COVID-19疫情期间远程医疗服务在基层医院的应用研究

Study on the Application of Telemedicine Service in Primary Hospitals During the Epidemic of COVID-19

目的:通过对COVID-19疫情期间远程医疗就诊情况分析,为进一步完善远程医疗工作提供依据。方法:采用描述性统计分析2020年疫情期间,北京交通大学社区卫生服务中心远程医疗就诊频次情况。疫情期间中心通过视频软件为门诊非急症患者提供远程医疗服务。每日安排1名全科主治医师及以上职称的医生与专科医生联合通过远程问诊,综合评估患者病情,根据不同情况给予医疗指导。结果:2020年2月10日至4月10日进行远程就诊患者276人次,男:女为1:1.07,年龄0.5~90岁。20~29岁年龄段就诊人数最多(占26.81%)。远程医疗就诊排序前3位的科室是全科(56.16%)、临床心理科(14.49%)、皮肤科(7.97%)。就诊疾病所属系统前3位的是循环系统64人次(23.19%)、呼吸系统35人次(12.68%)、内分泌系统29人次(10.51%)。慢性疾病常规随诊取药者106人次(38.41%)。疫情相关咨询31人次(11.23%),健康相关咨询81人次(29.35%),常见病诊治42人次,慢病随诊取药排序前3位的是高血压、糖尿病、高脂血症。结论:远程医疗涵盖了社区服务人群的常见病、多发病,与基层社区卫生机构的全科诊疗范围一致。疫情期间开展远程医疗,可有效减少就诊过程中与患者的直接接触,有助于降低传染概率。远程医疗以问诊为主,对全科医生的知识框架和诊疗思维能力是一个严峻的挑战,应加强全科医生临床诊疗能力提升,更好地发挥健康守门人的职责。

Objective:Through the analysis of the telemedicine visits during the COVID-19 epidemic,the basis for further improving the telemedicine work was provided.Methods:During the epidemic in 2020,the community health service center of Beijing Jiaotong University provided telemedicine services to nonemergency patients through video software.The center arranges a doctor with general practitioner and above titles to conduct a comprehensive assessment of the patient's condition through remote consultation with specialists and give medical guidance according to different conditions.Results:From February 10,2020 to April 10,2020,276 patients were treated remotely,male:female:1:1.07,aged 0.5〜90 years.The age group of 20〜29 years old had the largest number of visits(26.81%).The top 3 departments ranked by telemedicine visits were general department(56.16%),clinical psychology department(14.49%)and dermatology department(7.97%).The top three systems of the disease are the circulatory system,respiratory system and endocrine system.There were 106 patients(38.41%)receiving drugs during routine follow-up for chronic diseases,31 patients(11.23%)receiving epidemic-related counseling,81 patients(29.35%)receiving health-related counseling,and 42 patients receiving common diseases.The top 3 drugs for chronic diseases were hypertension,diabetes and hyperlipidemia.Conclusion:Telemedicine covers common diseases and frequently occurring diseases of community service population,which is consistent with the scope of general practice in basic community health institutions.Telemedicine during the epidemic can effectively reduce the direct contact with patients during the treatment and help reduce the probability of infection.Telemedicine is mainly based on inquiry,which is a serious challenge to the general practitioner's knowledge frame.