Telehealth care before and during COVID-19: trends and quality in a large health system

Abstract

Background COVID-19 accelerated telehealth use to ensure care delivery, but there is limited data on the patient perspective. Objective To examine telehealth visit uptake before and during COVID-19 and correlates of patient satisfaction and interest in future telehealth visits. Design Cross-sectional observational study between October 2019 and April 2020. Participants Patients who completed satisfaction surveys following telehealth visits. Key Results A total of 8,930 patients completed the satisfaction survey using 4-point Likert Scales. Multivariable, hierarchical, cumulative-logit models were constructed to examine correlates of satisfaction with quality of care and interest in future telehealth visits. Most patients were satisfied with the patient portal, video quality, and instructions (92.7-96.8%). Almost half reported saving 1-2 hours (46.9%). Correlates positively associated with quality of care and interest in future telehealth visits were ease of patient portal (OR = 1.43, 95%CI 1.30-1.58; OR = 1.56, 95%CI 1.41-1.73, respectively), video quality (OR = 1.62, 95%CI 1.50-1.75; OR = 1.26, 95%CI 1.16-1.37, respectively), instructions (OR = 5.62, 95%CI 5.05-6.26; OR = 1.80, 95%CI 1.62-2.01, respectively), and time saved (>4 hours: OR = 1.69, 95%CI 1.22-2.34; OR = 3.49, 95%CI 2.47-4.93, respectively). Being seen after the COVID-19 surge in telehealth (OR = 0.76, 95%CI 0.63-0.93) or by providers with higher visit volume (OR = 0.71, 95%CI 0.60-0.85) was associated with lower interest in future telehealth visits. Conclusions Patients expressed relatively high satisfaction levels with telehealth. Better technical quality, quality of instructions, and greater time saved were associated with higher satisfaction ratings. To maintain interest in future telehealth use and improve the patient experience, we must enhance the quality of telehealth delivery platforms and instructions provided to patients. Lay Summary COVID-19 accelerated telehealth use to ensure care delivery, but there is limited data on the patient perspective. Therefore, this study focused on factors impacting patient satisfaction with telehealth. We found that better technical quality, quality of instructions before the visit, and greater time saved by having a telehealth appointment rather than in person were associated with higher satisfaction ratings. Given that telehealth will likely remain an important aspect of healthcare delivery beyond the COVID-19 pandemic, we must enhance the quality of telehealth delivery platforms and instructions provided to patients to maintain interest in future telehealth use and improve the patient experience.

Patient factors associated with telehealth quality and experience among adults with chronic conditions

“…At a system or institutional-level consideration, also finding opportunities to evaluate a patients’ technology/internet access and internet quality as part of the scheduling process and providing technology onboarding and support as needed. 45 , 46 …”

Perceptions in using teleconsultation during the COVID-19 Pandemic in Chennai, South India

“…The authors reported that teleconsultation was feasible for provision of ophthalmic services during the lockdown (17). In a study by Luna et al (2022), the majority of patients were content with the ease of contact, video quality and the guidance provided by doctors. The authors suggested that the standard of telehealth delivery platforms and patient instructions should be raised in order to maintain interest in future telehealth use and enhance the patient experience (18).…”

“…In a study by Luna et al (2022), the majority of patients were content with the ease of contact, video quality and the guidance provided by doctors. The authors suggested that the standard of telehealth delivery platforms and patient instructions should be raised in order to maintain interest in future telehealth use and enhance the patient experience (18). In a similar study done by Alromaihi et al (2023), evaluation of patient satisfaction to teleconsultation services showed that around 89% of the patients were satisfied with the quality of teleconsultation (19) With high dependence on internet and mobile phone, technical glitches are likely during teleconsultation.…”

Telemedicine Use and Decrements to Type 2 Diabetes and Hypertension Care during the COVID-19 Pandemic

“…Research examining patients' experiences of telemedicine during the pandemic indicate that di culties with using patient portals and poor video quality could have impacted quality of care for telemedicine users with diabetes and/or hypertension. (35) To improve the reach of screening efforts, clinic-community pharmacy partnerships and other outreach methods may also be needed to consistently monitor HbA1c and BP during times when in-person care options are limited. (14)(15)(16)36) Our results should be considered with some limitations.…”