老年人对 COVID-19 大流行期间初级保健远程医疗的看法。
Older adults' perspectives on primary care telemedicine during the COVID-19 pandemic.
机构信息
Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA.
出版信息
J Am Geriatr Soc. 2022 Dec;70(12):3480-3492. doi: 10.1111/jgs.18035. Epub 2022 Sep 28.
BACKGROUND
Prior to the COVID-19 pandemic there were many barriers to telemedicine primary care for adults ≥65 years including insurance coverage restrictions and having lower digital access and literacy. With the pandemic, insurance coverage broadened and many older adults utilized telemedicine creating an opportunity to learn from their experiences to inform future policy.
METHODS
Between April 2020 and June 2021, we conducted a cross-sectional multimethod study of English-speaking, cognitively-intact, adults ≥65, who had a phone-only and/or video telemedicine visit with their primary care physician within one large Massachusetts health system (10 different practices) since March 2020. The study questionnaire asked participants their overall satisfaction with telemedicine (7-point scale) and to compare telemedicine with in-person care. We used linear regression to examine the association between participants' demographics, Charlson comorbidity score, and survey completion date with their satisfaction score. The questionnaire also included open-ended questions on perceptions of telemedicine; which were analyzed using qualitative methods.
RESULTS
Of 278 eligible patients reached, 208 completed the questionnaire; mean age was 74.4 years (±4.4), 61.5% were female, 91.4% were non-Hispanic White, 64.4% had ≥1 comorbidity, and 47.2% had a phone-only visit. Regardless of their age, participants reported being satisfied with telemedicine; median score was 6.0 on the 7-point scale (25th percentile = 5.0 and 75th percentile = 7.0). Non-Whites satisfaction scores were on average 1 point lower than those of non-Hispanic Whites (p = 0.02). Those with comorbidity reported scores that on average were 0.5 points lower than those without comorbidity (p = 0.07). Overall, 39.5% felt their telemedicine visit was worse than in-person care; 4.9% thought it was better. Participants appreciated telemedicine's convenience but described frustrating technical challenges. While participants preferred in-person care, most wanted telemedicine to remain available.
CONCLUSIONS
Adults ≥65 reported being satisfied with primary care telemedicine during the pandemic's first 14 months and wanted telemedicine to remain available.
背景
在 COVID-19 大流行之前，老年人（≥65 岁）的远程医疗初级保健存在许多障碍，包括保险覆盖范围的限制，以及较低的数字访问和读写能力。随着大流行的到来，保险范围扩大，许多老年人利用远程医疗，这为了解他们的经验以为未来的政策提供信息提供了机会。
方法
在 2020 年 4 月至 2021 年 6 月期间，我们对一家大型马萨诸塞州医疗系统（10 个不同的实践）中英语熟练、认知正常的≥65 岁的成年人进行了一项横断面多方法研究，这些成年人在 2020 年 3 月以来仅通过电话或视频与他们的初级保健医生进行了远程医疗就诊。研究问卷询问参与者对远程医疗的总体满意度（7 分制），并比较远程医疗与面对面护理。我们使用线性回归来检验参与者的人口统计学、Charlson 合并症评分和调查完成日期与他们的满意度评分之间的关联。问卷还包括对远程医疗看法的开放性问题；这些问题使用定性方法进行了分析。
结果
在联系到的 278 名符合条件的患者中，有 208 名完成了问卷；平均年龄为 74.4±4.4 岁，61.5%为女性，91.4%为非西班牙裔白人，64.4%有≥1 种合并症，47.2%仅通过电话就诊。无论年龄大小，参与者都报告对远程医疗感到满意；7 分制的中位数得分为 6.0（25%分位数为 5.0，75%分位数为 7.0）。非白人的满意度评分平均比非西班牙裔白人低 1 分（p=0.02）。有合并症的参与者的评分平均比没有合并症的参与者低 0.5 分（p=0.07）。总的来说，39.5%的人认为他们的远程医疗就诊不如面对面就诊；4.9%的人认为更好。参与者赞赏远程医疗的便利性，但描述了令人沮丧的技术挑战。虽然参与者更喜欢面对面护理，但大多数人希望远程医疗仍然可用。
结论
≥65 岁的成年人在大流行的前 14 个月报告对初级保健远程医疗感到满意，并希望远程医疗仍然可用。
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