者使用远程医疗的频率较低。远程医疗的诊断准确性为93%。
虽然远程医疗就诊后需要后续面对面就诊的风险较高，但远程医疗能够在大多数患者中以较高的诊断准确性满足眼科需求。这项大型医疗系统研究支持在疫情后环境中继续在眼科使用远程医疗。
