Objective

The use of a nation-wide, pediatricians online (PO) after-hours telemedicine service has been offered in Israel for more than a decade. We sought to compare PO visits with those to the primary care pediatrician (PCP).

Methods

This is a retrospective cross-sectional study using Israel's largest health care provider database. We included children aged 0 to 18 years using either PO or PCP between 2015 and 2018. We compared the baseline characteristics, matching by socioeconomic status, chronic illness, and diagnosis, and compared their admission rates, laboratory testing, and medication prescription.

Results

During this study period there were 262,541 PO visits and a random 10% sample of PCP visits which yielded 1,813,103 visits. Users of PO were more likely to have a higher socioeconomic status (43% vs 28.9%), fever (13.3% vs 4.4%) and less likely to have acute respiratory conditions (8.8% vs 16.7%). Users of PO had higher rates of emergency department admissions (2.9% vs 0.4%), hospital admissions (0.9% vs 0.2%), and lower rates of laboratory testing (3.7% vs 7.4%) and medication prescription (42.0% vs 52.0%) within 24 hours. All differences were statistically significant (P < .005).

Conclusions

Our pediatric telemedicine service operating after-hours has been found to be feasible, and widely used, for a myriad of clinical conditions. Significant differences exist between PO and PCP visit characteristics and outcomes. However, it remained unclear whether these differences reflect the difference in the patient population or whether they are the result of the different clinical services. Further research is warranted to clarify this matter.

中文翻译：

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下班后远程医疗与初级保健就诊的诊断和医疗保健利用

客观的

十多年来，以色列一直在全国范围内使用儿科医生在线 (PO) 下班后远程医疗服务。我们试图将 PO 访问与初级保健儿科医生 (PCP) 的访问进行比较。

方法

这是一项使用以色列最大的医疗保健提供者数据库的回顾性横断面研究。我们纳入了 2015 年至 2018 年期间使用 PO 或 PCP 的 0 至 18 岁儿童。我们比较了基线特征、社会经济地位匹配、慢性疾病和诊断，并比较了他们的入院率、实验室检测和药物处方。

结果

在此研究期间，有 262,541 次 PO 访问和随机 10% 的 PCP 访问样本，产生了 1,813,103 次访问。PO 使用者更有可能拥有较高的社会经济地位（43% 对 28.9%）、发烧（13.3% 对 4.4%）并且不太可能患有急性呼吸系统疾病（8.8% 对 16.7%）。PO 用户有较高的急诊入院率（2.9% 对 0.4%）、住院率（0.9% 对 0.2%）以及较低的实验室检测率（3.7% 对 7.4%）和药物处方（42.0% 对 52.0%） ） 24小时内。所有差异均具有统计学意义（P < .005）。

结论

我们在下班后运行的儿科远程医疗服务已被证明是可行的，并被广泛应用于无数临床情况。PO 和 PCP 就诊特征和结果之间存在显着差异。然而，尚不清楚这些差异是否反映了患者群体的差异，或者它们是否是不同临床服务的结果。需要进一步的研究来澄清这个问题。