Haimi Motti, Sergienko Ruslan, Hornik-Lurie Tzipi, Albukrek Dov
Health Systems Management Department, The Max Stern Yezreel Valley College, Afula, Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, 3109601, Israel.
BMC Med Inform Decis Mak. 2025 Aug 13;25(1):303. doi: 10.1186/s12911-025-03124-2.
BACKGROUND: Telemedicine has expanded healthcare accessibility, particularly during the COVID-19 pandemic. However, evidence regarding its economic efficiency and clinical quality remains inconclusive, with some studies suggesting increased costs, service utilization, and inappropriate antibiotic prescribing compared to traditional care modalities.
This study evaluated pediatric telemedicine services across three dimensions: clinical outcomes (antibiotic prescribing patterns), resource utilization implications (healthcare utilization and emergency department visits), and equity considerations (sociodemographic distribution of services).
We conducted a retrospective cohort study analysis of 1,500 children under 19 years within Israel's Clalit Health Services (Shron-Shomron District) from January 2021 to January 2022. Participants were randomly sampled from three groups based on their telemedicine utilization patterns: in-person primary care physician (PCP) visits only (n = 500); PCP plus phone/video telemedicine (n = 500); and PCP plus phone/video plus Tyto device telemedicine (n = 500). These children were classified as discrete groups, not only as solitary visits. We assessed emergency department (ED) admission rates, antibiotic prescription frequencies for common pediatric conditions, and sociodemographic characteristics across the groups.
Analysis of 21,968 visits revealed striking socioeconomic disparities in telemedicine utilization. While 58.1% of all participants had high socioeconomic status (SES), this increased to 68.6% among Tyto device users. Conversely, low-SES patients comprised 26.4% of in-person-only visits but only 3% of Tyto users. ED admission rates for all groups combined were 4.0%, 1.6% for the "PCP only" group, 5.4% for the "PCP + phone/video" group (12% after phone/video visits), and 3.6% for the "PCP + phone/video + Tyto" group (4.1% after Tyto only). Antibiotic prescribing rates were similarly divergent: mean rates of antibiotic prescriptions after PCP visits were 10.3%, after telephone/video visits were 16.8%, and after Tyto visits were 21.4% (p < 0.001). Multivariable analysis confirmed those findings and demonstrated higher ED utilization and antibiotic prescribing among low-SES patients and those in remote locations, independent of visit type.
Our findings challenge prevailing assumptions about telemedicine benefits, revealing unexpected associations between telemedicine services and higher ED utilization and antibiotic prescribing compared to traditional care, particularly among vulnerable populations. These associations may reflect complex interactions between patient characteristics, provider behavior, and care modalities that warrant further investigation. Healthcare systems should reconsider the implementation of telemedicine services to ensure they deliver on promises of expanded access while maintaining quality, appropriate resource utilization, and equitable distribution of benefits across socioeconomic groups.
Not applicable.
背景：远程医疗扩大了医疗服务的可及性，尤其是在新冠疫情期间。然而，关于其经济效率和临床质量的证据仍然不明确，一些研究表明，与传统护理模式相比，其成本增加、服务利用率提高且抗生素处方不当。
本研究从三个维度评估儿科远程医疗服务：临床结果（抗生素处方模式）、资源利用影响（医疗服务利用和急诊就诊情况）以及公平性考量（服务的社会人口学分布）。
我们对2021年1月至2022年1月期间以色列克拉利特医疗服务机构（Shron-Shomron地区）的1500名19岁以下儿童进行了回顾性队列研究分析。根据他们的远程医疗使用模式，从三组中随机抽样：仅面对面看初级保健医生（PCP）（n = 500）；PCP加电话/视频远程医疗（n = 500）；PCP加电话/视频加Tyto设备远程医疗（n = 500）。这些儿童被分类为不同的组，而不仅仅是单次就诊。我们评估了急诊（ED）入院率、常见儿科疾病的抗生素处方频率以及各组的社会人口学特征。
对21968次就诊的分析显示，远程医疗使用存在明显的社会经济差异。虽然所有参与者中有58.1%具有高社会经济地位（SES），但在Tyto设备用户中这一比例增至68.6%。相反，低SES患者在仅面对面就诊的患者中占26.4%，但在Tyto用户中仅占3%。所有组的ED入院率为4.0%，“仅PCP”组为1.6%，“PCP + 电话/视频”组为5.4%（电话/视频就诊后为12%），“PCP + 电话/视频 + Tyto”组为3.6%（仅Tyto就诊后为4.1%）。抗生素处方率也有类似差异：PCP就诊后的抗生素处方平均率为10.3%，电话/视频就诊后为16.8%，Tyto就诊后为21.4%（p < 0.001）。多变量分析证实了这些发现，并表明低SES患者和偏远地区患者的ED利用率和抗生素处方率更高，与就诊类型无关。
我们的研究结果挑战了关于远程医疗益处的普遍假设，揭示了与传统护理相比，远程医疗服务与更高的ED利用率和抗生素处方之间存在意外关联，尤其是在弱势群体中。这些关联可能反映了患者特征、提供者行为和护理模式之间的复杂相互作用，值得进一步研究。医疗系统应重新考虑远程医疗服务的实施，以确保在扩大可及性的同时，保持质量、合理利用资源并在社会经济群体中公平分配益处。
不适用。
