Marina Serper|Frederick A. Nunes|Nuzhat A. Ahmad|D. W. Roberts|David C. Metz|Shivan J. Mehta
Positive Early Patient and Clinician Experience with Telemedicine in an Academic Gastroenterology Practice During the COVID-19 Pandemic
University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania
telehealth telemedicine defined use communications technologies provide support health care distance become important part medical care coronavirus disease 2019 covid19 pandemic1centers medicare medicaid serviceshttpswwwcmsgovnewsroomfactsheetsmedicaretelemedicinehealthcareproviderfactsheettexttelehealth2c20telemedicine2c20and20related20termsprovision20f20healthcare20is20increasinggoogle scholar2national institutes healthhttpswwwnibibnihgovscienceeducationsciencetopicstelehealthgoogle scholar response emergent need reduce spread covid19 limiting physical contact medicares 1135 waiver lifted previous limits patient location range providers requirement patients reside designated rural areas patients established provider relationships receive medical services telemedicine additionally centers medicare medicaid services increased reimbursement telephone visits par video3centers medicare medicaid serviceshttpswwwcmsgovnewsroompressreleasestrumpadministrationissuessecondroundsweepingchangessupportushealthcaresystemduringcovidgoogle scholar however given limited telemedicine use precovid194serper et alhepatology 2020 72 723728crossref pubmed scopus 109 google scholar data clinician patient attitudes outside rural research settings lacking describe realworld experience patient clinicianrated acceptability telephone video outpatient visits initial 4 weeks emergency covid19 response large diverse gastroenterology gihepatology practice academic health system study approved expedited review university pennsylvanias institutional review board surveyed patients aged 18 years received video telephone visits 4 outpatient gihepatology practices march 16 april 10 2020 part standard care health system encouraged patients enroll online portal enable provider communication facilitate downloading technology enable video visits within 3 5 days completing telemedicine visits patients invited complete brief survey adapted prior literature assessing experiences5polinski jm et alj gen intern med 2016 31 269275crossref pubmed scopus 347 google scholar sent automatically via patient portal using online survey via telephone call study staff portal access using 5point likert scale ranging 1 dissatisfied 5 satisfied patients asked rate telemedicine ease use quality care received overall level satisfaction visits patients asked compare telemedicine experience facetoface medical visit comment likelihood future use indicate whether would recommend service others net promoter score clinicians physicians advanced practice providers answered similar questions regarding ease use quality visits care provided patient variables included sociodemographics type visit video vs telephone use online portal measure digital literacy clinician characteristics included provider type physician advanced practice provider age sex years clinical practice experience openended feedback regarding telemedicine experience obtained patients clinicians descriptive statistics calculated variables bivariate comparisons conducted 2 tests categorical variables wilcoxons rank sum tests appropriate logistic regression models examined factors associated video telemedicine study period 1718 patients gihepatology visits 104 6 person 1614 94 via telemedicine contrast 54 1177 5 visits conducted via telemedicine 2 weeks covid19 pandemic response mean patient age 60 years sd 16 years 59 women 20 black 64 white 16 otherunknown early period 27 visits conducted via video 72 via telephone week 1 7 telemedicine visits via video increased 47 week 4 adjusting study week demographics black race odds ratio 26 95 confidence interval 1642 age 60 years odds ratio 19 95 confidence interval 1427 independently associated telephone vs video visits notable racial age differences online portal use 87 portal use among whites vs 39 blacks 77 among age 60 years vs 48 among age 60 years p 0001 survey response 582 42 among patients via online portal 206 64 among portal figure 1 shows 2category responses notable patient visit characteristics total 67 rated telemedicine visit quality goodbetter facetoface 78 thought technology easy use 96 reported somewhatvery satisfied medical care 78 somewhatvery satisfied overall quality telemedicine experience 80 reported probabledefinite future telemedicine use available significant differences satisfaction noted age older patients less likely rate telemedicine goodbetter facetoface visit method 74 said video goodbetter facetoface compared 64 telephone race black patients less likely satisfied ease technology use report probabledefinite future use p0001 detailed patient survey responses stratified demographic variables summarized supplementary table 1 clinician response 82 63 77 eligible responded clinician responses stratified years practice 20 vs 20 years summarized supplementary table 2 total 88 clinicians rated video visits betteras good facetoface 41 telephone greater 80 somewhatvery satisfied care provided conducting telemedicine top patient clinician concerns lack physical exam clinicians concerns privacy workflow technology patients concerned feescharges privacy technology general patients felt telemedicine experience convenient informative good easy efficient great helpful professional first 4 weeks covid19 response large diverse academic gihepatology practice provided 94 visits telemedicine early feedback patients generally positive twothirds telemedicine visits rated goodbetter facetoface notable differences telemedicine acceptability video vs telephone use online portal use surrogate measure digital literacy noted black race older age present data influenced early covid19 experiences may challenging time adoption future studies investigate patient clinician perceptions experience telemedicine optimal integration facetoface telemedicine visits potential facilitators barriers telemedicine6mehta sj virtual mentor 2014 16 10141017crossref pubmed scopus 32 google scholar practices continue work mitigate disparities access technology low digital literacy7nouri et al nejm catalyst may 2020google scholar dr serpers time supported grant number k23dk115897 dr mehtas time supported grant number k08ca234326 national institutes health alex burdzy patrik garren christopher snider contributed data acquisition implementation study marina serper md ms conceptualization equal formal analysis lead methodology equal resources lead supervision lead writing original draft lead frederick nunes md conceptualization supporting writing review editing supporting nuzhat ahmad md conceptualization supporting writing review editing supporting divya roberts crnp data curation equal writing review editing supporting david metz md writing review editing supporting shivan mehta md mba mshp conceptualization equal investigation equal methodology equal writing review editing equal supplementary table 1patient perceptions telemedicine visits stratified visit method age portal usevariableleveloverall n 788telephone n 573video n 215p valueabold p values statistically significant p 05age 60 n 388age 60 n 400p valueabold p values statistically significant p 05no portal use n 206portal use n 582p valueabold p values statistically significant p 05age 3063 8042 7321 9803314 6849 84053303984 10753 9231 14412 5872 124404983 10560 10523 10722 10761 1055059158 201109 19049 22840 194118 20360400 508309 53991 423118 573282 485sexfemale466 591339 592127 59199228 588238 59588128 621338 58132male322 409234 40888 409160 412162 40578 379244 419visit methodtelephone573 727264 680309 773004180 874393 675001video215 273124 32091 22826 126189 325how video visit compare facetofaceworse139 182111 20128 13400760 15879 20600160 29179 142001as good396 520286 517110 526206 544190 49693 451303 545better112 14768 12344 21169 18243 11230 14682 147not sure115 15188 15927 12944 11671 18523 11292 165any concerns telemedicineno744 944539 941205 95360370 954374 93528197 956547 94048yes44 5634 5910 4718 4626 659 4435 60ease software downloadusevery dissatisfied16 2116 290 000125 1311 28670 0016 29002somewhat dissatisfied15 2011 204 198 217 183 1512 21neither satisfied dissatisfied25 3315 2710 4812 3213 3410 4915 27somewhat satisfied97 12763 11334 16347 12450 13037 18060 107very satisfied612 800451 811161 770307 810305 790156 757456 816overall satisfaction healthcare qualityvery dissatisfied21 2720 361 0507810 2611 28203 1518 32040somewhat dissatisfied7 095 092 101 036 161 056 11neither satisfied dissatisfied2 2918 324 199 2413 3412 5810 18somewhat satisfied90 11861 11029 13951 13539 10123 11267 120very satisfied625 817452 813173 828308 813317 821167 811458 819overall satisfaction telemedicine experiencevery dissatisfied19 2518 321 05187 1812 31681 0518 32046somewhat dissatisfied9 126 113 146 163 082 107 13neither satisfied dissatisfied21 2717 314 1911 2910 2610 4911 20somewhat satisfied100 13172 12928 13449 12951 13228 13672 129very satisfied616 805443 797173 828306 807310 803165 801451 807would use telemedicine futureprobably not60 8052 968 3900621 5739 10300531 15829 53001not sure54 7236 6618 8826 7028 7412 6142 76probably will291 389221 40770 341131 355160 42271 362220 399definitely will343 459234 431109 532191 518152 40182 418261 473net promoter scoreba score 50 considered excellent 40 considered good494554099455421504557note data presented number unless noted otherwisea bold p values statistically significant p 05b score 50 considered excellent 40 considered good open table new tab supplementary table 2clinician attitudes toward telemedicine first 4 weeks covid19 response stratified years practicetotal n 63in practice 20 years n 47in practice 20 years n 16p valueabold p values statistically significant p 05 ns indicates significantprovider type006 advanced practice provider16 25416 340 0 physician47 74631 6616100years practice001 0525 39725 530 0 61011 17511 230 0 112011 17511 230 0 2016 2540 016 100sex female33 52431 662 13001 male30 47616 3414 88age y001 303929 46029 620 0 404914 22214 300 0 505913 2063 610 63 607 1111 26 38telephone telemedicine99 no1 161 20 0 yes62 98446 9816 100video telemedicine99 no4 631 20 0 yes59 93746 9816 100how video visit compare facetoface001 better6 1021 20 0 good36 61046 9816 100 worse16 2711 20 0 sure1 1746 9816 100how telephone visit compare inperson79 better4 654 90 0 good21 33916 355 31 worse33 53223 5010 63 sure4 653 71 6any concerns telemedicine prior starting38 no28 44419 409 56 yes35 55628 607 44ease software download076 dissatisfied2 331 21 6 somewhat dissatisfied1 160 01 6 neither satisfied dissatisfied4 662 42 13 somewhat satisfied14 2309 205 31 satisfied40 65633 737 44overall satisfaction conducting telemedicine99 dissatisfied1 161 20 0 neither satisfied dissatisfied7 1135 112 13 somewhat satisfied28 45221 467 44 satisfied26 41919 417 44overall satisfaction care provided057 dissatisfied1 161 20 0 somewhat dissatisfied3 480 03 19 neither satisfied dissatisfied6 974 92 13 somewhat satisfied25 40320 435 31 satisfied27 43521 466 38would use telemedicine future12 probably not1 160 01 6 sure3 491 22 13 probably will13 21310 223 19 definitely will44 72134 7610 63net promoter scoreba score 50 considered excellent 40 considered good525444nsnote data presented number unless noted otherwisea bold p values statistically significant p 05 ns indicates significantb score 50 considered excellent 40 considered good open table new tab note data presented number unless noted otherwise note data presented number unless noted otherwise