Adler Limor, Vered Shiraz, Amran Menashe Meni, Zacay Galya, Bar-Ratson Edna, Cohen Bar, Yehoshua Ilan
Health Division, Maccabi Healthcare Services, Tel Aviv, Israel.
Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr J Health Policy Res. 2025 Jun 2;14(1):31. doi: 10.1186/s13584-025-00696-2.
Preventive medicine is one of the core elements of primary care physicians' (PCPs) work. This includes screening for cancer (such as Mammography and fecal occult blood test (FOBT) for breast and colon cancer) and also screening for chronic conditions (like bone density scans (DEXA scans) for osteoporosis). In recent years, especially since the COVID-19 pandemic, the use of telemedicine increased dramatically. This study aimed to identify the rate of preventative medicine referrals and performance in individuals who mostly had face-to-face encounters compared to those who mostly had remote encounters.
This retrospective cohort study is based on the electronic medical records of one healthcare maintenance organization (HMO) in Israel. We followed all individuals eligible for at least one of the screening tests in 2020 and 2021 and evaluated whether they received referrals to screening tests (mammography, FOBT, and DEXA scans) and performed them. Each individual was assigned to the face-to-face group (more than 60% of their encounters were face-to-face), the remote group (more than 60% of their encounters were remote), and the mixed group, which included the rest of the cohort.
For mammographies and FOBT, the referral rates were lower in the face-to-face group compared to remote and mixed groups (mammographies: 27.3% vs. 29.8% and 32.9%, p-value < 0.001; FOBT: 55.6% vs. 60.3% and 58.7%, p-value < 0.001, respectively). However, for all three tests, the performance rates were the lowest in the remote group compared to face-to-face and mixed (for mammographies, 68.2% vs. 76.3% vs. 78.1; for FOBT, 44% vs. 56.8% vs. 54.3%; for DEXA 9.2% vs. 22.9% vs. 20.7%, respectively). A referral from the PCP increased the odds of performing the test for mammographies OR-1.55, 95% CI 1.52-1.58, and for FOBT OR-1.96, 95% CI 1.93-1.99.
Although PCPs referred their patients to screening tests in remote visits, the performance rate of individuals who mainly used telemedicine was lower than those who mostly had face-to-face visits. A referral for a screening test from the PCP increased the odds of performing it. Understanding individuals' health behaviors using telemedicine is crucial to maintaining adherence to preventing medicine.
预防医学是初级保健医生（PCP）工作的核心要素之一。这包括癌症筛查（如乳腺癌和结肠癌的乳房X光检查和粪便潜血试验（FOBT））以及慢性病筛查（如骨质疏松症的骨密度扫描（DEXA扫描））。近年来，尤其是自新冠疫情以来，远程医疗的使用大幅增加。本研究旨在确定与主要进行面对面诊疗的个体相比，主要进行远程诊疗的个体中预防医学转诊率和执行情况。
这项回顾性队列研究基于以色列一家医疗维护组织（HMO）的电子病历。我们跟踪了2020年和2021年符合至少一项筛查测试条件的所有个体，并评估他们是否收到筛查测试（乳房X光检查、FOBT和DEXA扫描）的转诊并进行了这些测试。每个个体被分配到面对面组（超过60%的诊疗是面对面的）、远程组（超过60%的诊疗是远程的）和混合组，混合组包括队列中的其他个体。
对于乳房X光检查和FOBT，面对面组的转诊率低于远程组和混合组（乳房X光检查：27.3%对29.8%和32.9%，p值<0.001；FOBT：55.6%对60.3%和58.7%，p值分别<0.001）。然而，对于所有三项测试，远程组的执行率低于面对面组和混合组（乳房X光检查，分别为68.2%对76.3%对78.1%；FOBT，44%对56.8%对54.3%；DEXA，9.2%对22.9%对20.7%）。初级保健医生的转诊增加了进行乳房X光检查的几率（OR = 1.55，9
