Patient preferences using telehealth during the COVID‐19 pandemic in four Victorian tertiary hospital services

Abstract

Background The Coronavirus disease 2019 (COVID‐19) pandemic has had a major impact on healthcare services with many changes to telehealth care delivery. More information is needed about the patient perspective of telehealth in hospital services and the potential costs and benefits for patients. Aim To measure patients' evaluation of telehealth, preferences for telehealth versus in‐person appointments, and potential cost savings by patient characteristics. Methods A cross‐sectional online survey (including patient and appointment characteristics, telehealth evaluation, preferences for care and costs) of adult patients using video telehealth in four metropolitan tertiary hospital services in Melbourne, Victoria. Results A total of 1045 patients (median age 44 years; interquartile range 29–59) participated with an overall response rate of 9.2%. For 98.7% patients, telehealth was convenient, 96.4% stated that it saved time, 95.9% found telehealth acceptable to receive care and 97.0% found that telehealth improved their access to care. Most (62.6%) preferred in‐person consultations, although 86.9% agreed that telehealth was equivalent to an in‐person consultation. Those in regional and rural areas were less likely to prefer in‐person consultations. Patients attending for medical reasons were less likely to prefer in‐person consultation compared with patients with surgical reasons. Patient preference to telehealth was independent of level of education, appointment type, self‐rated health status and socio economic status. Patients saved an average of A$120.9 (standard deviation A$93.0) per appointment, with greater cost savings for patients from low and middle socio economic areas and regional or rural areas. Conclusion Telehealth video consultations were largely evaluated positively with most patients considering the service to be as good as in‐person. Understanding patient preference is critical to consider when implementing telehealth as mainstream across hospital health services.

The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey

“…Since the onset of the COVID-19 pandemic, telehealth services have been offered to a wider range of people in Australia than would normally access them, including through the replacement of their usual face-to-face services. Satisfaction with telehealth service experiences has generally remained high, and distal health care has been perceived as a safer option, allowing continued access to care while preventing potential COVID-19 infection [19][20][21][22][23]. However, willingness to continue to use telehealth services outside of the pandemic context is mixed [21][22][23].…”

“…Satisfaction with telehealth service experiences has generally remained high, and distal health care has been perceived as a safer option, allowing continued access to care while preventing potential COVID-19 infection [19][20][21][22][23]. However, willingness to continue to use telehealth services outside of the pandemic context is mixed [21][22][23].…”

“…Telehealth may particularly appeal to people who benefit most from its advantages, for example, those living greater distances from hospitals and specialist services [ 19 , 23 , 24 ], people with caring responsibilities [ 17 ], and people with health conditions or disabilities that make travel or face-to-face appointments more difficult [ 17 , 22 ]. Gender may also interact with some of the aforementioned factors; for example, women are more likely to perform caring roles [ 25 ].…”

“…Gender may also interact with some of the aforementioned factors; for example, women are more likely to perform caring roles [ 25 ]. In Australia, the perceived disadvantages of telehealth in comparison to face-to-face services (eg, poorer communication, difficulties accessing prescriptions, and pathology results) [ 20 , 21 , 23 ] may outweigh the benefits for people living in urban areas, closer to service locations, and with easy access to travel [ 20 , 23 ]. Telehealth can also be seen as inappropriate or less effective for certain kinds of appointments or concerns, for example, where physical examination may be necessary or beneficial, or when a new diagnosis is being made [ 18 , 21 ].…”

“…Research from the United States suggests that during the pandemic certain disadvantaged groups were less likely to access telehealth services, including people without health insurance, people living in a mobile home or trailer, and people living in areas with poorer broadband internet coverage [ 26 ]. This is particularly problematic as disadvantaged groups may stand to benefit most from many of the financial and logistical benefits that telehealth can provide [ 23 ]. A recent Australian study did not find an association between socioeconomic status and preferences for telehealth services.…”