Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study

Sharon Orrange, Arpna Patel, Wendy Jean Mack, Julia Cassetta, Sharon Orrange, Arpna Patel, Wendy Jean Mack, Julia Cassetta

Abstract

Background: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated.

Objective: The aim of this study is to examine correlates of patients' satisfaction with a telemedicine visit.

Methods: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression.

Results: Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients' satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005).

Conclusions: There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients' satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed.

Keywords: COVID-19; health care delivery; health services research; health policy; medicine; patient satisfaction; physicians; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sharon Orrange, Arpna Patel, Wendy Jean Mack, Julia Cassetta. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 22.04.2021.

References

    1. Ohannessian R, Duong TA, Odone A. Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health Surveill. 2020 Apr 02;6(2):e18810. doi: 10.2196/18810.
    1. Dorsey ER, Topol EJ. Telemedicine 2020 and the next decade. Lancet. 2020 Mar 14;395(10227):859. doi: 10.1016/S0140-6736(20)30424-4.
    1. Johns Hopkins University COVID-19 United States Cases by County. [2020-10-05]. .
    1. County of Los Angeles Public Health LA County COVID-19 Surveillance Dashboard. [2020-12-04]. .
    1. Peden CJ, Mohan S, Pagán V. Telemedicine and COVID-19: an Observational Study of Rapid Scale Up in a US Academic Medical System. J Gen Intern Med. 2020 Sep 04;35(9):2823–2825. doi: 10.1007/s11606-020-05917-9.
    1. Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med. 2020 Apr 30;382(18):1679–1681. doi: 10.1056/NEJMp2003539.
    1. Boehm K, Ziewers S, Brandt MP, Sparwasser P, Haack M, Willems F, Thomas A, Dotzauer R, Höfner T, Tsaur I, Haferkamp A, Borgmann H. Telemedicine Online Visits in Urology During the COVID-19 Pandemic-Potential, Risk Factors, and Patients' Perspective. Eur Urol. 2020 Jul;78(1):16–20. doi: 10.1016/j.eururo.2020.04.055.
    1. Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemed J E Health. 2016 May;22(5):342–75. doi: 10.1089/tmj.2016.0045.
    1. Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. J Gastrointest Surg. 2020 Jul;24(7):1692–1697. doi: 10.1007/s11605-020-04623-5.
    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 Aug 03;7(8):e016242. doi: 10.1136/bmjopen-2017-016242.
    1. Martinez KA, Rood M, Jhangiani N, Kou L, Rose S, Boissy A, Rothberg MB. Patterns of Use and Correlates of Patient Satisfaction with a Large Nationwide Direct to Consumer Telemedicine Service. J Gen Intern Med. 2018 Oct;33(10):1768–1773. doi: 10.1007/s11606-018-4621-5.
    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 Mar;31(3):269–75. doi: 10.1007/s11606-015-3489-x.
    1. Chen W, Feng Y, Fang J, Wu J, Huang X, Wang X, Wu J, Zhang M. Effect of trust in primary care physicians on patient satisfaction: a cross-sectional study among patients with hypertension in rural China. BMC Fam Pract. 2020 Sep 21;21(1):196. doi: 10.1186/s12875-020-01268-w.
    1. Krist AH, DeVoe JE, Cheng A, Ehrlich T, Jones SM. Redesigning Primary Care to Address the COVID-19 Pandemic in the Midst of the Pandemic. Ann Fam Med. 2020 Jul 13;18(4):349–354. doi: 10.1370/afm.2557.
    1. Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ. 2020 Mar 25;368:m1182. doi: 10.1136/bmj.m1182.
    1. Welch BM, Harvey J, O'Connell NS, McElligott JT. Patient preferences for direct-to-consumer telemedicine services: a nationwide survey. BMC Health Serv Res. 2017 Nov 28;17(1):784. doi: 10.1186/s12913-017-2744-8.
    1. Luz PLD. Telemedicine and the Doctor/Patient Relationship. Arq Bras Cardiol. 2019 Aug 08;113(1):100–102. doi: 10.5935/abc.20190117.
    1. Bertoncello C, Colucci M, Baldovin T, Buja A, Baldo V. How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews. PLoS One. 2018;13(11):e0207332. doi: 10.1371/journal.pone.0207332.
    1. Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990 Dec;67(3 Pt 2):1091–100. doi: 10.2466/pr0.1990.67.3f.1091.
    1. Ackerman SL, Gleason N, Shipman SA. Comparing Patients' Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey. J Gen Intern Med. 2020 Apr;35(4):1135–1142. doi: 10.1007/s11606-020-05703-7.
    1. Piette JD, Heisler M, Krein S, Kerr EA. The role of patient-physician trust in moderating medication nonadherence due to cost pressures. Arch Intern Med. 2005;165(15):1749–55. doi: 10.1001/archinte.165.15.1749.
    1. Rodriguez KL, Burkitt KH, Bayliss NK, Skoko JE, Switzer GE, Zickmund SL, Fine MJ, Macpherson DS. Veteran, primary care provider, and specialist satisfaction with electronic consultation. JMIR Med Inform. 2015 Jan 14;3(1):e5. doi: 10.2196/medinform.3725.
    1. Velsen LV, Tabak M, Hermens H. Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service. Int J Med Inform. 2017 Jan;97:52–58. doi: 10.1016/j.ijmedinf.2016.09.009.
    1. Donaghy E, Atherton H, Hammersley V, McNeilly H, Bikker A, Robbins L, Campbell J, McKinstry B. Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care. Br J Gen Pract. 2019 Sep;69(686):e586–e594. doi: 10.3399/bjgp19X704141.
    1. Cooley L. Fostering Human Connection in the Covid-19 Virtual Health Care Realm. NEJM Catal Innov Care Deliv. 2020 May 20;:10.1056/CAT.20.0166.
    1. Jiang J, Zhu Q, Zheng Y, Zhu Y, Li Y, Huo Y. Perceptions and Acceptance of mHealth in Patients With Cardiovascular Diseases: A Cross-Sectional Study. JMIR mHealth uHealth. 2019 Feb 04;7(2):e10117. doi: 10.2196/10117.
    1. Hammersley V, Donaghy E, Parker R, McNeilly H, Atherton H, Bikker A, Campbell J, McKinstry B. Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care. Br J Gen Pract. 2019 Sep;69(686):e595–e604. doi: 10.3399/bjgp19X704573.

Source: PubMed

3
Tilaa