@文章{信息:doi/10.2196/39728，作者=“Safavi, Amir H和Lovas, Mike和Liu, Zhihui Amy和Melwani, Sheena和Truong, Tran和Devonish, Shayla和Abdelmutti, Nazek和Sayani, Ambreen和Rodin, Danielle和Berlin, Alejandro”，标题=“COVID-19期间的虚拟护理和电子患者沟通:《加拿大三级癌症中心的不公平横断面研究》，期刊=“J Med Internet Res”，年=“2022”，月=“11”，日=“4”，卷=“24”，号=“11”，页=“e39728”，关键词=“数字健康;远程医疗;远程医疗;电子健康;肿瘤;癌症治疗;虚拟护理;卫生不公平现象;健康不平等; digital divide; COVID-19; electronic mail; cross sectional; engagement; satisfaction; patient reported; experience", abstract="Background: Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Inequities in access and patient experience may arise as these digital health tools become prevalent. Objective: We aimed to characterize inequities in access and patient-reported experience following adoption of digital health tools at a tertiary cancer center during the COVID-19 pandemic. Methods: We designed a cross-sectional study of outpatients with visits from September to December 2020. Patient characteristics and responses to an email-based patient-experience survey were collated. Inequities in access were assessed across three pairs of comparison groups: (1) patients with VC and in-person visits, (2) patients with and without documented email addresses, and (3) responders and nonresponders to the survey. Inequities in patient-reported experience were assessed among survey responders. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMDs), with SMD≥0.2 indicating differences between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with P<.05 indicating statistical significance. Results: Among the 42,194 patients who had outpatient visits, 62.65{\%} (n=26,435) had at least one VC visit and 31.15{\%} (n=13,144) were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD<0.2). Among emailable patients, 21.84{\%} (2870/13,144) responded to the survey. Survey responsiveness was similar across indices, aside from a small difference by age (SMD=0.24). Among responders, 24.4{\%} received VC and were similar to in-person responders across indices (SMD<0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (all P>.05). Regardless of visit type, patients had variable satisfaction with care domains across demographic and socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with the cultural appropriateness of their care (odds ratio [OR] 0.70, 95{\%} CI 0.57-0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95{\%} CI 0.48-0.93). Patients with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95{\%} CI 0.68-0.97) and emotional (OR 0.86, 95{\%} CI 0.77-0.96) symptoms, and also with the duration of their visit (OR 0.85, 95{\%} CI 0.74-0.98; P=.02). Male patients were more satisfied with how their health care provider had listened to them (OR 1.64, 95{\%} CI 1.11-2.44; P=.01). Conclusions: Adoption of VC and email can equitably maintain access and patient-reported experience in cancer care across demographics and socioeconomic indices. Existing health inequities among structurally marginalized patients must continue to be addressed to improve their care experience. ", issn="1438-8871", doi="10.2196/39728", url="//www.mybigtv.com/2022/11/e39728", url="https://doi.org/10.2196/39728", url="http://www.ncbi.nlm.nih.gov/pubmed/36331536" }