Digital Consultations During COVID-19: A Multiperspective Mixed-Methods Study in an Integrative Medicine Setting in Switzerland

Communication Challenges Experienced by Clinicians and Patients during Teleconsultation: A Scoping Review

BACKGROUND

 As teleconsultations continue to rise in popularity due to their convenience and accessibility, it is crucial to identify and address the challenges they present in order to improve the patient experience, enhance outcomes, and ensure the quality of care. To identify communication challenges that clinicians and patients experience during teleconsultation, a scoping review was conducted.

OBJECTIVE

 This study aimed to identify communication challenges that clinicians and patients experience during teleconsultation.

METHODS

 Studies were obtained from four databases (Ovid [MEDLINE], Ovid [Embase], CINAHL, and Scopus). Gray literatures were not included. Studies focused on communication challenges between clinicians and their patients during teleconsultation in the context of coronavirus disease 2019 (COVID-19) and published from January 2000 to December 2022, were collected. The screening process was conducted by two independent reviewers. Data extraction was performed using a standardized form to capture study characteristics and communication challenges. Extracted data were analyzed to identify the communication challenges during teleconsultation, adherent to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR).

RESULTS

 A total of 893 studies were collected from four databases and 26 studies were selected based on inclusion/exclusion criteria. Of these 26 eligible studies, 12 (46%) were from the United States, 3 studies (12%) were from Australia, and 2 (8%) were from the United Kingdom and Canada. These studies included 12 (46%) qualitative studies, 6 (23%) quantitative studies, 6 (23%) review articles, and 2 (8%) case reports. Eight factors contributing to communication challenges between clinicians and patients during teleconsultations were identified: technical issues, difficulties in developing rapport, lack of non-verbal communication, lack of physical examination, language barrier, spatial issues, clinician preparation, and difficulties in assessing patients' health literacy.

CONCLUSION

 Eight factors were identified as contributing to communication challenges during teleconsultation in the context of COVID-19. These findings highlight the need to address communication challenges to ensure effective teleconsultations. With the rise of teleconsultation in routine health care delivery, further research is warranted to confirm these findings and to explore ways to overcome communication challenges during teleconsultation.

Telemedicine and Patient Experience Ratings at an Academic Integrative Medicine Practice: Retrospective Examination

BACKGROUND

The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown.

OBJECTIVE

The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters.

METHODS

A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage "top box" scores (ie, the percentage of respondents who selected the most positive response category on the survey, "very good"), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05.

RESULTS

Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups.

CONCLUSIONS

Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine.

Practicing traditional Chinese medicine in the COVID-19 pandemic in Switzerland – an exploratory study

Background

To curb the spread of the first wave of the COVID-19 pandemic, the Swiss government declared a state of health emergency and ordered a legal restriction concerning the opening of healthcare institutions. In this study, we aimed to assess the proportion of traditional Chinese medicine (TCM) physicians and therapists who consulted patients regarding COVID-19 during the first wave of the pandemic in 2020 in Switzerland, as well as the extent to which COVID-19 affected their practices during the same period.

Methods

A retrospective study was performed by using a questionnaire from January to April 2021 among a random sample of TCM physicians and therapists based in Switzerland. The survey included questions on demographic characteristics, opening status of practices, channels of communication used for the medical encounter, and experience in managing the prevention, acute, and recovery stages of COVID-19 infection.

Results

Among the 320 participants, 76% consulted a patient regarding COVID-19 at least once. Overall, physicians and therapists consulted more patients during recovery (76.3%) and prevention (67.8%) than during the acute stage (19.8%) of the disease. Acupuncture was the most frequently used technique among TCM therapists and physicians consulting for prevention (80.4%) and recovery (92.5%), whereas Chinese pharmacopeia was the most used technique among those consulting for the acute stage (59.3%). Of those who closed their practices from March to April 2020 but kept consulting, telephone (30.4%) and home visits (29.9%) were the two principal methods of consultation.

Conclusions

The restriction concerning the opening of practices induced a loss of the health workforce, especially among TCM therapists. Nonetheless, TCM therapists and physicians consulted patients regarding COVID-19, especially during the recovery stage. As there is a demand for the use of TCM in the context of COVID-19, it raises the need for a better consideration of TCM in the Swiss health care system.