PDF(Pubmed)
Abstract：
BACKGROUND: Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability.
OBJECTIVE: This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response.
METHODS: We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse.
RESULTS: Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice.
CONCLUSIONS: Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.
OBJECTIVE: This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response.
METHODS: We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse.
RESULTS: Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice.
CONCLUSIONS: Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.
摘要：
背景：在COVID-19大流行期间，远程医疗迅速发展，作为关键的政策变化，财政支持,大流行的担忧打破了互联网医疗的平衡。尽管增加了对患者和临床医生的支持和益处，远程医疗的使用在临床医生和实践中是可变的。关于这种变异性背后的医生和机构特征知之甚少。
目的：本研究旨在评估一线医生在早期大流行反应中远程医疗的影响因素。
方法：我们在2020年6月或7月从美国医学会医师专业数据中抽取了全国一线临床医生分层抽样。调查询问了大流行远程医疗使用的第一个月和最近一个月（2020年6月）；样本数据包括临床医生性别，专业,人口普查地区，和多年的实践。在调查响应时，根据县级的COVID-19发病率数据估计了当地的大流行情况。数据采用加权逻辑回归分析，控制特定县的大流行数据，并加权以说明调查数据分层和无响应。
结果：在大流行的前3-4个月，在>30%的就诊中,医师报告使用远程医疗的比例从29.2%(70/239)增加至35.7%(85/238).相对于初级保健，在大流行的第一个月和2020年6月,大量远程医疗使用的几率(>30%)在传染病和重症监护医师中增加,在住院医师和急诊医师中减少.至少最低限度的预流行远程医疗使用（比值比[OR]11.41，95％CI1.34-97.04）和当地COVID-19病例的高2周移动平均值（OR10.16，95％CI2.07-49.97）也与2020年6月的大量远程医疗使用有关。根据临床医生性别差异无统计学意义，人口普查地区，或多年的实践。
结论：大流行前远程医疗的使用，当地新冠肺炎病例数很高，在早期大流行应对期间,临床医师专业与大量远程医疗使用水平较高相关.这些结果表明，面对大流行，远程医疗的吸收可能受到感知威胁水平和可用于实施的资源的严重影响。这种理解对于减少职业倦怠和为未来的公共卫生突发事件做好准备具有重要意义。
目的：本研究旨在评估一线医生在早期大流行反应中远程医疗的影响因素。
方法：我们在2020年6月或7月从美国医学会医师专业数据中抽取了全国一线临床医生分层抽样。调查询问了大流行远程医疗使用的第一个月和最近一个月（2020年6月）；样本数据包括临床医生性别，专业,人口普查地区，和多年的实践。在调查响应时，根据县级的COVID-19发病率数据估计了当地的大流行情况。数据采用加权逻辑回归分析，控制特定县的大流行数据，并加权以说明调查数据分层和无响应。
结果：在大流行的前3-4个月，在>30%的就诊中,医师报告使用远程医疗的比例从29.2%(70/239)增加至35.7%(85/238).相对于初级保健，在大流行的第一个月和2020年6月,大量远程医疗使用的几率(>30%)在传染病和重症监护医师中增加,在住院医师和急诊医师中减少.至少最低限度的预流行远程医疗使用（比值比[OR]11.41，95％CI1.34-97.04）和当地COVID-19病例的高2周移动平均值（OR10.16，95％CI2.07-49.97）也与2020年6月的大量远程医疗使用有关。根据临床医生性别差异无统计学意义，人口普查地区，或多年的实践。
结论：大流行前远程医疗的使用，当地新冠肺炎病例数很高，在早期大流行应对期间,临床医师专业与大量远程医疗使用水平较高相关.这些结果表明，面对大流行，远程医疗的吸收可能受到感知威胁水平和可用于实施的资源的严重影响。这种理解对于减少职业倦怠和为未来的公共卫生突发事件做好准备具有重要意义。
