Patient satisfaction and acceptability with telehealth at specialist medical outpatient clinics during the COVID-19 pandemic in Australia

Lucinda Adams, Susan Lester, Elizabeth Hoon, Heather van der Haak, Charlotte Proudman, Cindy Hall, Samuel Whittle, Susanna Proudman, Catherine L Hill, Lucinda Adams, Susan Lester, Elizabeth Hoon, Heather van der Haak, Charlotte Proudman, Cindy Hall, Samuel Whittle, Susanna Proudman, Catherine L Hill

Abstract

Background: Outpatient clinics were shifted rapidly to telehealth in Australia during the Coronavirus disease 19 (COVID-19) pandemic, drastically altering patient care and experience.

Aims: To investigate patient satisfaction and acceptability of telehealth consultations during the COVID-19 pandemic.

Methods: Prospective observation study conducted in two hospital rheumatology outpatient departments (OPD) undertaking telehealth consultations during COVID-19. A modified version of a validated telehealth evaluation survey was posted to all patients attending the telehealth OPD rheumatology clinics, including balanced 5-point Likert scales and free-text responses. Cluster analysis was applied to the Likert-scale questions, alongside thematic analysis of free-text responses.

Results: There were 128 respondents (29% response rate), of which 69.5% were women and the majority (87.5%) was aged 50 years or older. All telehealth consultations were conducted by telephone. Nearly one-fifth of patients indicated consistent dissatisfaction with telehealth across the range of questions. These patients were older, reported lower educational qualifications and lower health literacy scores and lacked access to the Internet. While many patients found this mode of consultation to be convenient, patients expressed concerns regarding absence of physical examination. A recurrent theme was a desire for a mixed-model clinic in the future, with flexibility of having both telehealth and face-to-face consultations.

Conclusions: This study offers unique insights into patients' experiences with telehealth, which until the current global pandemic, has been an uncommon mode of consultation delivery in urban areas. This study suggests when defining the place of telehealth in future healthcare delivery, patient perspective and careful patient selection will be key. Disease progression, language and cognitive ability, health literacy, technology access and patient and clinician preference are important considerations when deciding how effectively to embed and integrate telehealth into consultations.

Keywords: health system improvement; outpatient care; telemedicine.

© 2021 Royal Australasian College of Physicians.

Figures

Figure 1
Figure 1
Patient responses to patient satisfaction survey. (), Strongly disagree; (), disagree; (), neutral; (), agree; (), strongly agree.
Figure 2
Figure 2
Telehealth survey questions: Q14–Q31 by cluster (Gp 1 and Gp 2). (), Strongly disagree; (), disagree; (), neutral; (), agree; (), strongly agree.
Figure 3
Figure 3
Demographics and other relevant variables by cluster.

References

    1. Department of Health . Telehealth. Canberra: Australian Government; 2015. [updated 2015 Apr 7; cited 2020 Jun 30]. Available from URL:
    1. Hong Y‐R, Lawrence J, Williams D Jr, Mainous Iii A. Population‐level interest and telehealth capacity of US hospitals in response to COVID‐19: cross‐sectional analysis of Google search and national hospital survey data. JMIR Public Health Surveill 2020; 6: e18961.
    1. Boyages S. COVID‐19 consequence: telehealth will go mainstream. Med J Aust 2020; 15.
    1. Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen Jet al. Telehealth for global emergencies: implications for coronavirus disease 2019 (COVID‐19). J Telemed Telecare 2020: 26: 309–3.
    1. Wong ZW, Cross HL. Telehealth in cancer during COVID‐19 pandemic. Med J Aust 2020; 213: 237.e1.
    1. López‐Medina C, Escudero A, Collantes‐Estevez E. COVID‐19 pandemic: an opportunity to assess the utility of telemedicine in patients with rheumatic diseases. Ann Rheum Dis 2021; 80: e50.
    1. Beard M, Orlando JF, Kumar S. Overcoming the tyranny of distance: an audit of process and outcomes from a pilot telehealth spinal assessment clinic. J Telemed Telecare 2017; 23: 733–9.
    1. Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P. Challenges of rural cancer care in the United States. Oncology 2015; 29: 633–40.
    1. de la Torre‐Díez I, López‐Coronado M, Vaca C, Aguado JS, de Castro C. Cost‐utility and cost‐effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed J E Health 2015; 21: 81–5.
    1. Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open 2017; 7: e016242.
    1. Schulz TR, Richards M, Gasko H, Lohrey J, Hibbert ME, Biggs BA. Telehealth: experience of the first 120 consultations delivered from a new refugee telehealth clinic. Intern Med J 2014; 44: 981–5.
    1. Forducey PG, Glueckauf RL, Bergquist TF, Maheu MM, Yutsis M. Telehealth for persons with severe functional disabilities and their caregivers: facilitating self‐care management in the home setting. Psychol Serv 2012; 9: 144–62.
    1. Polinski JM, Barker T, Gagliano N, Sussman A, Brennan TA, Shrank WH. Patients' satisfaction with and preference for telehealth visits. J Gen Intern Med 2016; 31: 269–75.
    1. Bakken S, Grullon‐Figueroa L, Izquierdo R, Lee N‐J, Morin P, Palmas Wet al. Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. J Am Med Inform Assoc 2006; 13: 660–7.
    1. R Core Team . R: A Language and Environment for Statistical Computing. Vienna: R Project; 2013.
    1. Maechler M, Rousseeuw P, Struyf A, Hubert M, Hornik K.cluster: Cluster Analysis Basics and Extensions. R package version 2.0.8. Vienna: R Project; 2019.
    1. Terry G, Hayfield N, Clarke V, Braun V. Thematic analysis. In: The Sage Handbook of Qualitative Research in Psychology. Newbury Park, CA: SAGE Publications; 2017; 17–37.
    1. Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, Hinder Set al. Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework. BMC Med 2018; 16: 66.
    1. Devadula S, Langbecker D, Vecchio P, Tesiram J, Meiklejohn J, Benham H. Tele‐rheumatology to regional hospital outpatient clinics: patient perspectives on a new model of care. Telemed J E Health 2020; 26: 912–9.
    1. Poulsen KA, Millen CM, Lakshman UI, Buttner PG, Roberts LJ. Satisfaction with rural rheumatology telemedicine service. Int J Rheum Dis 2015; 18: 304–14.
    1. Kulcsar Z, Albert D, Ercolano E, Mecchella JN. Telerheumatology: a technology appropriate for virtually all. Semin Arthritis Rheum 2016; 46: 380–5.
    1. Nguyen‐Oghalai TU, Hunter K, Lyon M. Telerheumatology: the VA experience. South Med J 2018; 111: 359–62.
    1. Global Centre for Modern Ageing . Telehealth – Here to Stay?. Adelaide: Global Centre for Modern Ageing; 2020.
    1. Leggett P, Graham L, Steele K, Gilliland A, Stevenson M, O'Reilly Det al. Telerheumatology – diagnostic accuracy and acceptability to patient, specialist, and general practitioner. Br J Gen Pract 2001; 51: 746–8.
    1. Granlund H, Thoden CJ, Carlson C, Harno K. Realtime teleconsultations versus face‐to‐face consultations in dermatology: immediate and six‐month outcome. J Telemed Telecare 2003; 9: 204–9.
    1. Davis P, Howard R, Brockway P. Telehealth consultations in rheumatology: cost‐effectiveness and user satisfaction. J Telemed Telecare 2001; 7(Suppl): 10–1.
    1. Anderson R, Barbara A, Feldman S. What patients want: a content analysis of key qualities that influence patient satisfaction. J Med Pract Manage 2007; 22: 255–61.
    1. Wade VA, Karnon J, Elshaug AG, Hiller JE. A systematic review of economic analyses of telehealth services using real time video communication. BMC Health Serv Res 2010; 10: 233.
    1. Schulz TR, Leder K, Akinci I, Biggs B‐A. Improvements in patient care: videoconferencing to improve access to interpreters during clinical consultations for refugee and immigrant patients. Aust Health Rev 2015; 39: 395–9.
    1. Wood PR, Caplan L. Outcomes, satisfaction, and costs of a rheumatology telemedicine program: a longitudinal evaluation. J Clin Rheumatol 2019; 25: 41–4.
    1. Collins K, Walters S, Bowns I. Patient satisfaction with teledermatology: quantitative and qualitative results from a randomized controlled trial. J Telemed Telecare 2004; 10: 29–33.
    1. Rothschild B. Telerheumatology: not ready for prime time. Intern Med J 2013; 43: 468–9.
    1. Totten AM, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, et al. Telehealth: mapping the evidence for patient outcomes from systematic reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016.

Source: PubMed

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