耳鼻咽喉科远程医疗的真实世界使用情况与患者接受度：一项单中心观察性研究

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中文摘要

背景： 远程医疗可能改善就医可及性并优化患者就诊路径，但其在耳鼻咽喉科的真实世界使用情况仍不确定。本单中心研究评估了弗赖堡大学耳鼻咽喉科医院的一个在线预约模块（可选择视频咨询），并将真实世界使用情况与患者假设性的远程医疗使用意愿进行比较。
材料与方法： 该在线模块于2021年3月至6月实施。我们记录了症状类别、年龄、性别、到诊所的距离、保险状态、所请求的咨询类型，以及对视频咨询与面对面咨询的偏好。视频咨询在3月和4月单独进行评估。此外，于2021年2月对以耳部症状就诊的患者进行了一项独立调查，以评估其用等效远程医疗咨询替代面对面就诊的假设性意愿。
结果： 在7435次门诊接触中，507次（6.8%）使用了在线预约模块。其中，35次（6.9%）请求视频咨询，472次（93.1%）请求面对面预约；因此视频请求占所有门诊接触的0.47%。相比之下，55名调查受访者中有35名（63.6%）表示，如果有等效的远程医疗服务，他们愿意放弃面对面就诊。在3月和4月，经电话咨询后安排或请求了29次视频咨询，其中11次完成。11次完成的视频咨询中有9次（81.8%）不需要后续面对面就诊，而2次（18.2%）需要额外的听力检查或鼻内镜检查。由于仅完成了11次视频咨询，这些发现是描述性和探索性的。
结论： 假设性的远程医疗使用意愿显著高于真实世界的视频咨询使用率。这一差距表明，陈述的接受度不一定转化为实际使用，可能反映临床适用性、认知、组织或技术障碍，或患者偏好。考虑开展远程医疗的耳鼻咽喉科部门因此应采用针对性的患者选择和咨询前分诊，特别是对于不需要立即检查或诊断测试的随访、咨询和第二意见。单中心设计、较短的观察期、完成视频咨询数量少以及COVID-19大流行背景限制了其普遍适用性。

英文摘要

Background: Telemedicine may improve access to care and streamline patient pathways, but real-world uptake in otorhinolaryngology remains uncertain. This single-center study evaluated an online appointment module with an option for video consultation at ENT University Hospital Freiburg and compared real-world utilization with patients' hypothetical willingness to use telemedicine. Materials and Methods: The online module was implemented from March to June 2021. We recorded symptom category, age, gender, distance to the clinic, insurance status, type of consultation requested, and preference for video versus face-to-face consultation. Video consultations were evaluated separately in March and April. In addition, an independent survey was conducted in February 2021 among patients presenting with otological symptoms to assess hypothetical willingness to substitute an equivalent telemedical consultation for an in-person visit. Results: Of 7435 outpatient contacts, 507 (6.8%) used the online appointment module. Among these, 35 (6.9%) requested a video consultation and 472 (93.1%) requested a face-to-face appointment; video requests therefore represented 0.47% of all outpatient contacts. By contrast, 35 of 55 survey respondents (63.6%) stated that they would forgo an in-person visit if equivalent telemedical care were available. In March and April, 29 video consultations were scheduled or requested after telephone counseling, of which 11 were completed. Nine of the 11 completed video consultations (81.8%) did not require a subsequent in-person visit, whereas two (18.2%) required additional audiometry or nasal endoscopy. Because only 11 video consultations were completed, these findings are descriptive and exploratory. Conclusions: Hypothetical willingness to use telemedicine was substantially higher than real-world video consultation utilization. This gap indicates that stated acceptance does not necessarily translate into actual use and may reflect clinical suitability, awareness, organizational or technical barriers, or patient preference. ENT departments considering telemedicine should therefore use targeted patient selection and pre-consultation triage, particularly for follow-up visits, counseling, and second opinions that do not require immediate examination or diagnostic testing. Generalizability is limited by the single-center design, the short observation period, the small number of completed video consultations, and the COVID-19 pandemic context.