背景:患者自己的初级保健提供者(PCP)与其他可用的PCP进行远程医疗的有效性研究不足。
目的:检查初级保健就诊方式与及时性和随访患者医疗保健之间的关系,包括患者自身PCP与其他PCP的就诊差异。
方法:队列研究,包括大型初级保健就诊,2022年集成交付系统。
方法:结果包括及时性(安排后7天内完成的访问)和亲自随访(PCP访问,急诊科(ED)访问,住院)在索引PCP访视后7天内。Logistic回归测量了就诊方式(当面,视频,和仅音频远程医疗)与患者自己的PCP或另一个PCP和结果,根据特征进行调整。
结果:在4,817,317次初级保健就诊中,59%是面对面的,只有27%的音频,和14%的视频远程医疗。大多数(71.3%)患者患有自己的PCP。远程医疗访问更及时,与其他PCP相比,患者自身PCP的就诊方式具有更大的相关性(P<0.001)。对于访问患者自己的PCP,当面回访率为1.2%,5.3%为视频,仅音频为6.1%。对于另一个PCP,当面率为2.2%,视频7.3%,音频为8.1%。使用自己的PCP进行的ED随访率从1.4%(亲自)到1.6%(仅音频),与另一位PCP的1.9%(当面)至2.3%(仅限音频)相比。与他们自己的PCP相比,另一个PCP的门诊和远程医疗之间的回诊和ED就诊差异更大(P<0.001)。后续住院很少见,范围从0.19%(亲自使用自己的PCP)到0.32%(与另一个PCP的视频)。
结论:与自己的PCP相比,当患者看到不太熟悉的PCP时,面对面医疗和远程医疗之间的返回办公室和ED访问差异更大,加强护理连续性的重要性。
BACKGROUND: The effectiveness of telemedicine by a patient\'s own primary care provider (PCP) versus another available PCP is understudied.
OBJECTIVE: Examine the association between primary care visit modality with timeliness and follow-up in-person healthcare, including variation by visits with the patient\'s own PCP versus another PCP.
METHODS: Cohort study including primary care visits in a large, integrated delivery system in 2022.
METHODS: Outcomes included timeliness (visit completed within 7 days of scheduling) and in-person follow-up (PCP visits, emergency department (ED) visits, hospitalizations) within 7 days of the index PCP visit. Logistic regression measured the association between visit modality (in-person, video, and audio-only telemedicine) with the patient\'s own PCP or another PCP and outcomes, adjusting for characteristics.
RESULTS: Among 4,817,317 primary care visits, 59% were in-person, 27% audio-only, and 14% video telemedicine. Most (71.3%) were with the patient\'s own PCP. Telemedicine visits were timelier, with modality having a larger association for visits with patient\'s own PCP versus another PCP (P < 0.001). For visits with patient\'s own PCPs, return office visit rates were 1.2% for in-person, 5.3% for video, and 6.1% for audio-only. For another PCP, rates were 2.2% for in-person, 7.3% for video, and 8.1% for audio. Follow-up ED visits ranged from 1.4% (in-person) to 1.6% (audio-only) with own PCP, compared to 1.9% (in-person) to 2.3% (audio-only) with another PCP. Differences in return office and ED visits between in-person and telemedicine were larger for visits with another PCP compared to their own PCP (P < 0.001). Follow-up hospitalizations were rare, ranging from 0.19% (in-person with own PCP) to 0.32% (video with another PCP).
CONCLUSIONS: Differences in return office and ED visits between in-person and telemedicine were larger when patients saw a less familiar PCP compared to their own PCP, reinforcing the importance of care continuity.