JAMA：网络帮助患者更好使用临床服务

发表在最新一期《美国医学会杂志》上的一项研究揭示，与不能上网的病人相比，那些能够在互联网上获取医疗记录，并与临床医生进行电子邮件通讯的患者能够更多地使用临床服务资源。
 
一直以来，用健康资讯技术促进有效医疗保健服务是医疗改革的一个重要部分。以往研究提示，在网上为患者提供其健康记录，以及用电子邮件与医生沟通，可取代传统医疗保健服务。
 
这里存在一种假设，就是如果患者能够在网上查看诸如检验结果等健康资讯、请求处方药补充、安排预约，或给临床医生发送有安全保障的电子邮件，那么他们亲自到诊所看病及电话就诊的时间就会减少。
 
为了验证这些假设，美国科罗拉多凯萨医疗机构（KP）健康研究所的Ted E. Palen及其同事对病人上网获取服务与临床服务使用之间的关系进行了调查。研究人员检查了一组团体成员（年龄18岁或以上）对医疗服务的使用，这些人在2005年3月至2010年6月持续参加了KP综合卫生保健系统至少24个月。
 
利用“我的健康管理者”（MHM）—— 一种患者上网获取服务的系统—— 研究人员计算了使用者和非使用者的使用率。使用上网获取服务的参与者从2007年末的大约25%稳定增加至2009年6月的54%。能够获取MHM的人中有超过45%的人使用过至少一种MHM功能。
 
当研究人员比较MHM使用者和非使用者之间在指标日期前后对临床服务的使用时，他们发现每位成员的诊所就诊率（每年每位成员为0.7次）及电话联络（每年每位成员为0.3次）出现显著增加。与非使用者相比，MHM使用者的每1000名成员的下班后就诊率（每年18.7次）、急诊部门就诊率（每年11.2次）及住院率（每年19.9次）也有显著的增加。
 
研究人员称，原因可能是因为通过上网而发现了额外的健康问题，从而导致了亲自去诊所就诊时间的增加。另外，人们则可能会因预期的健康需要而激活他们对网上资源的使用。（来源：中国科学报 张章）

Association of Online Patient Access to Clinicians and Medical Records With Use of Clinical Services

Context Prior studies suggest that providing patients with online access to health records and e-mail communication with physicians may substitute for traditional health care services. Objective To assess health care utilization by both users and nonusers of online access to health records before and after initiation of MyHealthManager (MHM), a patient online access system. Design, Setting, and Participants Retrospective cohort study of the use of health care services by members (≥18 years old) who were continuously enrolled for at least 24 months during the study period March 2005 through June 2010 in Kaiser Permanente Colorado, a group model, integrated health care delivery system. Propensity scores (using age, sex, utilization frequencies, and chronic illnesses) were used for cohort matching. Unadjusted utilization rates were calculated for both MHM users and nonusers and were the basis for difference-of-differences analyses. We also used generalized estimating equations to compare the adjusted rates of utilization of health care services before and after online access. Main Outcome Measures Rates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters, and hospitalizations between members with and without online access. Results Comparing the unadjusted rates for use of clinical services before and after the index date between the matched cohorts, there was a significant increase in the per-member rates of office visits (0.7 per member per year; 95% CI, 0.6-0.7; P < .001) and telephone encounters (0.3 per member per year; 95% CI, 0.2-0.3; P < .001). There was also a significant increase in per-1000-member rates of after-hours clinic visits (18.7 per 1000 members per year; 95% CI, 12.8-24.3; P < .001), emergency department encounters (11.2 per 1000 members per year; 95% CI, 2.6-19.7; P = .01), and hospitalizations (19.9 per 1000 members per year; 95% CI, 14.6-25.3; P < .001) for MHM users vs nonusers. Conclusion Having online access to medical records and clinicians was associated with increased use of clinical services compared with group members who did not have online access.