背景:COVID-19大流行迅速改变了美国的临床实践;远程医疗成为医疗保健提供的基本模式,然而,在这种疾病出现多年后,远程医疗使用的许多组成部分仍然未知。
目的:我们旨在全面评估美国的远程医疗使用及其相关因素。
方法:这项横断面研究使用了一项全国代表性调查(健康信息国家趋势调查),该调查于2022年3月至2022年11月对美国成年人(≥18岁)进行。为了评估远程医疗的采用,对远程医疗的看法,对远程医疗的满意度,和远程医疗保健的目的,我们进行了加权描述性分析.为了识别远程医疗采用率低的亚群,我们建立了加权多变量逻辑回归模型。
结果:在总共6252名调查参与者中,39.3%(2517/6252)报告过去12个月使用远程医疗(视频:1110/6252,17.8%;音频:876/6252,11.6%)。不使用远程医疗的最主要原因是由于远程医疗提供商未能提供此选项(2200/3529,63%)。受访者不使用提供的远程医疗服务的最常见原因是偏爱亲自护理(527/578,84.4%)。使用远程医疗的主要动机是提供者的建议(1716/2517,72.7%)和便利性(1516/2517,65.6%),主要为急性轻症(600/2397,29.7%)和慢性病管理(583/2397,21.4%),然而护理目的因年龄而异,种族/民族,和收入。满意率较高,没有技术问题(1829/2517,80.5%),护理质量与现场护理相当(1779/2517,75%),没有隐私问题(1958/2517,83.7%)。年轻个体(奇数比[ORs]1.48-2.23;18-64岁vs≥75岁),女性(OR1.33,95%CI1.09-1.61),西班牙裔个体(OR1.37,95%CI1.05-1.80;与非西班牙裔白人相比),那些受过更多教育的人(OR1.72,95%CI1.03-2.87;至少大学毕业生vs高中以下),失业者(OR1.25,95%CI1.02-1.54),被保险人(OR1.83,95%CI1.25-2.69),或一般健康状况较差的人(OR1.66,95%CI1.30-2.13)使用远程医疗的几率更高。
结论:据我们所知,这是首批研究远程医疗使用患者因素的研究之一,包括使用动机,感知,满意,和远程医疗的护理目的,以及使用全国代表性调查与采用远程医疗相关的社会人口统计学因素。广泛的描述性发现和确定的关联将帮助提供者和卫生系统了解随着该技术在美国变得越来越常规,驱使患者走向或远离远程医疗访问的因素。为远程医疗使用和远程医疗研究提供未来方向。
BACKGROUND: The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease\'s emergence.
OBJECTIVE: We aim to comprehensively assess telehealth use and its associated factors in the United States.
METHODS: This cross-sectional
study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (≥18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model.
RESULTS: Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers\' recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ≥75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth.
CONCLUSIONS: To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research.