Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences

Abstract

Background During the first COVID-19 pandemic ‘lockdown’ in Aotearoa/New Zealand (March–May 2020, in which strict ‘stay at home’ measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future. Methods Using a mixed-method approach, we undertook an online survey and in-depth interviews with adults (> 18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n = 1010) and qualitative analysis of interview data (n = 38) and open-ended survey questions, using a framework of access to health care, from the patient’s perspective. Results In general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person. Conclusions Even in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients.

Access to sexual healthcare during New Zealand’s COVID-19 lockdown: cross-sectional online survey of 15–24-year-olds in a high deprivation region

“…We did not seek information about reasons for choice of consultation method in this study, but personal circumstances, familiarity/existing relationships with service providers, and perceived convenience are likely factors driving choice of method. 8 Hesitancy to use video consultations for sexual healthcare (and healthcare in general) has been associated with fears about confidentiality and security in previous research. 20 21 It has been suggested that despite being avid mobile phone users, many young people are not comfortable making or taking calls, 22 which could partly explain the lack of support for telephone consultations.…”

“…4 5 'In-person' consultations were reserved for limited numbers of patients and conditions as determined by telephone triage, and consultations were conducted by telephone, video and messaging applications (telehealth or telemedicine). 4 6 7 Researchers have already explored patient experiences of primary healthcare delivered by telehealth during lockdown in New Zealand, 8 but the extent to which telehealth is appropriate for, and was used for, sexual and reproductive health (SRH) issues is unclear. SRH consultations often involve discussion of confidential, sensitive issues.…”

“…Researchers have already explored patient experiences of primary healthcare delivered by telehealth during lockdown in New Zealand, 8 but the extent to which telehealth is appropriate for, and was used for, sexual and reproductive health (SRH) issues is unclear. SRH consultations often involve discussion of confidential, sensitive issues.…”

Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm

“…In particular, the establishment of primary care or the initial consultation, similar to a first date, may not be welcomed by all and could negatively affect patient experience or the development of a sense of "my doctor." A survey of primary care patients during the pandemic found that telehealth was considered the most appropriate in the presence of a pre-existing clinical relationship [21]. An analysis of 620 patient satisfaction survey outcomes from clinic encounters found that new visit type was associated with lower patient satisfaction (parameter estimate -0.75; 95% CI -1.00 to -0.049) [22].…”

Young peoples’ perspectives about care in a youth-friendly general practice

“…Offering the option of phone or zoom interviews may be helpful for youth participants, particularly in light of COVID-19 changes. 41 In this study undertaken in 2019 (pre COVID-19), phone interviews appear to yield comparable data and may be a good option for some young people. 42 This study shows that even in an intentionally youth-friendly practice, barriers exist in offering an accessible, acceptable, equitable, appropriate, effective safe consulting environment.…”