@文章{信息:doi/10.2196/34088，作者=“Sharma, Anjana E和Khoong, Elaine C和Sierra, Maribel和Rivadeneira, Natalie A和Nijagal, Malini A和Su, George和Lyles, Courtney R和DeFries, Triveni和Tuot, Delphine S和Sarkar, Urmimala”，标题=“与电话和视频访问使用相关的系统级因素:《新冠肺炎大流行早期安全网临床医生调查》，期刊=“JMIR Form Res”，年=“2022”，月=“3”，日=“10”，卷=“6”，数=“3”，页数=“e34088”，关键词=“远程医疗;安全网医院;提供保健服务;门诊;弱势群体;COVID-19;调查;脆弱的;远程医疗; hospital; safety; delivery; video; implementation; health system", abstract="Background: The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective: This study aimed to assess health system--level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods: We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system--level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results: We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4{\%}. Clinician respondents (N=311) included 34.7{\%} (n=108) primary or urgent care, 35.1{\%} (n=109) medical, and 7.4{\%} (n=23) surgical specialties. Our sample included 178 (57.2{\%}) high telephone adopters and 81 (26.05{\%}) video adopters. Among high telephone adopters, 72.2{\%} utilized personal devices for telemedicine (vs 59.0{\%} of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6{\%} vs 27.2{\%}, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3{\%}, compared to 50.4{\%} of medical and 37.5{\%} of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1{\%}, compared to 14.8{\%} of primary care and 12.5{\%} of surgical specialties, P<.001). Conclusions: Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine. ", issn="2561-326X", doi="10.2196/34088", url="https://formative.www.mybigtv.com/2022/3/e34088", url="https://doi.org/10.2196/34088", url="http://www.ncbi.nlm.nih.gov/pubmed/35148271" }