Kis Anne, Sorbe Christina, Augustin Matthias, Otten Marina, Augustin Jobst
Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.
Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2025 Feb;192:11-18. doi: 10.1016/j.zefq.2024.11.012. Epub 2024 Dec 31.
Telemedicine applications are perceived as having great potential to address regional health service deficits. However, it is unclear to what extent telemedicine can actually contribute to ensuring care in medically underserved regions. The aim of this study is to prospectively identify underserved regions and to investigate the potential of telemedicine applications using teledermatology as an example.
Well-served regions were identified using selected indicators. Points were awarded for each indicator and added up to form two scores. The results were analyzed for spatial autocorrelation (Moran's I), and visualized as a bivariate choropleth map. Data on broadband availability (BMVI) and descriptive statistics (Spearman's Rho, Beeswarm plots) were used to analyze the potential for telemedicine applications. All analyses were carried out at county level.
Out of 401 counties, 159 can be classified as vulnerable because of their supply situation. They are mainly located in the north-west part of Germany. Locally, there are infrastructure deficits, i. e. insufficient bandwidth for telemedicine applications. Spearman's Rho shows negative correlations between broadband availability and the scores obtained (ρ: -0.654/-0.229, p < 0.001).
The results indicate a consolidation of regional disparities. If the identified regions are inhabited by patients with limited mobility and by socially disadvantaged patients, there is a risk of "double gaps in care". In the context of an increasing demand and workload, barriers to telemedicine should be removed, especially in the identified areas, and alternative care models should be implemented.
远程医疗应用被认为在解决区域卫生服务不足方面具有巨大潜力。然而，远程医疗在实际中能够在多大程度上有助于确保医疗服务欠缺地区的医疗护理尚不清楚。本研究的目的是前瞻性地确定医疗服务欠缺地区，并以远程皮肤病学为例研究远程医疗应用的潜力。
使用选定指标确定医疗服务良好的地区。为每个指标打分并相加得出两个分数。对结果进行空间自相关分析（莫兰指数I），并可视化为双变量分级统计图。利用宽带可用性数据（联邦交通、建筑和城市发展部）和描述性统计（斯皮尔曼等级相关系数、蜂群图）分析远程医疗应用的潜力。所有分析均在县级层面进行。
在401个县中，有159个县因其供应情况可被归类为易受影响地区。它们主要位于德国西北部。在当地，存在基础设施不足的问题，即远程医疗应用的带宽不足。斯皮尔曼等级相关系数显示宽带可用性与所得分数之间呈负相关（ρ：-0.654/-0.229，p<0.001）。
结果表明区域差距在加剧。如果所确定的地区居住着行动不便的患者和社会弱势群体患者，就存在“医疗护理双重缺口”的风险。在需求和工作量不断增加的背景下，应消除远程医疗的障碍，特别是在已确定的地区，并应实施替代护理模式。
