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加拿大安大略省大流行期间及之后,护理模式与门诊护理敏感型疾病的住院和急诊就诊之间的关联。

The association between care modality and hospitalizations and emergency department visits for ambulatory care-sensitive conditions during and after the pandemic in Ontario, Canada.

作者信息

Mohammadrezaei Dorsa, Moineddin Rahim, Wang Jun John, Valencia Javier Silva, Lapadula Maria Carla, Ortigoza Angela, O'Neill Braden, Gronsbell Jessica, Butt Debra A, Train Anthony, Gershon Andrea S, Tu Karen

机构信息

Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada.

Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.

出版信息

PLoS One. 2025 Jul 1;20(7):e0324805. doi: 10.1371/journal.pone.0324805. eCollection 2025.


DOI:10.1371/journal.pone.0324805
PMID:40591636
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12212508/
Abstract

The COVID-19 pandemic required a rapid transition to virtual care as a key strategy to maintain healthcare access while minimizing virus transmission risks. However, the impact of this shift on hospitalizations and emergency department (ED) visits for ambulatory care-sensitive conditions (ACSCs) remains unclear. This study aims to assess the relationship between the modality of outpatient care for ACSCs and their outcomes in Ontario, Canada. In this population-based retrospective cohort study, we analyzed hospitalization and ED visit data for ACSCs, including diabetes, epilepsy, congestive heart failure, hypertension, and angina, during the pandemic (April 2020 to April 2023) and post-pandemic (May 2023 to August 2023) periods. Monthly trends in hospitalizations and ED visits were evaluated using Generalized Additive Models and Generalized Additive Mixed Models, accounting for the effects of virtual and in-person care within 30 days and 60 days preceding each event. Despite a notable decrease in virtual visits and a corresponding rise in in-person visits, overall hospitalizations and ED visits for ACSCs remained relatively stable. Our analysis found no significant association between care modality and changes in hospitalizations and ED visits, suggesting that virtual care, particularly during the early pandemic, effectively supported chronic disease management and contributed to the stability of acute care needs. In conclusion, virtual care proved to be a sustainable component of ACSC management during and after the COVID-19 pandemic, complementing in-person care.

摘要

新冠疫情要求迅速转向虚拟医疗,将其作为一项关键策略,以在尽量降低病毒传播风险的同时维持医疗服务可及性。然而,这种转变对门诊医疗敏感疾病(ACSC)的住院率和急诊科就诊率的影响仍不明确。本研究旨在评估加拿大安大略省ACSC的门诊医疗模式与其治疗结果之间的关系。在这项基于人群的回顾性队列研究中,我们分析了疫情期间(2020年4月至2023年4月)和疫情后(2023年5月至2023年8月)ACSC(包括糖尿病、癫痫、充血性心力衰竭、高血压和心绞痛)的住院和急诊科就诊数据。使用广义相加模型和广义相加混合模型评估住院和急诊科就诊的月度趋势,并考虑每次事件前30天和60天内虚拟医疗和面对面医疗的影响。尽管虚拟就诊显著减少,面对面就诊相应增加,但ACSC的总体住院率和急诊科就诊率保持相对稳定。我们的分析发现,医疗模式与住院和急诊科就诊变化之间没有显著关联,这表明虚拟医疗,尤其是在疫情早期,有效地支持了慢性病管理,并有助于急性医疗需求的稳定。总之,虚拟医疗在新冠疫情期间及之后被证明是ACSC管理的一个可持续组成部分,对面对面医疗起到了补充作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/3327c0fe6fdc/pone.0324805.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/acdb3de6d0d1/pone.0324805.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/53b17330f25f/pone.0324805.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/11b56d005033/pone.0324805.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/3327c0fe6fdc/pone.0324805.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/acdb3de6d0d1/pone.0324805.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/53b17330f25f/pone.0324805.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/11b56d005033/pone.0324805.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf9a/12212508/3327c0fe6fdc/pone.0324805.g004.jpg

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本文引用的文献

[1]
Changes in reasons for visits to primary care after the start of the COVID-19 pandemic: An international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID).

PLOS Glob Public Health. 2024-8-22

[2]
A Phenomenological Inquiry of the Shift to Virtual Care Delivery: Insights from Front-Line Primary Care Providers.

Healthcare (Basel). 2024-4-20

[3]
Incidence of new-onset hypertension before, during, and after the COVID-19 pandemic: a 7-year longitudinal cohort study in a large population.

BMC Med. 2024-3-19

[4]
Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study.

Front Public Health. 2023

[5]
The COVID-19 pandemic did not negatively impact frequency or continuity of outpatient care in Alberta, Canada.

Sci Rep. 2023-9-21

[6]
Incidence of New-Onset Hypertension Post-COVID-19: Comparison With Influenza.

Hypertension. 2023-10

[7]
Virtual Care and Emergency Department Use During the COVID-19 Pandemic Among Patients of Family Physicians in Ontario, Canada.

JAMA Netw Open. 2023-4-3

[8]
Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory-Care Sensitive Conditions During the COVID-19 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study.

J Am Heart Assoc. 2023-2-7

[9]
Possible post-COVID epilepsy: A review of epilepsy monitoring unit admissions during the two years of COVID-19 pandemic.

Epilepsy Behav Rep. 2023

[10]
Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis: A Retrospective Cohort Study.

Neurology. 2023-2-21

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