HumanInsight Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis
J Med Internet Res. 2022 Jul 31. doi: 10.2196/40288. Online ahead of print.
BACKGROUND: Although the coronavirus disease 2019 (COVID-19) pandemic has accelerated the adoption of telemedicine and virtual consultations globally, complex factors that may affect the use of virtual clinics are still unclear.
OBJECTIVE: This study aimed to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan.
METHODS: We retrospectively analyzed a total of 187,742 outpatient visits (176815 in-person visits and 10,972 virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021 after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients' demographic characteristics, disease type, physicians' features and specialties/departments were collected; and physicians' opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics.
RESULTS: Patient/visit-level, physician-level, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR]=1.27, P<.001), residing at a greater distance away from the hospital (OR=2.36 if distance >50 km, P<.001; OR=3.95 if extensive travel required, P<.001), reimbursement by the National Health Insurance (OR=7.29, P<.001), seeking care for a major chronic disease (OR=1.33, P<.001), physician's positive attitude about virtual clinics (OR=1.50, P=.002), and visits within certain departments including the heart center, psychiatry, and internal medicine (OR=2.55, P =.004) were positively associated with the utilization of virtual clinics. Patient's age, physician's age, and physician's sex were not associated with the utilization of virtual clinics in our study.
CONCLUSIONS: Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including patient's sex and distance from the hospital, factors at visit-level (insurance type, disease type), physician-level (physician's attitude about virtual clinics), and department-level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in number of virtual visits during the pandemic compared with pre-pandemic period, the majority (176815/187742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.
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