Peles Ido, Novack Lena, Peleg Shosh, Levanon Eran, Gordon Michal, Abayev Mariya, Novack Victor, Codish Shlomi
Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Med Internet Res. 2025 Apr 28;27:e66499. doi: 10.2196/66499.
In recent years, the use and impact of telemedicine for providing health care services to patients has increased, reducing the requirement for physical, in-person encounters.
This study aimed to compare the use of telemedicine for outpatient visits versus in-person visits across different medical specialties; assess its association with clinical outcomes; and examine the influence of patient and physician characteristics on telemedicine use in a large, tertiary, teaching hospital.
The study cohort consisted of adult patients who attended outpatient clinics in five medical fields (psychiatry, endocrinology, nephrology, hemato-oncology, and gastroenterology) in 2019 and survived until the beginning of 2020. Telemedicine use during the period of 2019-2021 was the main exposure of interest. The primary outcomes were emergency department (ED) referrals and hospitalizations. The analysis used multivariate mixed models and subgroup analysis by patient demographic characteristics, chronic disease medical fields, and physicians' characteristics.
The cohort included 32,445 patients. In 2019, a total of 99.6% (82,668/83,000) of visits were in person, and by 2020-2021, a total of 22.6% (10,850/48,120) of patients had used telemedicine. Telemedicine patients were slightly older (standardized mean difference=0.281; P<.001), with a higher comorbidity burden than in-person patients or patients without visits (standardized mean difference=0.328; P<.001). Presurge telemedicine users had higher rates of ED referrals (incidence rate ratio [IRR] 1.15, 95% CI 1.09-1.21) and hospitalizations (IRR 1.14, 95% CI 1.08-1.20) than in-person visit users. These ratios remained stable during the surge (IRR 1.1, 95% CI 1.06-1.16 and IRR 1.12, 95% CI 1.05-1.19, respectively), with no evidence of worsening outcomes for telemedicine users relative to in-person care. Health care providers with higher telemedicine use had reduced rates of ED referrals (IRR 0.85, 95% CI 0.79-0.91) and hospitalizations (IRR 0.78, 95% CI 0.72-0.84) than providers with lower telemedicine use.
This study provides insights into telemedicine use patterns and their association with clinical outcomes in chronic disease management. Our findings suggest that the increase in telemedicine use was not associated with a rise in ED referrals or hospitalizations when compared to in-person visits. It highlights the importance of health care providers' perspectives and use of remote visits. Telemedicine should be tailored to individual patient-physician needs, considering the nature of the patient's disease.
近年来，远程医疗在为患者提供医疗服务方面的应用及影响不断增加，减少了面对面就诊的需求。
本研究旨在比较不同医学专科中门诊远程医疗就诊与面对面就诊的使用情况；评估其与临床结局的关联；并在一家大型三级教学医院中，考察患者和医生特征对远程医疗使用的影响。
研究队列包括2019年在五个医学领域（精神病学、内分泌学、肾脏病学、血液肿瘤学和胃肠病学）门诊就诊且存活至2020年初的成年患者。2019 - 2021年期间远程医疗的使用是主要关注的暴露因素。主要结局为急诊转诊和住院治疗。分析采用多变量混合模型，并按患者人口统计学特征、慢性病医学领域和医生特征进行亚组分析。
该队列包括32445名患者。2019年，总共99.6%（82668/83000）的就诊为面对面就诊，到2020 - 2021年，共有22.6%（10850/48120）的患者使用了远程医疗。远程医疗患者年龄稍大（标准化均值差 = 0.281；P <.001），合并症负担高于面对面就诊患者或未就诊患者（标准化均值差 = 0.328；P <.001）。疫情期间使用远程医疗的患者急诊转诊率（发病率比[IRR] 1.15，95%置信区间1.09 - 1.21）和住院率（IRR 1.14，95%置信区间1.08 - 1.20）高于面对面就诊患者。这些比率在疫情期间保持稳定（分别为IRR 1.1，95%置信区间1.06 - 1.16和IRR 1.12，95%置信区间1.05 - 1.19），没有证据表明远程医疗使用者的结局相对于面对面就诊更差。远程医疗使用频率较高的医疗服务提供者的急诊转诊率（IRR 0.85，95%置信区间0.79 - 0.91）和住院率（IRR 0.78，95%置信区间0.72 - 0.84）低于远程医疗使用频率较低的提供者。
本研究为慢性病管理中远程医疗的使用模式及其与临床结局之间的关联提供了见解来源。我们的研究结果表明，与面对面就诊相比，远程医疗使用的增加与急诊转诊或住院率的上升无关。它凸显了医疗服务提供者对远程就诊的看法和使用的重要性。应根据患者 - 医生的个体需求，结合患者疾病的性质，量身定制远程医疗服务。
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