Patient Satisfaction with Video Telemedicine

Evidence-Based Answer:

Yes. Patients rate video telemedicine visits comparably to face-to-face visits for satisfaction and quality of care. (SOR: B, systematic review and cross-sectional studies) Time saved is an advantage; video communication and technical concerns are disadvantages. (SOR: B, systematic review and cross-sectional study) Predictors of higher satisfaction with telemedicine include patient understanding of telehealth, female gender, and uninsured status. (SOR: B, cross-sectional study) Cross-sectional studies included patients agreeable to telehealth visits and may be subject to selection bias. More studies are needed in primary care.

Evidence Summary:

A 2000 systematic review assessed 32 studies with more than 2,300 patients from 1966 to 1998 that measured patient satisfaction after video telehealth consultations with healthcare providers.1 The review included 1 RCT (N=104), 1 case control study (N=50), and 30 cross sectional studies with participant inclusion via random selection, referrals, convenience samples, volunteers, or unspecified techniques). Included studies ranged over varying healthcare provider settings from family medicine to a range of differing specialties. Studies were excluded if they used telecommunication technology for educational or administrative purposes not involving provision of care to patients. The primary outcome was overall participant satisfaction with telemedicine. There was no standardized outcome measure used; 26 studies used survey instruments, while 1 used qualitative analysis and 5 did not specify. Methodological heterogeneity therefore precluded formal statistical analysis and there were no numbers to report in this study. The authors conducted qualitative analysis of the data and findings with no standardized scoring method. The qualitative analysis revealed that video telemedicine was generally well-accepted in all studies; specific advantages were access to specialist care, less travel, and reduced wait times; disadvantages were video communication. Authors critically appraised each study using a checklist and found several concerns related to validity and generalizability of individual studies. This study is limited by the subjective nature of qualitative analysis and unclear methodology of the analysis; the largest study in this review (N=585) was conducted in a prison setting, limiting generalizability of results to the general patient population.

A 2018 cross-sectional study surveyed adults (N=764) who completed video telehealth visits at an urban academic hospital system in Philadelphia during 2015 to 2016 to evaluate their satisfaction after a non-urgent video telehealth visit.2 Participants had concerns suitable for telehealth (as determined by the provider), agreed to download an electronic application, and remotely attend a scheduled video telehealth visit with a physician or advanced nurse practitioner in one of various specialties; 32 of 3018 visits were in family medicine. A few of the participants (15%) had prior experience with video telehealth visits (other baseline characteristics were not provided). Primary outcomes included participant ratings of telehealth visits compared to face-to-face visits based on level of care and impact on ability to receive care where and when needed. Secondary outcomes included participants time saved and reasons for dissatisfaction, and likelihood of recommending telehealth visits. Out of the 3018 telehealth visit participants, 25% (N=764) completed the survey. The majority of participants (86%) agreed or strongly agreed about that the telehealth visits made it easier to get care. The majority (82.7%) also reported same level of care as face-to-face visits. For time saved, 10% reported < 1 hour, 45.5% reported 1-3 hours, and 39.7% reported > 3 hours. 91.3% (N=728) reported satisfaction; for unsatisfied participants, 85% attributed this to technical issues and 7% to dislike of interacting on a video. Baseline characteristics of the study population (age group, gender, complexity of health comorbidities, distance of home from the hospital, income level, access to technology, education level) were not assessed in detail, making it difficult to generalize findings to local patient populations and to predict ideal patient candidates who would rate telehealth visits favorably; participants self-selected into telehealth visits, which may have contributed to overly favorable results.

A 2016 cross-sectional study surveyed adults (N=1,734) presenting to 11 immediate care clinics in 2014 to evaluate their satisfaction after an urgent care video telehealth visit.3 Participants were included if they had symptoms suitable for telehealth algorithms (pharyngitis, sinusitis, otitis media, otitis externa, upper respiratory infections, bronchitis, allergic rhinitis, influenza, conjunctivitis, or urinary tract infections), no previous exposure to telehealth, and agreed to a video telehealth visit with an offsite nurse practitioner or physician assistant when the onsite provider was busy. Of the participants, most (70%) were female; several (41%) had no primary care physician. Primary outcomes included whether patients preferred telehealth visits compared to traditional face-to-face visits (rated as “better”, “just as good”, “worse”, or “not sure”), whether patients liked telehealth visits compared to traditional face-to-face visits (rated as “better, “just as good”, or various other neutral or inferior responses), how patients rated satisfaction on a 5-point Likert scale ranging from 1 (“very dissatisfied”) to 5 (“very satisfied”) for overall understanding of telehealth, ease of seeing diagnostic images on the monitor, ease of seeing and hearing the remote practitioner, the practitioner’s capability, quality of care, utility of the treatment and educational materials received, convenience of the visit, and overall satisfaction, and how patients rated likelihood to use telehealth again and likelihood of recommending it to someone else (rated as “definitely will”, “probably will”, “probably will not” or “definitely will not”). Secondary outcomes included whether or not patient satisfaction in specific aforementioned areas predicted whether they preferred or liked telehealth visits compared to face-to-face visits. Out of the 3303 telehealth visit participants, 54% (N=1,812) completed the survey; 78 participants were excluded for prior exposure to telehealth. Most participants (89%) preferred telehealth compared to face-to-face visits; most (89%) also liked telehealth compared to face-to-face visits. A significant majority of participants (94-98%) selected “very satisfied” for the aforementioned satisfaction parameters. Nearly all participants (98%) said they “definitely will” or “probably will” use telehealth again; nearly all (98%) said the same for recommending telehealth. The only identified statistically significant predictor of preference for telehealth compared to face-to-face visits was lack of health insurance compared to insured status (odds ratio (OR) 1.21; 95% CI, 1.02—1.43). Statistically significant predictors of liking of telehealth compared to face-to-face visits included female gender (OR 1.68; 95% CI, 1.04—2.72), higher satisfaction with understanding of telehealth (OR 2.76; 95% CI, 1.84—4.15), higher satisfaction with quality of care (OR 2.34; 95% CI, 1.42—3.87), and higher satisfaction with convenience of care (OR 2.87; 95% CI, 1.09—7.94). Results may not be generalizable to older patients, pediatric patients, or patients with symptoms not amenable to management algorithms; the analysis did not account for patient education level or complexity of comorbid health conditions; participants self-selected into telehealth visits, which may have contributed to overly favorable results.

Author Information:

Pooja Saigal, MD

Ryan Gorji, MD

University of Chicago (NorthShore)

Chicago, IL

References:

1. Mair F, Whitten P. Systematic review of studies of patient satisfaction with telemedicine. BMJ. 2000;320(7248):1517-20. [STEP 3]

2. Powell, R., Stone, D. and Hollander, J. Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study. JMIR Medical Informatics. 2018;6(1), p.e10. [STEP 3]

3. Polinski JM, Barker T, Gagliano N, Sussman A, Brennan TA, Shrank WH. Patients' Satisfaction with and Preference for Telehealth Visits. J Gen Intern Med. 2016;31(3):269-75. [STEP 3]