Deliva Robin D, Tsang Kyle, Manafzadehtabriz Parham, Graham Ashley, Comrie Rebecca, Palmert Mark R
Virtual Care Support, Hospital for Sick Children, Toronto, Canada.
Department of Physiotherapy, University of Toronto, Toronto, Canada.
Telemed J E Health. 2025 Jun 26. doi: 10.1089/tmj.2025.0059.
: Telemedicine and broadly, virtual care are established modes of health care delivery but may present unintended barriers to access. We assessed postpandemic ambulatory care provision to determine whether marginalized areas were underrepresented among virtual visits. : We retrospectively analyzed 396,624 ambulatory visits (January 2022 through December 2023), using patient demographics and the Ontario Marginalization Index to compare virtual (78% electronic health record-integrated video) and in-person visits across the domains of residential instability, material deprivation, dependency, and ethnic concentration. Logistic regression was used to compare virtual to in-person visits, adjusting for age, sex, and geographic location. : We found higher virtual care utilization for children in remote areas (41% [OR: 1.72 {1.66-1.78}]) and progressively higher virtual care utilization across age groups. Virtual care use for children aged 1-12 was 27% (OR: 1.57 [1.53-1.62]); for adolescents aged 12-16 was 33% (OR: 2.02 [1.96-2.09]); and for those over 16 years was 38% (OR: 2.56 [2.49-2.64]), compared to infants (19%). Indices of residential instability, dependency, and material deprivation had minimal impact on access to virtual care; however, areas with high ethnic concentrations had significantly fewer virtual visits compared to the least ethnically concentrated areas (26.1% vs. 35.0%; adjusted OR: 0.65 [0.63-0.67]). Each quintile increase in marginalization within the ethnic concentration index was associated with an 11% decrease in the odds of a virtual visit. : Virtual care use was higher for those at greater distance but lower in ethnically concentrated areas. Further investigation of strategies targeting language barriers, technological literacy, and cultural beliefs is warranted.
远程医疗以及广义上的虚拟医疗是已确立的医疗服务提供模式，但可能会带来意想不到的获取障碍。我们评估了疫情后门诊医疗服务的提供情况，以确定边缘化地区在虚拟就诊中是否占比过低。
我们回顾性分析了396,624次门诊就诊（2022年1月至2023年12月），利用患者人口统计学数据和安大略省边缘化指数，比较了虚拟就诊（78%为电子健康记录集成视频）和面对面就诊在居住不稳定、物质匮乏、依赖性和种族集中等方面的情况。采用逻辑回归比较虚拟就诊和面对面就诊，并对年龄、性别和地理位置进行了调整。
我们发现偏远地区儿童的虚拟医疗利用率较高（41%[比值比：1.72{1.66 - 1.78}]），且各年龄组的虚拟医疗利用率逐渐升高。1至12岁儿童的虚拟医疗使用率为27%（比值比：1.57[1.53 - 1.62]）；12至16岁青少年为33%（比值比：2.02[1.96 - 2.09]）；16岁以上人群为38%（比值比：2.56[2.49 - 2.64]），而婴儿为19%。居住不稳定、依赖性和物质匮乏指数对获取虚拟医疗的影响最小；然而，与种族集中度最低的地区相比，种族集中度高的地区虚拟就诊显著减少（26.1%对35.0%；调整后比值比：0.65[0.63 - 0.67]）。种族集中指数中每增加一个五分位数的边缘化程度，虚拟就诊的几率就会降低11%。
距离较远的人群虚拟医疗使用率较高，但在种族集中地区较低。有必要进一步研究针对语言障碍、技术素养和文化信仰的策略。
