Systematic review of studies of patient satisfaction with telemedicine

Comparison of Online Visual Acuity Testing with Dynamic Dyop and Static LogMAR Optotypes in Healthy Non-Presbyopic and Presbyopic Individuals

Introduction

Visual acuity (VA) is typically measured using stationary optotypes, though real-world visual experiences involve dynamic targets. The Dyop (dynamic optotype) VA test is a computerized motion perception assessment designed to simulate daily visual experiences. With the rise of telemedicine, this study examined the feasibility and agreement between virtual online VA testing using Dyop compared to standard LogMAR optotypes in non-presbyopic and presbyopic participants.

Methods

After an initial online Zoom® meeting verifying inclusion criteria and technical feasibility, participants accessed the examiner's computer using the "Anydesk" application enabling them to view the "Chart 2020" program. Monocular right eye VA was measured three consecutive times using Dyop and LogMAR optotypes in a counter-balanced design. Participants aged 18-39 yrs were considered non-presbyopic, and those 40-60 yrs were considered presbyopic. VA measurements were analyzed using the Mann-Whitney U-test, Spearman correlation coefficients, intraclass correlation coefficients (ICC), and non-parametric Bland-Altman analysis, which examined median differences and limits of agreement (LoA).

Results

Of the 110 participants, (70% females, mean age: 32.5 ± 13.0, range: 18-60), 73 (66%) were considered non-presbyopic (mean age: 24.1 ± 4.9, range: 18-39), and 37 (34%) were presbyopic (mean age: 49.0 ± 6.4, range: 40-60). The mean VA measured with the Dyop and LogMAR charts for the entire cohort (0.09 and 0.08), for the non-presbyopic (0.09 and 0.07) and the presbyopic (0.10 and 0.09) sub-groups was significantly positively correlated (r = 0.80, p < 0.001, r = 0.82, p < 0.001 and r = 0.72, p < 0.001, respectively), with a small mean difference (-0.01 ± 0.08, -0.02 ± 0.08, -0.01 ± 0.09 log units), for the entire cohort, the non-presbyopic, and the presbyopic, respectively. There were no significant differences between the two tests for the whole cohort (p = 0.80), for group 1 (p = 0.98) and for group 2 (p = 0.62).

Conclusion

This study demonstrated the feasibility of online VA measurements and that online VA measurements using Dyop and LogMAR optotypes are interchangeable in healthy non-presbyopic and presbyopic participants.

Advancing ocular oncology care through teleophthalmology: a patient-centric perspective

OBJECTIVE

Assessing patient satisfaction is an important component of understanding a program's efficacy and quality. The purpose of this study is to evaluate patient satisfaction with a teleophthalmology program tailored for ocular oncology that provides screening, remote assessment, care planning, and follow-up.

STUDY DESIGN

Retrospective survey.

METHODS

An adapted version of the Telehealth Satisfaction Scale, consisting of the 8 questions plus 5 additional questions specific to the teleophthalmology program, was used to survey patients. The teleophthalmology program involves diagnostic imaging, remote physician assessments, and follow-up phone calls from health care team members to deliver results to patients. For reporting, the Consensus-Based Checklist for Reporting of Survey Studies was used. T-tests explored satisfaction differences across demographics and teleophthalmology visits.

RESULTS

Among the 95 patients contacted, 91 agreed to participate in the survey (96% response rate). Participants exhibited high overall satisfaction with the teleophthalmology program, reflected in a mean Telehealth Satisfaction Scale score of 28.88 (SD = 3.35 of 32). The median number of teleophthalmology visits completed was 4.0 (range of 1-8 appointments). No significant differences in satisfaction were found on the basis of age (P = 0.56), urban or rural residence (P = 0.17), or the number of telemedicine appointments (P = 0.51).

CONCLUSIONS

This analysis displays high satisfaction levels among patients within an ocular oncology clinic participating in the current telemedicine program, irrespective of age, geography, or number of teleophthalmology visits. Participants reported having their health care needs met with minimal clinical encounters due to remote consultations and telephone communications.

Connected health in cancer survivorship: Evaluating the usability and utility of the cancer thriving and surviving programme in Ireland

BACKGROUND

Cancer survivorship care has become increasingly complex, with a growing population of people living with and beyond the disease requiring holistic support and follow-up. Connected health (CH) offer a promising solution to enhance care delivery.

AIM

This study evaluated the usability and effectiveness of CH, and motivations of participants in the Cancer Thriving and Surviving (CTS) programme in Ireland.

METHODS

A cross-sectional survey of persons living with and beyond cancer (PLWBC) who completed the CH-delivered CTS was conducted between December 2022 and April 2023. Closed and open-ended questions captured participants experiences and motivations. Telehealth Usability Questionnaire (TUQ) assessed the CH usability. Qualitative content analysis examined recurring themes in participant responses.

RESULTS

Forty-four participants who engaged in CTS completed the survey. Participants were predominantly female (88%), diagnosed with breast cancer (76%), and had third-level education or higher (86%). Slightly over one third (36%) were in full time employment. Motivations for engaging in CTS included seeking peer support, psychosocial assistance, and practical self-management tools. Most respondents agreed that the programme improved their psychological wellbeing (90%), quality of life (76%) and helped them take more control of their health (83%). TUQ scores indicated high usability of the CH systems.

CONCLUSION

Findings suggest that the CH-delivered CTS programme effectively benefits PLWBC, improving psychological well-being and quality of life. The high CH system usability and positive user experiences highlight its potential to complement in-person care, supporting the continued development and evaluation of CH systems to enhance cancer survivorship, particularly within Irish digital health initiatives.

Effect of Medication Management at Home via Pharmacist-Led Home Televisits: Protocol for a Cluster Randomized Controlled Trial

BACKGROUND

Older adults are more likely to have multiple chronic conditions, be prescribed multiple medications, and be more susceptible to adverse drug reactions (ADRs) to their medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimens. Complex medication regimens are potentially harmful to older adults. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as reviews of medication lists and the implementation of "brown bag" reconciliation, continue to be challenging, with limited success. Pharmacist-led interventions to improve appropriate medication use in older adults have demonstrated effectiveness in reducing ADRs. Video visits have the potential to provide direct visualization of medications in older adults' homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist-led management of older adults' medication regimens may improve appropriate medication use in older adults.

OBJECTIVE

The objective of this study is to examine the effect of pharmacist-led medication through home televisits compared to usual care on appropriate medication use, medication discrepancies, medication adherence, and ADRs.

METHODS

We will conduct a 2-site cluster randomized controlled trial (RCT). The intervention will be a pharmacist-led home televisit including medication reconciliation and assessment of actual medication use. The cluster RCT was iteratively adapted after a pilot test. The primary outcome of medication appropriateness of the intervention will be measured using the STOPP (Screening Tool of Older Persons' Prescriptions) criteria for potentially inappropriate medications (PIMs) at 6 months. Medication lists obtained will be compared against electronic medical records (EMRs) by a clinician to establish discrepancies in medications. The clinician will review medications using the validated Medication Appropriateness Index (MAI).

RESULTS

This project has been peer-reviewed and selected for support by the Veterans Affairs (VA) Health Services Research Service. The pilot phase of the study was completed December 2021 with 20 veterans and was primarily informed by the Steinman model of the prescribing process adapted to include system- and provider-level factors. The last date of enrollment was August 6, 2021. We anticipate the completion of the ongoing trial in spring 2025. The first results are expected to be submitted for publication in 2025.

CONCLUSIONS

The cluster RCT will provide evidence on medication management through televisits. If found effective in improving the use of medications, the intervention has the potential to impact older adults with multiple chronic conditions and polypharmacy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04340570; https://clinicaltrials.gov/study/NCT04340570.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/65141.

Evaluation of a Telehealth Paediatric Asthma and Allergy Clinic Patient Follow-Up During the COVID-19 Pandemic

BACKGROUND/OBJECTIVES

The COVID-19 pandemic created many challenges for health services, particularly during lockdown periods. Asthma is one of the most common childhood conditions, and children with asthma are generally cared for in an outpatient setting. In regional Northwest Tasmania, during the COVID-19 lockdowns, asthma and allergy outpatient clinic services were transferred to a virtual platform in the form of telehealth appointments for routine consultations. This study aims to explore the patient and family perspectives of a telehealth outpatient asthma review service in a regional area.

METHODS

We utilised a mixed-methods approach, interviewing parents and children who attended the clinic via telehealth and collating routine clinical audit data collected during the same period.

RESULTS

Sixty-three patient reviews were audited, with a mean age of 9.79 years. Since their last review, 13% visited their GP, 9% presented to the ED, 6% were hospitalised, and 19% had changes in their treatment plan. Interviews highlighted three main themes: (i) telehealth is a convenient strategy for routine asthma and allergy review appointments, (ii) barriers associated with using telehealth are a minor concern for parents of children with asthma and allergy routine appointments, and (iii) shared decision-making between clinicians and parents of children with asthma and allergy around the type of appointment required is valued.

CONCLUSIONS

We demonstrated that the benefits of telehealth include implementing treatment changes and facilitating access to care for children living in rural and remote areas.

A review of questionnaires used for the assessment of telemedicine

INTRODUCTION

Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires.

METHODS

We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication.

RESULTS AND DISCUSSION

We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.

Primary eyecare in paediatrics population (PREPP) - II study: Study of satisfaction of services and barrier for not reporting to the base hospital on referral among pediatric patients treated in six major vision centers of a tertiary eye care facility in Southern India

PURPOSE

This study was conducted in continuation of Primary Eyecare in Paediatrics Population (PREPP-I) and was aimed to assess parents' satisfaction with pediatric-eye-care services across six vision centers (VCs) of a tertiary eye hospital in Southern India. The barriers among the parents for not attending the base hospital (BH) when referred from these VCs were also evaluated.

METHODS

A standard-validated-satisfaction questionnaire (VSQ) was used to assess patient satisfaction. Responses were assessed on a 5-point Likert scale: 0 (very dissatisfied) to 4 (very satisfied) against each response. Responses were expressed as percentages with 0 (very dissatisfied) and 100% (very satisfied). Patients were referred with a form mentioning reasons for referral (urgent/non-urgent). All referrals were evaluated by the principal investigator. In case of failure to report, parents were enquired about the barrier based on the validated barrier questionnaire (VBQ) over a telephonic conversation.

RESULTS

All 250 patients of the PREPP-1 study were included in the satisfaction study. Different domains were evaluated using VSQ (accessibility of VC, waiting hours, financial aspects, spectacle dispensing service, and teleophthalmology). The overall satisfaction was 75%. The most common reason for dissatisfaction was the lack of meeting the ophthalmologist in person, followed by waiting time. 58 patients wanted to visit BH to consult a pediatric ophthalmologist in person (23%). For the barrier study, 14 out of 47 referrals did not report and were evaluated using VBQ (knowledge, physical, time, and financial barriers). The majority had a financial barrier (43%), followed by knowledge (28.6%) and time barrier (14%).

CONCLUSION

PREPP-II demonstrated that 3/4 th of pediatric patients are happy to be treated at VC with teleophthalmology services. However, a significant percentage want to consult a specialist at BH. One-fourth of total referrals did not report to BH due to financial constraints and a lack of awareness of the child's condition.

The use of telemedicine for perioperative pain management during the COVID-19 pandemic

INTRODUCTION

Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management.

METHODS

A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre-post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits.

RESULTS

The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed.

CONCLUSION

The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine.

How do consumers prefer their care delivered: In-person, telephone or videoconference?

AIM

To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations.

METHODS

A national cross-sectional survey was administered to a representative sample of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online sampling service. The sample was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which individuals sought a general practitioner.

RESULTS

A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes).

CONCLUSIONS

Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.

The Therapeutic Relationship in Videoconferencing Psychotherapy: A Qualitative Study of Therapists' Experiences

Objective

The growth of videoconferencing psychotherapy (VP) requires a closer conceptualization of the therapeutic relationship in VP. Therefore, we investigated the therapeutic relationship in VP from the clinicians' perspective.

Method

We conducted three focus groups with 27 Italian VP professional psychotherapists of different theoretical orientations, focusing on their experience of the therapeutic relationship in VP. Data analysis was conducted through inductive thematic analysis.

Results

The following themes emerged: (a) construction and management of the online setting (regarding the complexity of the therapeutic boundaries in VP and the efforts to manage this); (b) meaning construction of the request for help and the therapeutic process (regarding how patients and therapist represent the meaning of the therapeutic space and work in VP); (c) patient and therapist involvement in the online relationship (addressing the depth of the therapeutic relationship in VP in terms of intimacy, openness/closure, distance/closeness, and involvement); (d) new elements of the therapeutic relationship introduced by VP (regarding the source and nature of information about the patient and the effects of the technical environment on the relationship); (e) nonverbal aspects and corporeality in VP (dealing with how different aspects of para- and extralinguistic communication may impact the therapeutic relationship in VP); (f) differences in the quality of the emotional and relational level of VP (regarding the emotional attitudes and reactions of patients and therapists and the overall quality of the therapeutic relationship); (g) treatment satisfaction and drop-out (regarding ease of leaving the session, patient satisfaction, and dificulties in terminating therapy); and (h) personal characteristics of patient and therapist that influence VP (regarding the impact of patients personality and therapists training/approach on the progress of VP).

Conclusions

Results suggest that the therapeutic relationship in VP has specific features that distinguish it from face-to-face psychotherapy. Implications for practice, training, and research are discussed.

Multi-Dimensional Analysis of Japanese Telemedicine Patient Satisfaction

Introduction

Telemedicine is a growing segment of the healthcare industry. As telemedicine gains prominence in Japan, the importance of telemedicine patient satisfaction research will also grow. This study examines whether Japanese patients are equally impacted by the same latent dimensions discovered in the multi-dimensional service satisfaction model used by a United States (U.S.) study.

Methods

The subjects (n = 110) were patients who received telemedicine service between January and December 2023 at Juntendo University Hospital, Tokyo, Japan. Patient satisfaction perceptions were collected using a questionnaire composed of Likert scale items. Overall patient satisfaction served as the dependent variable, and patient perceptions of various aspects of the service were the independent variables. LASSO regression analysis was used to test the impact of the independent variables on overall patient satisfaction along with cluster analysis to examine the satisfaction ratings based upon patient characteristics.

Results

Japanese patient perceptions of telemedicine health benefits were the most impactful driver of overall satisfaction. Cluster analysis indicated that males were generally more satisfied than females. The least satisfied patients were predominately female and those experiencing telemedicine for the first time. Patients receiving service from a specialist physician were least satisfied with the telemedicine financial costs.

Discussion

Patient satisfaction levels were found to be highly impacted by perceptions of the health benefits received and the non-financial costs of service. These benefits could be highlighted by Japanese telemedicine providers to increase utilization of telemedicine services. Patient satisfaction was also found to be influenced by patient-centered care (ie, the "soft skills" of providers) to a lesser degree. Therefore, Japanese telemedicine providers may benefit from developing patient-centered communication skills.

Conclusion

The model used provides nuanced understandings of telemedicine patient satisfaction, which highlights where targeted improvements in Japanese telemedicine patient satisfaction are likely to be most impactful.

A Comparison of the Convenience, Quality of Interaction, and Satisfaction of Virtual and In-Person Healthcare Consultations: A Nationwide Study

Background: There are few direct comparisons of service utilization and patient-reported outcomes in patients attending medical consultations in person or virtually. This was a prospective, cross-sectional study of adults engaging with a healthcare practitioner via virtual or in-person consultations. Methods: Participants were recruited in person by convenience sampling between November 2023 and January 2024 across Saudi Arabia, and data were gathered on (i) basic demographic and consultation information and (ii) convenience, quality of interaction, and satisfaction with their consultations. Results: Of 3196 individuals who completed the survey, 28.7% had attended their most recent healthcare interaction virtually and 71.3% had attended in person. Participants attending virtual consultations were more likely to live rurally (69.0% vs. 21.9% for in-person consultations; p < 0.001). Virtual appointments were more common for primary care and diabetes/endocrinology but not surgical specialties (p < 0.001), and private apps and hospitals more frequently provided virtual appointments. Conclusions: Overall, patients found virtual consultations to be significantly more convenient, prompt, private, and well communicated than in-person appointments, translating into extremely high satisfaction (97.4% overall vs. 84.0% for in-person consultations; p < 0.001). This study provides population-level data on the current prevalence of telehealth use in Saudi Arabia. Further prospective research demonstrating the clinical noninferiority of telemedicine could help promote further uptake in specialties such as surgery.

Enhancing Access Through Language-Tailored Approach in Telehealth and Veterans Video Connect: Traumatic Brain Injury (TBI) Veterans Satisfaction Assessment

INTRODUCTION

Traumatic brain injury (TBI) can impact language processing, necessitating language-tailored approaches. Telehealth may expand rural Veterans' access but has unknown feasibility for language preferences. This study explored telehealth/Veterans Video Connect satisfaction for Spanish/English TBI screening.

MATERIALS AND METHODS

The study was approved by the VA Caribbean Healthcare System Institutional Review Board and the Research and Development Committee. Mixed methods evaluated telehealth satisfaction in Veterans receiving TBI assessments from October 2021 to October 2023. Surveys included the 16-item Clinical Video Telehealth (CVT) questionnaire on communication, technical factors, coordination, and overall satisfaction, and the 21-item Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) examining usefulness, ease of use, manners, quality, and satisfaction. Mean domain/item scores were calculated among 57 Veterans, 12 English, and 45 Spanish-speaking. Semi-structured interviews also elicited user experiences from 4 providers and 5 Veterans. Transcripts underwent qualitative coding for themes using Atlas.ti.8.

RESULTS

On CVT (0-5 scale), overall satisfaction averaged 4.50 (English) and 4.69 (Spanish). Lowest scoring item for English users was easy video connection (4.25), while unclear expectations had the lowest Spanish score (3.60). For TSUQ, overall mean scores were 4.50 (English) and 4.67 (Spanish), with improved health post-telehealth having the lowest average (English 3.33, Spanish 3.67). Qualitatively, Veterans and providers noted strengths like access and communication but weaknesses around connectivity, care delays, and privacy. Differences emerged regarding convenience (Veterans) versus operational barriers (providers). There was a strong positive correlation for Spanish surveys and a moderate correlation for English surveys (r = 0.71 Spanish surveys, r = 0.69 English surveys) between TSUQ and CVT for individual respondents.

CONCLUSIONS

Patients conveyed positive experiences, but qualitative data revealed actionable targets for optimization like infrastructure and coordination improvements. Key limitations include small samples and lack of comparison to in-person care. Still, high satisfaction coupled with specific user feedback highlights telehealth's potential while directing enhancements. The results found high Veteran satisfaction with Spanish/English TBI telehealth, but mixed methods illuminated salient domains for better accommodating user needs, particularly regarding logistics and technology. Rigorously integrating experiences with metrics over expanded diverse samples and modalities can further guide refinements to enhance telehealth with a language-tailored approach.

Patient Opinions about Virtual Consultations in Saudi Arabia: A Nationwide Cross-Sectional Study

There have been no nationwide studies of patient opinions regarding telehealth in Saudi Arabia to identify the factors that might influence patients' perceptions and satisfaction. This was a prospective cross-sectional study of adults in the general population who last engaged with a healthcare practitioner via a virtual appointment. The participants were recruited by convenience sampling across Saudi Arabia between November 2023 and January 2024, completing a questionnaire that gathered data on (i) basic demographic and virtual consultation information and (ii) telehealth service delivery and technology based on the Telehealth Usability Questionnaire. Of the 916 participants, 53.7% were female, with a mean age of 47.2 (14.1) years. Nearly half attended primary care appointments, with the remainder attending a range of hospital specialties. Over 90% preferred having a virtual appointment over an in-person visit. About half had telephone consultations, while about a third had video calls through hospital-provided platforms; >90% found virtual appointments useful and convenient, easy to use, effective, reliable, and produced a favorable clinical interaction; and 97.4% were satisfied with their remote consultation experience despite the technical interruptions. The individuals who were less happy with their virtual consultation were significantly younger, lived in urban areas, attended specialty clinics, were seen by a psychologist, preferred in-person appointments, and had consultations by telephone. These data provide momentum to continue with and expand telehealth, especially through video calls, supported by educational initiatives.

Outcomes of telemedicine care during the COVID-19 pandemic: Experience from an intervention program designed for vulnerable population in Brazil

PURPOSE

Telehealth plays an important role on the combat of COVID-19. In this context, the SAS Brasil telemedicine program became a viable option in Brazil, where the population faced challenging access to healthcare services during the pandemics. In this study, we describe the sociodemographic profile, reasons for enrollment, outcomes of consultation, and satisfaction of participants who received telemedicine consultations through the SAS program.

METHODS

A retrospective cross-sectional study was conducted with data from the SAS Telemedicine program including consultations performed from July 15, 2020, to April 15, 2021. The study describes the SAS Brasil experience and data collected in the period. Patients' satisfaction perception was evaluated through the Net Promoter Score (NPS).

RESULTS

A total of 6490 participants were evaluated, 69.5% of them were female and 40.8% with age from 21 to 40 years. In the period, 22,664 teleconsultations were performed, mainly due to Mental health (40.4%), Respiratory (35.8%), and Nutritional (4.5%) disorders. Out of the 6312 patients with a defined outcome along the period, 96.0% were discharged and 4.0% were referred to presential care. The calculated NPS was + 95.77 and most patients answered that they would use the service again if needed (99.21%) and had their issue resolved (89.76%).

CONCLUSION

During the period of the COVID-19 pandemic, telehealth has been consolidated as a tool that offers access to specialized healthcare with wide acceptance by users and can be implemented in populations in vulnerability situations.

Patient and Staff Experience of Remote Patient Monitoring-What to Measure and How: Systematic Review

BACKGROUND

Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience-measuring methods and tools exists.

OBJECTIVE

This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain.

METHODS

Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By "RPM interventions," we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique.

RESULTS

In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation.

CONCLUSIONS

At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain.

Patient satisfaction and patient accessibility in a small fiber neuropathy diagnostic service in the Netherlands: A single-center, prospective, survey-based cohort study

INTRODUCTION

Small fiber neuropathy (SFN) is a common cause of neuropathic pain in peripheral neuropathies. Good accessibility of diagnostics and treatment is necessary for an accurate diagnosis and treatment of SFN. Evidence is lacking on the quality performance of the diagnostic SFN service in the Netherlands. Our aim was to determine the patient satisfaction and -accessibility of the diagnostic SFN service, and to identify areas for improvement.

METHODS

In a single-center, prospective, survey-based cohort study, 100 visiting patients were asked to fill in the SFN patient satisfaction questionnaire (SFN-PSQ), with 10 domains and 51 items. Cut-off point for improvement was defined as ≥ 25% dissatisfaction on an item. A chi-square test and linear regression analyses was used for significant differences and associations of patient satisfaction.

RESULTS

From November 2020 to May 2021, 98 patients with SFN-related complaints filled in the online SFN-PSQ within 20 minutes. In 84% of the patients SFN was confirmed, average age was 55.1 (52.5-57.8) years and 67% was female. High satisfaction was seen in the domains 'Waiting List Period', Chest X-ray', 'Consultation with the Doctor or Nurse Practitioner (NP)', 'Separate Consultation with the Doctor or NP about Psychological Symptoms', and 'General' of the SFN service. Overall average patient satisfaction score was 8.7 (IQR 8-10) on a 1-to-10 rating scale. Main area for improvement was shortening the 8-week period for receiving the results of the diagnostic testing (p < 0.05). General health status was statistically significant associated with patient satisfaction (p < 0.05).

CONCLUSION

A good reflection of the high patient satisfaction and -accessibility of the SFN-service is shown, with important points for improvement. These results could help hospitals widely to optimize the logistic and diagnostic pathway of SFN analysis, benchmarking patient satisfaction results among the hospitals, and to improve the quality of care of comparable SFN services.

The Effectiveness of Virtual Reality, Augmented Reality, and Mixed Reality Rehabilitation in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used in postoperative rehabilitation of total knee arthroplasty (TKA). The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of XR-based rehabilitation in TKA compared to conventional rehabilitation.

METHODS

In this study, we searched PubMed (MEDLINE), Embase (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to February 15, 2023 for eligible studies. A total of 14 randomized controlled trials with 989 patients were included in our study. The primary outcomes were pain and function. The secondary outcomes were anxiety and quality of life. A systematic review and meta-analysis was performed.

RESULTS

The pooled data indicated XR-based rehabilitation significantly improved the visual analog scale (standardized mean difference [SMD] = -0.31, 95% Confidence Interval [CI] [-0.47 to -0.15], P = .0001), the Western Ontario and McMaster Universities Osteoarthritis Index (SMD = -0.46, 95% CI [-0.86 to -0.06], P = .02), range of motion (SMD = 0.40, 95% CI [0.09 to 0.72], P = .01), and anxiety scores (mean difference = -3.95, 95% CI [-7.76 to -0.13], P = .04) than conventional rehabilitation, but Timed Up and Go test and quality of life were similar in the 2 groups.

CONCLUSION

This systematic review and meta-analysis found XR-based rehabilitation improved pain, function, and anxiety, but not quality of life in TKA compared to conventional rehabilitation within 1 month postoperatively. Based on the pooled results, we suggested that XR-based rehabilitation may have benefit in patients' postoperative rehabilitation in TKA.

The ENGAGE study: a 3-arm randomized hybrid type 1 effectiveness and implementation study of an in-home, collaborative PCP model of remote telegenetic services to increase uptake of cancer genetic services in childhood cancer survivors

BACKGROUND

Germline cancer genetic testing has become a standard evidence-based practice, with established risk reduction and screening guidelines for genetic carriers. Access to genetic services is limited in many places, which leaves many genetic carriers unidentified and at risk for late diagnosis of cancers and poor outcomes. This poses a problem for childhood cancer survivors, as this is a population with an increased risk for subsequent malignant neoplasms (SMN) due to cancer therapy or inherited cancer predisposition. The ENGaging and Activating cancer survivors in Genetic services (ENGAGE) study evaluates the effectiveness of an in-home, collaborative PCP model of remote telegenetic services to increase uptake of cancer genetic testing in childhood cancer survivors compared to usual care options for genetic testing.

METHODS

The ENGAGE study is a 3-arm randomized hybrid type 1 effectiveness and implementation study within the Childhood Cancer Survivor Study population which tests a clinical intervention while gathering information on its delivery during the effectiveness trial and its potential for future implementation among 360 participants. Participants are randomized into three arms. Those randomized to Arm A receive genetic services via videoconferencing, those in Arm B receive these services by phone, and those randomized to Arm C will receive usual care services.

DISCUSSION

With many barriers to accessing genetic services, innovative delivery models are needed to address this gap and increase uptake of genetic services. The ENGAGE study evaluates the effectiveness of an adapted model of remote delivery of genetic services to increase the uptake of recommended genetic testing in childhood cancer survivors. This study assesses the uptake in remote genetic services and identify barriers to uptake to inform future recommendations and a theoretically-informed process evaluation which can inform modifications to enhance dissemination beyond this study population and to realize the benefits of precision medicine.

TRIAL REGISTRATION

This protocol was registered at clinicaltrials.gov (NCT04455698) on July 2, 2020.

SWOT analysis of the models used by social enterprises in scaling effective refractive error coverage to achieve the 2030 in SIGHT in Kenya

Uncorrected refractive error has predominantly been delivered through commercial entrepreneurship in Kenya. However, to achieve the 2030 IN SIGHT, integration of other forms of entrepreneurship such as the social entrepreneurship is desirable to supplement the efforts of the dominant commercial entrepreneurship. Therefore, this study intended to undertake a SWOT analysis of the current models used by social enterprises in scaling effective refractive error coverage to achieve the 2030 IN SIGHT in Kenya. A review of the seven national strategic plans for eye health in Kenya was undertaken to get a glimpse on the efforts directed towards uncorrected refractive error in achieving the 2030 IN SIGHT. The review was inclined towards assessing the efforts directed by the strategic plans towards scaling human resource, spectacle provision and refraction points. A SWOT analysis was undertaken based on the financial, impact and the approach report for each model. A key informant interview was conducted with a representative and three to five members of the social enterprise about the model. Thereafter, the modified SWOT analysis based on the review and the interview was presented to the representatives of the social enterprises. Purposive sampling was used to identify seven models used by social enterprises in the delivery of refractive error services in Kenya. Finally, the recommendations were presented to key opinion leaders for an input through a Delphi technique. Out of the seven national strategic plans for eye health reviewed, only the strategic plan 2020-2025 intends to establish optical units within 15 different counties in Kenya. Of the seven models currently utilized by social enterprises, only the Kenya Society for the Blind has integrated the telemedicine concept. On application of mHealth, all of the social enterprises models tend to embrace the approach for screening activities. None of the models has a strengthened referral pathway utilizing telereferral and telemedicine. Out of all the models, only Operation Eyesight Universal, Fred Hollow Foundation and Peek Acuity do not depend on sales of subsidized spectacles for sustainability. Every model has the capacity to propel the delivery of refractive error services depending on its comprehensiveness. However, for the 2030 IN SIGHT to be achieved, models prioritizing human resource through telemedicine integration, service provision across all sectors, awareness creation and enhancing cost efficiency are desirable.

Proposed task shifting integrated with telemedicine to address uncorrected refractive error in Kenya: Delphi study

BACKGROUND

Developing countries such as Kenya still experience challenges around human resource to deliver refractive error services. However, given the burden of uncorrected refractive error, adoption of innovative and cost effective approaches is desirable. Hence this study intended to develop a task shifting framework integrated with telemedicine to potentially scale refractive error services.

METHODS

This was an exploratory study conducted in four phases as follows: a scoping review of the scope of practice for ophthalmic workers in Kenya, an interview with key opinion leaders on the need for integration of public health approaches such as the vision corridors within the eye health ecosystem in Kenya and their knowledge on task shifting, and finally development and validation of a proposed task shifting framework through a Delphi technique. Purposive sampling was used to recruit key opinion leaders and data was collected via telephonic interviews. The qualitative data was analyzed thematically using NVivo Software, Version 11.

RESULTS

The scoping review showed that only optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction in Kenya. All of the key opinion leaders (100%) were aware of task shifting and agreed that it is suitable for adoption within the eye health ecosystem in Kenya. All of the key opinion leaders (100%) agreed that skills development for healthcare workers without prior training on eye health supervised by optometrists through telemedicine is desirable. Notwithstanding, all of the key opinion leaders (100%) agreed that integration of public health approaches such as the vision corridors across all levels of healthcare delivery channels and development of a self-assessment visual acuity tool is desirable. Finally all of the key opinion leaders (100%) agreed that task shifting is relevant for adoption within the eye health ecosystem in Kenya. The developed framework prioritized partnership, advocacy, skills development, establishment and equipping of refraction points. The proposed framework advocated for a telemedicine between professionals with conventional training and those with skills development.

CONCLUSION

Task shifting integrated with telemedicine could cost effectively scale refractive error service delivery. However, internal and external factors may hinder the success warranting the need for a multi-faceted interventions and a connection between planning and training to scale the uptake.

Experiences of remote consultation in UK primary care for patients with mental health conditions: A systematic review

Objectives

There has been a rapid shift from face-to-face to remote consultation across healthcare settings. 90% of patients with mental health conditions are cared for entirely in primary care. Remote consultation can present challenges and benefits for patients with mental health conditions. The aim of this systematic review was to collate and examine the evidence relating to remote consultation in UK primary care on the experiences of patients with mental health conditions.

Methods

Six major databases were searched for empirical studies published in the English language between 1 January 2010 and 21 October 2022. Studies were included where remote consultation occurred between a patient and primary care clinician. Outcomes of interest include mode of remote consultation, patient experiences and characteristics. Final included studies were assessed for quality, and results analysed with narrative synthesis.

Results

Six studies met the inclusion criteria, covering a range of mental health conditions and remote consultation modalities (telephone, video, online, email, text-based). Patients were overall satisfied with remote consultation, with particular benefit for certain mental health conditions or anxious patients. However, several studies found that face-to-face was the preferred method, with highlighted negatives to remote consultation, such as inflexibility of online formats. Acceptability of remote consultation is context specific and influenced by the purpose of the consultation and individual patient. Remote consultation may reduce anxiety in some patients, but is potentially less acceptable than face-to-face for relational appointments.

Conclusions

Acceptability of remote consultation is context dependent. There is a lack of evidence surrounding patient characteristics and access to remote consultation.

Impact of telemedicine on antenatal care at a teaching institution in Eastern India: An insight into the future of better India

Objectives

Telemedicine (TM) emergence has been profound in using technology to address the problems of obstetrics in remote and rural places, especially in low-risk pregnancy. Through this study, we made an effort to assess the satisfaction level and concerns of antenatal and postnatal patients who availed the telemedicine facility during the study period. We also made an effort to facilitate improved access to antenatal and postnatal care, especially the low-risk pregnancies through telemedicine for patients from remote areas of eastern India that do not have the availability of specialists.

Materials and Methods

Primary data were collected by means of a telephonic survey of all the antenatal patients who used telemedicine services of AIIMS, Kalyani, based on a preformed questionnaire.

Results

A total of 80 antenatal patients gave consent to participate in the study. Most of the patients were from the upper lower class [43.75%] followed by the lower middle class [35%]. The average gestational age of respondents was 23.95 weeks. Seventy-one out of 80 patients felt that the appointment was made within a reasonable time. Only 12 patients [15.3%] had waiting time greater than 10 min. The average waiting time was 6.93 min. 56.3% of respondents felt that the person who attended their call was very cooperative. 86.3% of respondents strongly agreed that the consultant was able to understand their health issues completely. Eighty percent of the respondents said that they would like to continue using telemedicine in the future. There is a significant difference between those preferring to use telemedicine in the future and those who do not prefer telemedicine in the future. Poor internet facility and privacy were prominent reasons for not opting for telemedicine in the future by some respondents.

Conclusion

From this study, it was concluded that TM certainly has great potential to make health care accessible to people residing in rural and far-off places.

Telehealth and Health Equity in Older Adults With Heart Failure: A Scientific Statement From the American Heart Association

Enhancing access to care using telehealth is a priority for improving outcomes among older adults with heart failure, increasing quality of care, and decreasing costs. Telehealth has the potential to increase access to care for patients who live in underresourced geographic regions, have physical disabilities or poor access to transportation, and may not otherwise have access to cardiologists with expertise in heart failure. During the COVID-19 pandemic, access to telehealth expanded, and yet barriers to access, including broadband inequality, low digital literacy, and structural barriers, prevented many of the disadvantaged patients from getting equitable access. Using a health equity lens, this scientific statement reviews the literature on telehealth for older adults with heart failure; provides an overview of structural, organizational, and personal barriers to telehealth; and presents novel interventions that pair telemedicine with in-person services to mitigate existing barriers and structural inequities.

Trends and frontiers of research on telemedicine from 1971 to 2022: A scientometric and visualisation analysis

BACKGROUND

With the continuous development of the Internet and information technology, telemedicine has gradually become a popular medical model, which has always attracted much attention. Especially in recent years, research has shown a rapid increase in the use of telemedicine due to the impact of COVID-19. We have conducted a scientific metrological analysis of telemedicine to identify its hot spots and frontiers and promote cooperation and development.

METHODS

We retrieved 19,171 articles related to telemedicine published from 1971 to 2022 in the Web of Science (WOS) database. Then, we conducted co-author network analysis (author, institution, country), co-citation analysis (author, journal, literature) and burst analysis (thematic trends and frontier topics).

RESULTS

The number of publications has been on the rise since 1993 and began to rise rapidly in 1997. Influenced by the COVID-19 pandemic, the number of articles doubled in 2020 compared to the prior year. The United States produced the greatest number of articles (43.4%). Although studies in Greece are fewer and more recent, the country is demonstrating tremendous development potential in this field and is an active contributor to telemedicine research. The main research topics identified include the application, system and services of telemedicine; the application of telemedicine in providing medical services to rural and remote areas where medical resources are scarce; the quality control of medical images in telemedicine; the application of telemedicine in chronic disease care; and the comparison of in-person medical care and telemedicine. Emerging topics include the application and impact of telemedicine during the COVID-19 pandemic.

CONCLUSION

The main telemedicine research fields over the past 52 years are identified, the meanings of analyses results are discussed, and emerging trends are highlighted.

Needs and Considerations for Standardization of Kidney Disease Education in Patients with Advanced CKD

Kidney health advocacy organizations and leaders in the nephrology community have repeatedly emphasized the need to increase home dialysis utilization in the United States. Limited awareness and understanding of options for the management of kidney failure among patients living with advanced CKD is a significant barrier to increasing the selection and use of home dialysis. Studies have shown that providing targeted comprehensive patient education before the onset of kidney failure can improve patients' awareness of kidney disease and substantially increase the informed utilization of home dialysis. Unfortunately, in the absence of validated evidence-based education protocols, outcomes associated with home dialysis use vary widely among published studies, potentially affecting the routine implementation and reporting of these services among patients with advanced CKD. This review provides pragmatic guidance on establishing effective patient-centered education programs to empower patients to make informed decisions about their KRT and, in turn, increase home dialysis use.

Telemedicine in the primary care of older adults: a systematic mixed studies review

BACKGROUND

Family physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality option for primary care delivery. However, it poses unique challenges for older adults. Our aim was therefore to explore the effects of TM and the determinants of its use in primary care for older adults.

METHODS

In this systematic mixed studies review, MEDLINE, PsycINFO, EMBASE, CINHAL, AgeLine, DARE, Cochrane Library, and clinical trials research registers were searched for articles in English, French or Russian. Two reviewers performed study selection, data extraction and assessment of study quality. TM's effects were reported through the tabulation of key variables. TM use determinants were interpreted using thematic analysis based on Chang's framework. All data were integrated using a joint display matrix.

RESULTS

From 3,328 references identified, 20 studies were included. They used either phone (n = 8), videoconference (n = 9) or both (n = 3). Among studies reporting positive outcomes in TM experience, 'user habit or preferences' was the most cited barrier and 'location and travel time' was the most cited facilitator. Only one study reported negative outcomes in TM experience and reported 'comfort with patient communication' and 'user interface, intended use or usability' as barriers, and 'technology skills and knowledge' and 'location and travel time' as facilitators. Among studies reporting positive outcomes in service use and usability, no barrier or facilitator was cited more than once. Only one study reported a positive outcome in health-related and behavioural outcomes.

CONCLUSIONS

TM in older adults' primary care generally led to positive experiences, high satisfaction and generated an interest towards alternative healthcare delivery model. Future research should explore its efficacy on clinical, health-related and healthcare services use.

Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial

BACKGROUND

With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards.

OBJECTIVE

This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat.

METHODS

We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7%) or to first receive a health worker-assisted telemedicine consultation (45/104, 43.3%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard.

RESULTS

We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74% (77/104) diagnostic concordance and 79.8% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker-doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95% concordance; Cohen kappa=0.93) and diabetes (14/15, 93% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33%) and patients presenting with nonspecific symptoms (3/10, 30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols.

CONCLUSIONS

The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care-seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities.

Patients With Cardiovascular Disease Revisiting Specialist Physicians via Remote Treatment: Interview Study of Experiences

BACKGROUND

Access to health care for an aging population with growing needs presents major challenges in northern Sweden's sparsely populated regions. Few people, the lack of professionals, and long distances make it difficult to provide health care on equitable terms according to the Swedish legislation. Remote treatment (RT) using information and communication technology has been suggested to overcome these difficulties, and person-centered care (PCC) is a desired philosophy to improve the quality of health care. However, there is scarce knowledge about how patients experience RT meetings.

OBJECTIVE

This study aimed to describe the experiences of patients with cardiovascular disease revisiting specialist physicians via RT guided by a PCC perspective in northern Sweden's sparsely populated regions.

METHODS

A qualitative study was conducted based on interviews with 8 patients with cardiovascular disease revisiting their physician through RT, from a digital health room to a health care center or from a health care center to a hospital. The interviews were recorded, transcribed verbatim, and analyzed using inductive content analysis. The results are discussed from a PCC perspective.

RESULTS

The analysis resulted in 6 categories: good accessibility, safety with good relationships, proximity and distance with technology, habit and quality of the technology facilitating the meeting, cherishing personal integrity, and participation in own care. These categories were interpreted as the theme, participation and relationships are important for good and close care via RT.

CONCLUSIONS

The study shows that participation and relationships are important for good and close care via RT. To improve the quality of an RT meeting, PCC can be applied but needs to be extended to the digital domain-electronic PCC, especially the communication component, as it is the most salient difference from a face-to-face meeting. Important factors that should be considered before, during, and after the RT meeting have been identified.

Telemedicine Adoption in an NCI-Designated Cancer Center During the COVID-19 Pandemic: A Report on Patient Experience of Care

BACKGROUND

Patients with cancer require timely access to care so that healthcare providers can prepare an optimal treatment plan with significant implications for quality of life and mortality. The COVID-19 pandemic spurred rapid adoption of telemedicine in oncology, but study of patient experience of care with telemedicine in this population has been limited. We assessed overall patient experience of care with telemedicine at an NCI-designated Comprehensive Cancer Center during the COVID-19 pandemic and examined changes in patient experience over time.

PATIENTS AND METHODS

This was a retrospective study of outpatient oncology patients who received treatment at Moffitt Cancer Center. Press Ganey surveys were used to assess patient experience. Data from patients with appointments between April 1, 2020, and June 30, 2021, were analyzed. Patient experience was compared between telemedicine and in-person visits, and patient experience with telemedicine over time was described.

RESULTS

A total of 33,318 patients reported Press Ganey data for in-person visits, and 5,950 reported Press Ganey data for telemedicine visits. Relative to patients with in-person visits, more patients with telemedicine visits gave higher satisfaction ratings for access (62.5% vs 75.8%, respectively) and care provider concern (84.2% vs 90.7%, respectively) (P<.001). When adjusted for age, race/ethnicity, sex, insurance, and clinic type, telemedicine visits consistently outperformed in-person visits over time regarding access and care provider concern (P<.001). There were no significant changes over time in satisfaction with telemedicine visits regarding access, care provider concern, telemedicine technology, or overall assessment (P>.05).

CONCLUSIONS

In this study, a large oncology dataset showed that telemedicine resulted in better patient experience of care in terms of access and care provider concern compared with in-person visits. Patient experience of care with telemedicine visits did not change over time, suggesting that implementing telemedicine was effective.

Evaluating the Efficacy of Teleophthalmology in Delivering Ophthalmic Care to Underserved Populations: A Literature Review

Technological advancement has brought commendable changes in medicine, advancing diagnosis, treatment, and interventions. Telemedicine has been adopted by various subspecialties including ophthalmology. Over the years, teleophthalmology has been implemented in various countries, and continuous progress is being made in this area. In underserved populations, due to socioeconomic factors, there is little or no access to healthcare facilities, and people are at higher risk of eye diseases and vision impairment. Transportation is the major hurdle for these people in obtaining access to eye care in the main hospitals. There is a dire need for accessible eye care for such populations, and teleophthalmology is the ray of hope for providing eye care facilities to underserved people. Numerous studies have reported the advantages of teleophthalmology for rural populations such as being cost-effective, timesaving, reliable, efficient, and satisfactory for patients. Although it is being practiced in urban populations, for rural populations, its benefits amplify. However, there are certain obstacles as well, such as the cost of equipment, lack of steady electricity and internet supply in rural areas, and the attitude of people in certain regions toward acceptance of teleophthalmology. In this review, we have discussed in detail eye health in rural populations, teleophthalmology, and its effectiveness in rural populations of different countries.

Scoping Review of Pulmonary Telemedicine Consults: Current Knowledge and Research Gaps

Rationale: Telemedicine consults, including video consults, telephone consults, electronic consults, and virtual conferences, may be particularly valuable in the management of chronic pulmonary diseases, but there is limited guidance on best practices for pulmonary telemedicine consults. Objectives: This scoping review aims to identify, characterize, and analyze gaps in the published literature on telemedicine consults health providers use to manage patients with chronic pulmonary diseases. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library from database origin through July 10, 2021. We included manuscripts describing applications of telemedicine consults for patients with chronic pulmonary diseases (asthma, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and interstitial lung disease). We restricted our review to full-length articles published in English about provider-led (as opposed to nurse-led) telemedicine consults. Results: Our search yielded 3,118 unique articles; 27 articles met the inclusion criteria. All telemedicine consult modalities and chronic pulmonary conditions were well represented in the review except for pulmonary hypertension and interstitial lung disease, which were represented by one and no articles, respectively. Most articles described a small, single-center, observational study that focused on the acceptability, feasibility, use, and/or clinical effectiveness of the telemedicine consult. Few studies had objectively measured clinical outcomes or included a comparator group, and none compared telemedicine consult modalities against one another. Conclusions: Our scoping review identified limited literature describing pulmonary telemedicine consults and highlighted several gaps in the literature that warrant increased attention. Providers treating chronic pulmonary diseases are left with limited guidance on best practices for telemedicine consults.

Factors affecting the acceptance of teledentistry determined using the technology acceptance model: A cross-sectional study

Objective

The aim of this pilot study is to identify the main predictors and barriers that influence user intention to adopt teledentistry services among the Saudi population.

Methods

A total of 426 respondents completed a questionnaire. Our study used the technology acceptance model to predict how users will adopt teledentistry. An analysis of the factors that influence patient users' intention to utilize teledentistry was conducted using partial least square structural equation modeling.

Results

Among the factors that influenced the intention to use teledentistry services, social influence positively affected the intention (β = 0.18, t = 2.19, p-value = 0.03), whereas perceived risk negatively affected it (β = -0.21, t = 2.69, p-value =0.01).

Conclusion

The perception of risk was a major barrier to the adoption of teledentistry services, while social influence was a significant positive predictor. Using the findings of the study, policymakers and health service providers can gain a better understanding of the factors influencing the implementation of teledentistry.

Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model

Background

The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers.

Methods

A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model.

Results

In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation.

Conclusions

In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.

Awareness, knowledge, attitude, and skills regarding telemedicine among Syrian healthcare providers: A cross-sectional study

Background

After the widespread of coronavirus disease (COVID-19) around the globe, it was imperative to establish preventative measures to restrict the virus's transmission. The purpose of this research was to present an overview of the awareness, knowledge, attitude, and abilities of Syrian physicians about telemedicine technology.

Methods

An online cross-sectional study was conducted from April 1 to May 15, 2022. The questionnaire was taken from published study, and the inclusion criteria consist the Syrian doctors who worked in hospitals during the COVID-19 pandemic, mainly those who had direct contact with patients.

Results

Among 385 responses, 52.72% of them were females, 83.9% of them were aged less than 30 years old, and 66% were working in the governmental sector; 66% of participants have moderate knowledge about using computers and the internet, 80% have heard about telemedicine. Despite that, 95.1% of participants have not attended any training workshop on telemedicine, and most of them have reported no availability of a telemedicine unit in their department. Only 31.7% participants have shown high awareness of telemedicine. Furthermore, no significant correlation was identified between the academic level with the age and telemedicine awareness, knowledge, attitude, or computer skills. Despite that, there was an obvious correlation between age and computer skills (P-value < 0.05). There was a significant correlation between the medical specialty and awareness, and computer abilities, especially the anesthesiology (88.5 ± 5.2), (84 ± 8.7), respectively. Spearman's rho test showed mild positive significant association in various subscales (awareness and experience, experience and skills, knowledge and attitude, knowledge and skills, and attitude and skills).

Conclusion

The study results demonstrate that most of the participating clinical doctors have a neutral view of telemedicine, even though they do not know much about it and do not have considerable experience with it. It is practical to educate and train academic staff, practicing physicians, residents and medical students within the clinical stages about telemedicine.

Healthcare utilization in Canadian children and young adults with asthma during the COVID-19 pandemic

Literature is limited regarding the COVID-19 pandemic's impact on health services use in younger Canadian populations with asthma. We utilized health administrative databases from January 2019-December 2021 for a population-based cross-sectional study to identify Ontario residents 0-25 years old with physician-diagnosed asthma and calculate rates of healthcare use. Multivariable negative binomial regression analysis was used to adjust for confounders. We included 716,690 children and young adults ≤25 years. There was a sharp increase of ICS and SABA prescription rates at the start of the pandemic (March 2020) of 61.7% and 54.6%, respectively. Monthly virtual physician visit rates increased from zero to 0.23 per 100 asthma population during the pandemic. After adjusting for potential confounders, rate ratios (RR) with 95% confidence intervals (CI) showed that the pandemic was associated with significant decrease in hospital admissions (RR = 0.21, 95% CI: 0.18-0.24), emergency department visits (RR = 0.35, 95% CI: 0.34-0.37), and physician visits (RR = 0.61, 95% CI: 0.60-0.61). ICS and SABA prescriptions filled also significantly decreased during the pandemic (RR = 0.58, 95% CI: 0.57-0.60 and RR = 0.47, 95% CI: 0.46-0.48, respectively). This Canadian population-based asthma study demonstrated a dramatic decline in physician and emergency department visits, hospitalizations, and medication prescriptions filled during the COVID-19 pandemic. An extensive evaluation of the factors contributing to an 80% reduction in the risk of hospitalization may inform post-pandemic asthma management.

The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review

Objective: Optometrists are increasingly adopting teleoptometry as an approach to delivering eye care. The coronavirus disease 2019 (COVID-19) pandemic has created further opportunities for optometrists to utilize innovation in telehealth to deliver eye care to individuals who experience access barriers. A systematic literature review is presented detailing the evidence to support the use of teleoptometry. Methods: Databases of MEDLINE, Global Health, and Web of Science were searched, and articles were included if they reported any involvement of optometrists in the delivery of telehealth. Findings were reported according to the mode of telehealth used to deliver eye care, telehealth collaboration type, and the format and geographical areas where eye care via telehealth is being delivered. Results: Twenty-seven relevant studies were identified. Only 11 studies included the role of optometrists as a member of the telehealth team where the scope of practice extended beyond creating and receiving referrals, collecting clinical data at in-person services, and continuing in-person care following consultation with an ophthalmologist. Both synchronous and asynchronous telehealth services were commonly utilized. Optometrists were most commonly involved in ophthalmology-led telehealth collaborations (n = 19). Eight studies reported optometrists independently delivering primary eye care via telehealth, and commonly included videoconferencing. Conclusion: The application of teleoptometry to deliver eye care is rapidly emerging, and appears to be a viable adjunct to the delivery of in-person optometry services. The review highlighted the scarcity of evidence surrounding the clinical benefits, safety, and outcomes of teleoptometry. Further research is required in this area.

Feasibility and Acceptability of a Multidisciplinary Academic Telemedicine System for Memory Care in Response to COVID-19

Background and Objectives

In response to the restrictions imposed by the COVID-19 pandemic, the University of California San Francisco Memory and Aging Center (UCSF MAC) has deployed a comprehensive telemedicine model for the diagnosis and management of Alzheimer disease and related dementias. This review summarizes a large academic behavioral neurology clinic's experience transitioning to telemedicine services, including the impact on clinic care indicators, access metrics, and provider's experience. We compared these outcomes from 3 years before COVID-19 to 12 months after the transition to video teleconferencing (VTC) encounters.

Methods

Patient demographics and appointment data (dates, visit types, and departments) were extracted from our institution's electronic health record database from January 1, 2017, to May 1, 2021. We present data as descriptive statistics and comparisons using Wilcoxon rank-sum tests and Fisher exact tests. The results of anonymous surveys conducted among the clinic's providers are reported as descriptive findings.

Results

After the implementation of telemedicine services, the proportion of clinic encounters completed via VTC increased from 1.9% to 86.4%. There was a statistically significant decline in both the percentage of scheduled appointments that were canceled (32.9% vs 27.9%; p < 0.01) and total cancelations per month (mean 240.3 vs 179.4/mo; p < 0.01). There was an increase in the percentage of completed scheduled appointments (60.2% vs 64.8%; p < 0.01) and an increase in the average estimated commuting distance patients would need to drive for follow-up appointments (mean 49.8 vs 54.7 miles; p < 0.01). The transition to telemedicine services did not significantly affect the clinic's patient population as measured by age, gender, estimated income, area deprivation index, or self-reported racial/ethnic identity. The results of the provider survey revealed that physicians reported a more positive experience relative to neuropsychologists. Both types of providers reported telemedicine services as a reasonable equivalent and acceptable alternative to in-person evaluations with notable caveats.

Discussion

UCSF MAC's comprehensive integration of telemedicine services maintained critical ambulatory care to patients living with dementia during the COVID-19 pandemic. The recognized benefits of our care model suggest dementia telemedicine may be used as a feasible and equivalent alternative to in-person ambulatory care in the after COVID-19 era.

Innovation through participatory design: Collaborative qualitative methods in the development of speech-language pathology technology

Speech-language pathologists have embraced many aspects of technology in their practice, from telehealth to tablet device applications (apps) that support intervention practice. In this article, we consider the design, development, and implementation of technology. We discuss how some processes of technology development in Speech-language pathology (SLP) tend to follow research pathways which centre clinicians and researchers as designers of the intervention. This approach side-lines user involvement. We propose that a Participatory Design framework is a suitable way to reconceptualise design and development of these technological innovations in a client-centred way. Further, we explore how Participatory Design approaches utilise methods from and have much in common with qualitative research. We explore this overlap and propose that technology design teams take up the challenge of innovation in technology by engaging in a participatory rather than clinician-driven process for future technology design. Implications for both research and clinical practice are explored.

Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review

The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.

A study in patient satisfaction regarding telemedicine consultations in radiation oncology

INTRODUCTION

Telemedicine consultations can be a cost-effective and convenient method of communication, particularly with patients living in remote areas. Given the dearth of patient-reported satisfaction data with this form of consultation in Radiation Oncology, we surveyed patients to assess this in our department.

METHODS

The study recruited patients who had experienced both a Telemedicine consultation and an in-person consultation with the same radiation oncologist at our tertiary centre in South Australia. Eligible patients were identified from the Royal Adelaide Hospital oncology information system. The patient satisfaction questionnaire was sent via registered post with a reply-paid envelope. The questionnaire consisted of 38 questions divided into four major categories, focusing on communication, medical care, privacy/confidentiality and convenience. Results of the survey were tabulated in an excel spreadsheet.

RESULTS

Between 1 January 2018 and 1 January 2019, 130 eligible patients were identified. One hundred and nine patients were alive and contactable of whom 37 responded (34%). Two surveys were returned incomplete resulting in 35 patient responses available for analysis. The median age was 70 years (range 35-87); 74% were male. There was no statistically significant difference between the satisfaction scores for Telemedicine and in-person consultations with regards to communication, privacy/confidentiality or overall satisfaction. The respondent felt it was more important to be examined when the consultation was conducted in-person and found Telemedicine consultations more convenient in terms of cost and time.

CONCLUSION

Telemedicine used in Radiation Oncology is an effective form of consultation that is convenient, provides a similar level of patient satisfaction and maintains patient confidentiality. Telemedicine consultations should therefore be considered for all rural and remote cancer patients where feasible.

Fit theory: A cancer experience grounded theory emerging from semi-structured interviews with cancer patients and informal caregivers in Manitoba Canada during the COVID-19 pandemic

BACKGROUND

It is not clear how changes to healthcare delivery related to the COVID-19 pandemic, including virtual care and social distancing restrictions, have impacted the experience of living with cancer. This study aimed to discover a theory capable of describing the cancer experience, how the pandemic impacted it, and for guiding predictions about how to improve it.

METHODS

Between October 2020 and July 2021 digitally recorded semi-structured one-on-one interviews were conducted virtually with adult cancer patients and informal caregivers in Manitoba, Canada. Transcriptions and field notes from the interviews were analyzed using classic grounded theory.

RESULTS

Interviews with 33 patients and 6 informal caregivers were conducted. Fit emerged as the core concept of the theory and describes the relationship between the healthcare system and the unique combination of characteristics each patient has. Good fit results in a positive experience and poor fit in a negative experience. Virtual care improves fit in clinical situations where non-verbal communication and physical examination are not important. Support from informal caregivers improves fit. Social distancing restrictions reduce the ability of informal caregivers to provide support.

CONCLUSIONS

The impact of fit on the cancer experience suggests that care delivery should be tailored to both the individual needs of the patient and the intention of the clinical interaction. Developing evidence-based strategies to inform the integration of virtual care into oncology practice, with aim of promoting good fit between patients and healthcare services, is an important future direction.

Surgeon Personal Factors Associated with Care Strategies in Musculoskeletal Telehealth

BACKGROUND

Most surgeons used, or are currently using telehealth during the SARS-CoV-2 (COVID-19) pandemic. We studied surgeon personal factors associated with relative use of telehealth during the worldwide height of the pandemic. Questions/Purposes: (1) Are there any personal factors/characteristics associated with use and utilization of telehealth? (2) What are surgeon's perspectives/ opinions with regard to use of telehealth for five common upper extremity conditions in terms of future prospects and viability?

METHODS

Hand and upper extremity surgeons in the Science of Variation Group (SOVG) were invited to participate in a web-based survey. The first part of the survey focused on surgeon characteristics and work preferences. The second part focused on care strategies during the pandemic and utilization of telehealth. The final part of the survey addressed the care of five common upper extremity conditions during the pandemic.

RESULTS

Ninety percent of surgeons used telehealth during the first few months of the pandemic, but only 20% of visits were virtual. A greater percentage of telehealth visits compared to office visits was independently associated with a policy of only seeing people with emergencies in person (RC: 0.64; CI 95%: 0.21 to 1.1; P<0.01). Surgeons found it difficult to reproduce most parts of the physical examination on video, but relatively easy to make a diagnosis, with both ratings associated with less belief that the physical exam is essential. Comfort in offering surgery by video visit was associated with having young children, preference for remote meetings, and less belief that the physical exam is essential.

CONCLUSION

Utilization of, and comfort with, telehealth is related to personal factors and preferences, acceptance of a more limited physical examination in particular. Utilization of early adopters and training to increase comfort with the probabilistic aspects of medicine could facilitate incorporation of telehealth into standard practice.

A comparison of in-person versus telephone consultations for outpatient hospital care

The SARS-CoV-2 pandemic has triggered a transition towards telemedicine for delivering outpatient care. The evidence base for telemedicine is heterogeneous and its efficacy remains debated. We, therefore, designed a mixed-methods semi-structured survey to evaluate patients' and clinicians' experiences of outpatient telemedicine clinics during the pandemic. One-hundred and eighty-eight patients and 69 clinicians from two hospitals in Gloucestershire completed the survey. The quantitative results for patients rated in-person and telemedicine appointments similarly in all areas except communication (p<0.001) and overall quality (p=0.004), both in favour of in-person consultations, while clinicians rated all aspects of telemedicine appointments as inferior, with the exception of convenience (p=0.643). Qualitative analysis highlighted themes of communication and relationship building difficulties, confidentiality concerns, loss of visual inspection as a clinical tool and debatable time efficiency associated with telemedicine. Significant adaptation of current telemedicine services is required before it will be integrated into current practice.

Patient Acceptance and Intention to Use e-Consultations During the COVID-19 Pandemic in the Eastern Province of Saudi Arabia

Background

Over the last decade, the use of digital technology has increased immeasurably and transformed both our personal and professional lives. The medical profession quickly embraced this development, especially after the spread of the COVID-19 pandemic. Medical consultations were transitioned to online settings as a substitute for face-to-face consultations. This exponential acceleration of the use of remote online consultations (e-consultations) was deemed necessary to respond to the impact of the global pandemic. This study identifies the factors that influence actual patient use and the intention to use e-consultations in Saudi Arabia.

Methods

A cross-sectional survey was distributed online via social media platforms targeting the population living in Saudi Arabia from August to December 2020. The questionnaire measured patient perceptions of and attitudes toward utilizing e-consultations using a validated questionnaire informed by the technology acceptance model (TAM). Analyses were performed in SPSS to identify the external factors that influence patients' actual use of e-consultations and to assess the TAM factors (usefulness, social influence, and ease of use) that influence the intention to use e-consultations across both actual users and never-users.

Results

A total of 150 participants completed the questionnaire; the average age was 38 years old, 85% of the participants were females, and 67% reported never using e-consultations. Additionally, motivation, trust, attitude, and social influence were significantly related to participants' intention to use e-consultations.

Conclusion

Participants' trust in and perception of the usefulness of e-consultations were significant factors in their intention to use e-consultation services. Policymakers' attention to those factors could play a role in increasing public acceptance and the use of e-consultations to improve distance medical care.

Telemedicine Patient Satisfaction Dimensions Moderated by Patient Demographics

Background: A multi-dimensional telemedicine patient satisfaction measure is utilized to provide managerial insights into where service improvements are needed and factors that impact patient service perceptions. This research explores the influence of patient demographics on telemedicine satisfaction. Four dimensions of telemedicine patient satisfaction (health benefits, patient-centered care, monetary costs, and non-monetary costs) were compared across patient gender, income, and education levels. Methods: A survey of 440 US telemedicine patients on patient satisfaction was measured with Likert scale items to create a multi-dimensional construct using the SERVQUAL model. MANOVA, ANOVA, and linear contrasts were used to examine the impact of patient demographics on telemedicine satisfaction dimensions. Results: The findings revealed that patient demographic characteristics moderated various dimensions of their telemedicine experience satisfaction. Satisfaction with telemedicine health benefits was moderated by patient gender and income levels. Patient-centered care was moderated by patient gender, income, and education levels. Satisfaction with the monetary cost of telemedicine was associated with patient gender and education level. Patient education level influenced their satisfaction with telemedicine non-monetary costs. Discussion: Notable trends include generally higher patient satisfaction for women and those with lower education levels. Patient income showed mixed trends regarding the four dimensions of patient satisfaction. Improvements in patient health literacy along with customized services may improve telemedicine patient care satisfaction and health outcomes. Conclusions: Measuring telemedicine patient satisfaction with a multi-dimensional assessment tool provides insights into how patient demographics influence perceptions of services received. The findings highlighted perceptions of telemedicine patient satisfaction dimensions that differed across patient demographics and provided insights into their overall impact on telemedicine patient satisfaction.

Patient and family experience with telemedicine and in-person pediatric and obstetric ambulatory encounters throughout 2020, during the COVID-19 epidemic: the distance effect

BACKGROUND

Telemedicine has grown significantly in recent years, mainly during the COVID-19 pandemic, and there has been a growing body of literature on the subject. Another topic that merits increased attention is differences in patient and family experience between telehealth and in-person visits. To our team's knowledge, this is the first study evaluating pediatric and obstetrics outpatients experience with telemedicine and in-person visit types in an academic maternal and children's hospital, and its correlation with geographic distance from the medical center throughout 2020, during the COVID-19 crisis.

METHODS

We aim to evaluate and compare patients' telemedicine and in-person experience for ambulatory encounters based on survey data throughout 2020, during the COVID-19 pandemic, with particular focus on the influence of distance of the patient's home address from the medical facility. A total of 9,322 patient experience surveys from ambulatory encounters (6,362 in-person and 2,960 telemedicine), in a maternal and children's hospital during 2020 were included in this study. The percentage of patients who scored the question "Likelihood to recommend practice" with a maximum 5/5 (top box) score was used to evaluate patient experience. The k-means model was used to create distance clusters, and statistical t-tests were conducted to compare mean distances and Top Box values between telemedicine and in-person models. Logistic regression analysis was used to evaluate the correlation between Top Box scores and patients' distance to the hospital.

RESULTS

Top Box likelihood to recommend percentages for in-person and telemedicine were comparable (in-person = 81.21%, telemedicine = 81.70%, p-value = 0.5624). Mean distance from the hospital was greater for telemedicine compared to in-person patients (in-person = 48.89 miles, telemedicine = 61.23 miles, p-value < 0.01). Patients who live farther displayed higher satisfaction scores regardless of the visit type (p-value < 0.01).

CONCLUSIONS

There is a direct relationship between the family experience and the distance from the considered medical center, during year 2020, i.e., patients who live farther from the hospital record higher Top Box proportion for "Likelihood to Recommend" than patients who live closer to the medical center, regardless of the approach, in-person or telemedicine.

Use of telemedicine consultations in head and neck cancer: patient perceptions, acceptability and accessibility

BACKGROUNDS

Telemedicine has been effective in the management of various medical conditions, however, there is limited knowledge of its use in head and neck oncosurveillance. This is of importance currently while trying to mitigate the risk of transmission during the COVID-19 pandemic. This study aims to evaluate acceptability, satisfaction and perceptions of telemedicine technology among outpatients for head and neck oncologic surveillance.

METHODS

A cross-sectional study was conducted for head and neck surgical oncology patients who attended telemedicine consultations between March and October 2020 at the Peter MacCallum Cancer Centre. Data on demographic, socioeconomic and acceptability variables was collected, utilizing Likert scale questions. The primary outcome measures were patient satisfaction and perceptions, while the secondary outcome was access to technology.

RESULTS

One hundred and fifteen patients were invited to participate, and 100 were included in the final analysis; 95% of patient's had a positive experience with telemedicine appointments and were willing to have future telemedicine appointments. Regional and rural patients were more accepting of telemedicine consultations, citing savings in travel time and the minimal disruption to normal day-to-day activities. All participants had access to telecommunication devices, with 63% having three or more devices. Issues identified include a lack of physical examination by clinician for 65% of participants and the inability to self-examine for 88% of participants.

CONCLUSION

The study demonstrates patients' acceptance of telemedicine appointments as a component of outpatient surveillance for head and neck surgical oncology. This has benefits during the COVID-19 pandemic in addition to increasing accessibility for rural patients.