Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study

Abstract

Background The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. Conclusions This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits.

Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study

“…Finally, it was beyond the scope of this research to capture the patient perspective. Studies have started to assess patient experience with telehealth during the COVID-19 pandemic; however, there has been limited study of this in oncology [ 104 - 106 ]. Future studies should assess the perspectives of patients with cancer regarding telehealth to explore patient satisfaction, barriers and facilitators to telehealth access, and patient preferences for telehealth (eg, whether certain services should be delivered in person vs virtually and preferences for how interpreter services should be implemented).…”

The Research on Patient Satisfaction with Remote Healthcare Prior to and during the COVID-19 Pandemic

“…Nine studies utilised well-defined, known, validated and reliable measures. These measures included the following: SQUIRE 2.0 [ 39 ], WCM Press Ganey Medical Practice Survey [ 5 ], Telehealth Usability Questionnaire (TUQ) [ 39 , 40 ], Patient Satisfaction Questionnaire-18 (PSQ-18) [ 41 , 42 , 43 ], Teleconsultation Satisfaction Questionnaire (TSQ) [ 8 ], Short Assessment of Patient Satisfaction (SAPS) [ 44 ], Patient Assessment of Communication during Telemedicine (PACT) [ 45 ] ( Table 2 ).…”

Adaptations of paediatric cardiology practice during the COVID-19 pandemic

“…Various surveys across different specialties have demonstrated high patient satisfaction with telemedicine visits. 14 Over time provider satisfaction will likely continue to improve as shown in various recent surveys after providers have the chance to familiarize with the telemedicine technology. 15,16 This technology has also useful in imaging heavy disciplines such as fetal cardiology.…”