Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences

Abstract

© 2020, The Author(s). Background: During the first COVID-19 pandemic ‘lockdown’ in Aotearoa/New Zealand (March–May 2020, in which strict ‘stay at home’ measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future. Methods: Using a mixed-method approach, we undertook an online survey and in-depth interviews with adults (> 18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n = 1010) and qualitative analysis of interview data (n = 38) and open-ended survey questions, using a framework of access to health care, from the patient’s perspective. Results: In general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person. Conclusions: Even in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients.

Patients’ and physicians’ experiences with remote consultations in primary care during the COVID-19 pandemic: a multi-method rapid review of the literature

“…Reimbursement for previously 'free' services 1 -4 5 23,26,34,35,36 Remote consultations enable better monitoring of cases 3 -1 4 15,17,21,33 Increased appointment adherence 1 -1 2 21,28 Increased involvement by family members and insights into patient's home environment --1 1 21 Patients feel empowered to discuss more personal issues via remote consultation 1 --1 21 Advantages -Patients and PCPs Convenience 9 2 -11 16,17,18,20,21,24,25,29,33,35,36 Reduced risk of COVID-19 3 --3 13,14,24…”

“…Difficulty in making clinical decisions 3 1 4 13,15,31,33 Lack of motivation/support --3 3 17,35,36 Changes to consultation type 2 --2 13,27 Issues -Patients Concerns about privacy 3 -1 4 20,25,29,32 Monetary concerns 3 --3 20,24,29 Physician missing appointments 1 -- 16 Issues -Patients and PCPs Lack of confidence in, and access to, the technical skills/ technology required for remote consultations 8 1 6 14,16,17,20,21,23,24,25,28,29,30,33,34,35,36 Loss of non-verbal communication and patient-physician rapport 6 2 1 13,16,17,20,21,24,25,33,36 Loss of physical and visual assessment of symptoms 5 2 1 13,16,17,20,21,25,31,…”

Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic

“…In the UK, Imlach et al (2020) also found that patients reported high satisfaction with virtual care, describing it as a convenient mode of care that allowed them to safely access health care without having to weigh up the fear of COVID-19 infection against the need to be observed. 16 Yet, it is important to note that patients' experiences vary across patients' characteristics; our results suggest a better experience by those with higher digital health literacy and, in Italy, by some ethnic groups. Timeliness and efficiency were reported as the quality of care dimensions most positively impacted by the introduction of virtual care.…”

Healthcare provider-to-patient perspectives on the uptake of teleconsultation services in the Nigerian healthcare system during the COVID-19 pandemic era

“…The ongoing COVID-19 Pandemic has necessitated the urgent and crucial need to adopt strategies in the healthcare sector that seek to minimize face-to-face consultations, triage hospital visitations, and opt for teleconsultations whenever possible to limit the spread of the SARS--CoV-2 virus [1,2]. The adoption of telehealth services during this Pandemic has ensured the continuity of healthcare delivery-breaking down physical and geographical barriers to assessing medical care even as most countries worldwide enforced movement restrictions and physical distancing measures aimed at reducing community nosocomial spread [3,4].…”