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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.
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.
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.
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,
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.
In its most simplistic form, telehealth or telemedicine refers to the mixture of art and science to maintain health and prevent disease from a distance [
Perceived barriers from the physician-side include the lack of a comprehensive physical examination, technically challenged staff and patients, public resistance to telehealth, cost, reimbursement issues, and lower standards of care concerns [
Additionally, Di Lenarda et al [
Despite the continuing dialectic around the efficacy of telehealth in cardiology, the onset of the global COVID-19 pandemic necessitated a more or less immediate shift toward remote modalities to ensure continuation of care for cardiology patients, without increasing health risks. The transition has generated many important research questions about not only quality care but also patient use and perceptions of the novel modality. Will patients be able to access this care? Will they be satisfied with the experience? What are their perceived advantages and disadvantages to this new approach? Few studies have evaluated satisfaction with telemedicine in a broad range of cardiology patients, but what is available comes mostly from heart failure studies. Kraii et al [
One such instrument, developed and validated by Agha et al [
Kentucky presently serves as an ideal study location in the United States for examining the efficacy of and patient satisfaction with telehealth in cardiology. In recent years, Kentucky has ranked in the top 10 states for prevalence of obesity (2018) and among the top five states for prevalence of diabetes (2016) [
The cardiovascular needs of Kentuckians, coupled with the limitations described, provides the context for a timely natural experiment. Here, we use a survey of cardiology patients to investigate the utility of telehealth from their perspective. Our primary objectives were to determine the existing limitations of telehealth accessibility, patient satisfaction with telehealth relative to traditional in-person visits in a situation where the mandatory shift to telehealth minimized self-selection bias, and the resulting 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. We needed to know what was working and what was not so as to inform adaptive management in the near term. Second, we intended to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology.
We employed a web-based survey and used existing electronic medical record (EMR) data to answer these research questions. Although an online survey may seem like an odd choice (the same barriers that may keep patients from using telehealth could also keep them from answering an online survey on a PC or other device, such as lack of broadband internet access or lack of computer skills), it afforded the rapid analyses required to answer these questions in real time.
We intended to survey individuals who had appointments scheduled with their cardiologist at Western Kentucky Heart and Lung (WKHL) during the COVID-19 pandemic. WKHL is the primary cardiology and pulmonary and critical care training site for the University of Kentucky cardiovascular fellowship programs in Bowling Green, Kentucky and is associated with The Medical Center as its main hospital. WKHL office staff consolidated the contact information for all patients scheduled between March 15, 2020 (the start of telehealth-only appointments due to COVID-19), and the survey implementation date on June 7, 2020. The resulting pool consisted of 2019 patients across 7 cardiologists. Our research protocol and questionnaire were approved by the Institutional Review Board of the Medical Center (IRB #20-6-05-SinA-TeleCOVID). All respondents provided an informed consent and data were kept on a secure device.
We constructed the questionnaire using Qualtrics (Qualtrics International Inc) and sent a bulk invitation email with a direct link to the online questionnaire to all 2019 patients. We optimized the survey for mobile browsers and sent two reminders, both as text messages and emails, with a direct link to the questionnaire [
Data were collected via an anonymous online survey following Dillman et al’s [
Following consent, the survey began with demographic questions to ensure we could measure representation in our sample, especially because economic and health disparities may be related to demography as well as access to telehealth. Respondents were also asked if they had sought medical care during the pandemic, about their travel time to their cardiologist, and if they participated in telehealth through their cardiologist during the pandemic. The answer to this last question bifurcated respondents onto two different survey paths.
If a respondent answered “no” regarding their participation in telehealth, they were directed to a “No Tele” set of questions regarding potential barriers to their access of telehealth. They were asked what factors may have influenced their decision not to participate in a telehealth visit, which included not medically necessary, no access to a smartphone or other device, privacy concerns, preference for in-person visits, and an open response option to include other influential factors. Respondents were asked to rank each option on a 3-point Likert-type scale as not a factor, somewhat of a factor, or the primary factor.
If a respondent answered “yes” regarding their participation in telehealth, they were directed to a “Had Telehealth” set of questions. They were asked about the modality of their telehealth visit (eg, phone call or face-to-face with a smartphone, computer, or tablet) and which platform was used (eg, Zoom [Zoom Video Communications] or Doxy.me). Respondents were then asked to rank potential disadvantages (eg, technology issues due to internet connectivity, technology issues related to a device, understanding of device use, comfort communicating via camera and microphone, and privacy concerns) and potential advantages (eg, reduced travel time, reduced visit wait time, and reduced travel costs) associated with telehealth on a 3-point Likert-type scale. They were also provided an open response option to include and rank additional disadvantages and advantages. Respondents were next asked to rank their level of agreement, on a 5-point Likert scale, with 11 positive statements regarding the four domains of patient satisfaction. Lastly, respondents were asked to rank their overall experience on a 5-point Likert-type smile scale [
Following these two separate paths, all respondents concluded the survey with a section regarding perceptions of their standard in-person visits with their cardiologists. The first section asked respondents to rank their level of agreement, on a 5-point Likert scale, with the same 11 positive statements regarding the four domains of patient satisfaction. Similarly, they were also asked to rank their overall experience on a 5-point Likert-type smile scale [
Aside from data collection via the survey, we also used EMR data to determine the no-show rate for telehealth appointments during our research period as well as the standard no-show rate for in-person visits during the 10 weeks prior to the state stay-at-home order. These additional data were collected to help address our questions around access to care and to ensure our sample was representative (ie, that we received enough responses from those who declined or missed their telehealth visits) and not suffering from nonresponse bias.
All statistical analyses were carried out using SYSTAT, version 13 (Systat Software Inc). Cronbach alpha was used to test for internal consistency and scale reliability among related questions. Paired difference in the average ratings for telehealth versus in-person appointments was tested for significance using a Wilcoxon signed rank test. Differences among cardiologists in mean ratings for telehealth versus in-person appointments were examined using Kruskal-Wallis (KW) nonparametric analysis of variance. Individual items were tested for significant differences in ratings using chi-square tests of association. Correlations among survey items were computed using Spearman rank correlations and interpreted for significance based on Bonferroni-adjusted criteria. Post hoc power analysis was used to determine the level of statistical power in our comparisons of satisfaction ratings between telehealth and in-person visits.
A total of 224 unique individuals (based on Internet Protocol addresses) consented to take the survey (11% of our total sample of 2019). Of those, 86% (n=193) were recruited (ie, completed the first page and consented). Of those recruited, our completion rate was 62% (n=120), and early terminated surveys were analyzed by completed sections only. The vast majority of the 193 respondents identified as White, non-Hispanic (n=172, 89.1%); 10 (5.2%) respondents identified as African American, 2 (1.0%) as Hispanic/Latinx, 1 (0.5%) as Asian, and the remainder as unidentified; these percentages are consistent with the racial and ethnic diversity of the surrounding region [
Over the course of our study period, the no-show rate for scheduled telehealth appointments at WKHL was 17% (343/2019); the no-show rate of in-person visits in the 10 weeks prior to the switch to telehealth was also between 16% and 17% (526/3172). Among our 193 respondents, 28% (n=55) did not attend their scheduled telehealth visit. However, of the 32 respondents completing the section on barriers to telehealth, 20 (62.5%) indicted they did not realize they had been scheduled for a telehealth visit during the study time frame. There were 15 (47%) respondents that cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision; 20 (62.5%) cited a preference for in-person appointments as at least somewhat of a factor in their declining telehealth; 7 (21.9%) cited comfort with technology as playing a role in their decision, while a small percentage identified access to technology (n=2, 6.2%) or privacy concerns (n=2, 6.2%) as factors. These data are summarized in
Distribution of responses to survey items relating to respondents’ basis for opting out of telehealth and perceived advantages/disadvantages of telehealth by those who had a telehealth appointment.
Survey items | No factor, n (%) | Somewhat, n (%) | Primary, n (%) | |
|
||||
Not scheduled | 5 (15.6) | 7 (21.9) | 20 (62.5) | |
Not medically necessary | 17 (53.1) | 5 (15.6) | 10 (31.3) | |
Access to technology | 30 (93.8) | 0 (0.0) | 2 (6.2) | |
Comfort with technology | 25 (78.1) | 5 (15.6) | 2 (6.3) | |
Privacy concerns | 30 (93.8) | 1 (3.1) | 1 (3.1) | |
Preference for in-person | 12 (37.5) | 13 (40.6) | 7 (21.9) | |
|
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Reduced travel time | 12 (11.3) | 33 (31.1) | 61 (57.5) | |
Reduced visit wait time | 12 (11.3) | 37 (34.9) | 57 (53.8) | |
Travel or cost savings | 19 (18.0) | 44 (41.5) | 43 (40.5) | |
|
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Poor internet connectivity | 71 (67.0) | 27 (25.5) | 8 (7.5) | |
Device technology issues | 82 (77.4) | 19 (17.9) | 5 (4.7) | |
Comfort with device/software | 76 (71.7) | 21 (19.8) | 9 (8.5) | |
Communication issues | 73 (68.9) | 26 (24.5) | 7 (6.6) | |
Privacy concerns | 91 (85.8) | 11 (10.4) | 4 (3.8) |
Both in-person and telehealth experiences were viewed favorably, but in-person more so. The highest ratings were seen on individual items relating to the cardiologist’s perceived competence, interpersonal skills, and interest in their patient’s medical concerns; this pattern was consistent across both telehealth and in-person formats. The lowest ratings were given on items relating to the cardiologist’s support for the patient’s emotions, perceived interest in establishing a medical partnership, and thoroughness of the clinical exam. Mean scores were nearly identical among three of the four survey domains, ranging between 4.32 and 4.33 out of 5. Only the clinical competence domain generated a lower mean score (4.23), and this was driven entirely by the low rating on the item related to the thoroughness of the clinical exam; when this item was excluded, the domain mean score improved to 4.33. There was also high reliability among items within each survey domain, as Cronbach alpha values ranged from .879 to .973. These data are summarized in
Summary of responses by those who participated in telehealth, characterizing their telehealth (n=106) and in-person (n=96) experiences.
Survey domains, items, and mode | Strongly disagree, n (%)a | Disagree, n (%)a | Neither, n (%)a | Agree, n (%)a | Strongly agree, n (%)a | Mean (SE)b |
|
|||
|
||||||||||
|
.74 | |||||||||
Telef | 5 (4.7) | 1 (0.9) | 8 (7.6) | 30 (28.3) | 62 (58.5) | 4.35 (0.10) | 0.46 | |||
In-Pg | 2 (2.1) | 2 (2.1) | 5 (5.2) | 29 (30.2) | 58 (60.4) | 4.45 (0.09) | 0.49 | |||
|
.22 | |||||||||
Tele | 7 (6.6) | 2 (1.9) | 5 (4.7) | 38 (35.8) | 54 (51.0) | 4.23 (0.11) | 0.40 | |||
In-P | 2 (2.1) | 3 (3.1) | 7 (7.3) | 25 (26.0) | 59 (61.5) | 4.42 (0.09) | 0.48 | |||
|
.16 | |||||||||
Tele | 4 (3.8) | 2 (1.9) | 15 (14.1) | 45 (42.5) | 40 (37.7) | 4.09 (0.09) | 0.35 | |||
In-P | 2 (2.1) | 1 (1.0) | 7 (7.3) | 34 (35.4) | 52 (54.2) | 4.39 (0.09) | 0.41 | |||
|
.54 | |||||||||
Tele | 4 (3.8) | 3 (2.8) | 8 (7.6) | 44 (41.5) | 47 (44.3) | 4.20 (0.09) | 0.40 | |||
In-P | 2 (2.1) | 2 (2.1) | 5 (5.2) | 33 (34.3) | 54 (56.3) | 4.41 (0.09) | 0.56 | |||
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||||||||||
|
.71 | |||||||||
Tele | 5 (5.7) | 2 (1.9) | 8 (7.6) | 39 (36.7) | 51 (48.1) | 4.20 (0.10) | 0.43 | |||
In-P | 2 (2.1) | 2 (2.1) | 5 (5.2) | 33 (34.4) | 54 (56.2) | 4.41 (0.09) | 0.40 | |||
|
.007 | |||||||||
Tele | 5 (4.7) | 6 (5.7) | 29 (27.4) | 38 (35.8) | 28 (26.4) | 3.74 (0.10) | 0.49 | |||
In-P | 2 (2.1) | 2 (2.1) | 14 (14.6) | 30 (31.2) | 48 (50.0) | 4.25 (0.10) | 0.41 | |||
|
.27 | |||||||||
Tele | 5 (4.7) | 0 (0.0) | 6 (5.7) | 39 (36.8) | 56 (52.8) | 4.30 (0.09) | 0.40 | |||
In-P | 2 (2.1) | 1 (1.0) | 4 (4.2) | 26 (27.1) | 63 (65.6) | 4.53 (0.08) | 0.45 | |||
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|
.76 | |||||||||
Tele | 4 (3.8) | 2 (1.9) | 14 (13.2) | 42 (39.6) | 44 (41.5) | 4.13 (0.10) | 0.39 | |||
In-P | 2 (2.1) | 2 (2.1) | 10 (10.4) | 34 (35.4) | 48 (50.0) | 4.29 (0.09) | 0.41 | |||
|
.54 | |||||||||
Tele | 4 (3.8) | 3 (2.8) | 7 (6.6) | 40 (37.7) | 52 (49.1) | 4.26 (0.10) | 0.39 | |||
In-P | 2 (2.1) | 3 (3.1) | 6 (6.3) | 27 (28.1) | 58 (60.4) | 4.42 (0.09) | 0.42 | |||
|
.33 | |||||||||
Tele | 4 (3.8) | 0 (0.0) | 6 (5.7) | 37 (34.9) | 59 (55.6) | 4.38 (0.09) | 0.42 | |||
In-P | 3 (3.1) | 2 (2.1) | 5 (5.2) | 24 (25.0) | 62 (64.6) | 4.46 (0.10) | 0.53 | |||
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|
.37 | |||||||||
Tele | 5 (4.7) | 0 (0.0) | 10 (9.4) | 43 (40.6) | 48 (45.3) | 4.22 (0.09) | 0.32 | |||
In-P | 2 (2.1) | 1 (1.0) | 7 (7.3) | 32 (33.3) | 54 (56.3) | 4.41 (0.09) | 0.41 | |||
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|
.001 | |||||||||
Tele | N/Am | N/A | N/A | N/A | N/A | 4.19 (0.08) | N/A | |||
In-P | N/A | N/A | N/A | N/A | N/A | 4.40 (0.08) | N/A | |||
|
.22 | |||||||||
Tele | 2 (1.9) | 3 (2.8) | 5 (4.7) | 25 (23.6) | 71 (67.0) | 4.51 (0.08) | N/A | |||
In-P | 1 (1.0) | 1 (1.0) | 6 (6.4) | 20 (20.8) | 68 (70.8) | 4.59 (0.08) | N/A |
aThese columns show number and percentage of respondents selecting a given response.
bThese columns summarize tests of difference in means for items between formats.
cThis column shows the Spearman correlation between individual items and respondent’s overall rating of their experiences; all were significant at
dCronbach alpha: Tele .920 and In-
ePCC: patient-centered communication.
fTele: telehealth.
gIn-P: in-person.
hCronbach alpha: Tele .879 and In-
iCC: clinical competence.
jCronbach alpha: Tele .931 and In-
kIS: interpersonal skills.
lSE: supportive environment.
mN/A: not applicable.
Respondents rated the in-person experience somewhat higher across all 11 individual items (
Changes in satisfaction ratings for individual survey items between telehealth and in-person. Points are expressed as the deviation of the mean of individual survey items from the grand mean of 4.30 for in-person (horizontal axis) and telehealth experiences (vertical axis). Labels reflect the survey domain and item number as indicated in Table 2. Points above and/or to the right of their respective axis indicate items whose mean rating was above the grand mean of all items, while those to the left and/or below indicate points with ratings below the grand mean. The lower right quadrant contains items for which in-person mean ratings were above the grand mean, while in telehealth were below the grand mean. CC: clinical competence; IS: interpersonal skills; PCC: patient-centered communication; SE: supportive environment.
All individual survey items showed significant positive correlations with respondents’ overall rating of their experience, across both telehealth and in-person formats, based on Bonferroni-adjusted criteria. For telehealth, Spearman correlations ranged from 0.49 for the item related to thoroughness of the clinical examination (
Average ratings for all cardiologists across both telehealth and in-person formats was uniformly high; all means for both were above 4.0 on a five-point scale (
Average ratings of survey items relating to the telehealth (light grey bars) versus in-person experience (medium grey bars) by cardiologist. Dark grey bars represent the paired difference in ratings.
Reduced travel time was seen as a big advantage over traditional in-person appointments by 61 (57.5%) of the 106 respondents who participated in telehealth, and 94 (88.7%) viewed it at least somewhat of an advantage. Similarly, the majority (n=57, 53.8%) viewed reduced visit wait time as a big advantage, and 94 (88.7%) saw it as at least somewhat of an advantage. A similar percentage (n=87, 82.0%) saw travel cost savings as at least somewhat of an advantage to telehealth, including 43 (40.5%) who rated it as a big advantage. These data are summarized in
There was no relationship between communication modality (ie, phone, smartphone, computer, or tablet) and respondents’ overall rating of the telehealth experience (
Among the 106 respondents who participated in telehealth, fewer than 10% (range 4-9 respondents, 3.8%-8.5%) rated any of the potential issues as a big disadvantage; by contrast, individual survey items were rated as
This study takes advantage of the natural experiment provided by the COVID-19 pandemic to explore the utility of telehealth from the patient perspective. We found both opportunities and challenges related to accessibility, and the modality is perceived by patients as a viable alternative to in-person office visits and patients saw clear benefits to its use. Our results have implications for cardiology practices moving forward but should be interpreted with caution due to sampling constraints and the unique context of the global pandemic.
Internet and technology access do not seem to be significant barriers to the use of telehealth. Of the 193 initial respondents, 55 (28.4%) reported declining to use telehealth. However, among the 32 respondents who declined and reported factors, only a small percentage (n=2, 6.2%) cited access to technology as a factor in their decision. Of the 106 respondents who participated in telehealth, a similarly low percentage (n=8, 7.5%) viewed internet connectivity as a big disadvantage, though a more substantial 25.5% (n=27) did cite it as somewhat of a disadvantage. Nevertheless, patients expressed a fairly high level of satisfaction with telehealth, in terms of both average ratings among items and overall rating of their experience. Similarly, more than 70% of respondents reported unfamiliarity with technology (both hardware and software) as not being a factor in declining telehealth or as a disadvantage by those who participated (n=82, 77.4% and n=76, 71.7%, respectively). These findings suggest that, even during a period of rapid and unplanned change, internet access and use of technology are likely manageable issues for most patients and that continued, intentional efforts on the part of governments, health care systems, and corporate providers to address access disparities will only improve the situation moving forward.
However, there is some evidence that it may be harder to coordinate telehealth appointments, at least initially. Although respondents did not indicate significant issues in navigating or communicating as part of their telehealth appointments, our data do suggest there was some ambiguity about the need for or opportunity to participate in telehealth. Of the 32 respondents who did not participate in telehealth, 27 (84.4%) cited not having an appointment as at least somewhat of a factor in their decision. However, all patients invited to participate in the study had an appointment scheduled with their cardiologist prior to the COVID-19–related executive orders prohibiting in-person delivery of nonacute health care services; these appointments were shifted to a telehealth format. The most common reason patients did not meet their telehealth appointment was inability of the WKHL office to contact patients the day of their appointment, and we suspect miscommunication between the WKHL office and the patients or patients’ family members regarding changes in the appointment modality as the possible reason for this. Going forward, it will be important for providers to ensure consistent and reliable communication with patients to minimize any confusion regarding appointments.
There was no significant shift in rankings of patient satisfaction scores between modalities. Although satisfaction scores decreased somewhat in telehealth for all items, the decreases were generally modest and consistent. This suggests that the different modalities do not present qualitatively different challenges to establishing a physician-patient relationship, though more intentional effort may need to be applied across the board to ensure that patients perceive telehealth as offering an equivalent standard of care.
Satisfaction scores were high and consistent among all 7 cardiologists represented in the sample. Despite having little or no previous experience with telehealth, all physicians appeared to operate effectively within the new environment. On a broader scale, there were few if any differences in patient satisfaction scores among the four survey domains of the physician-patient experience, both within and among telehealth and in-person modalities.
The only item that showed a significant decrease in patient satisfaction between in-person and telehealth visits was the perceived thoroughness of the clinical exam. Our patient population included a substantial number of older and rural individuals, many with limited technology abilities, limited access to technology, and limited access to broadband connection. This translated into a significant proportion of telehealth visits done without face-to-face evaluation, which might have contributed to a lower scoring on the physical examination component.
This finding is also consistent with existing concerns regarding telehealth in specialty fields [
More than 80% of the 106 respondents identified time (n=94, 88.7%) and cost savings (n=87, 82.1%) as either somewhat or a primary advantage of telehealth, and overall satisfaction with telehealth was independent of the distance traveled by respondents to in-person appointments. This suggests that the perceived time and cost savings are threshold benefits that positively impact the majority of patients more or less equally. By contrast, privacy concerns were not viewed as a factor either by those who participated in telehealth or those who opted out. This pattern suggests that time and cost efficiency for patients should be a primary concern when implementing telehealth and that sensitive issues such as privacy protection can be readily accommodated.
Our study has some unavoidable limitations, due to its
Although our data highlight relevant lessons for the continued or expanded use of telehealth in cardiology, we must also be cautious. Satisfaction ratings of in-person appointments may be less reliable (and perhaps inflated) due to differences in reporting period; that is, we asked respondents to rate in-person experiences that occurred less recently than telehealth experiences. Longer reporting periods cause respondents’ ratings to be more affected by the most intense or recent experiences, while the impact of milder experiences is attenuated [
These caveats suggest that, although we could expect the patterns among individual survey items to hold, we should be cautious in assuming that the degree of equivalency observed between telehealth and in-person satisfaction can be generalized to new health care delivery contexts. They also argue for considering even nonsignificant trends, as these may be indicative of differences that could become accentuated in a more normal environment. Finally, they highlight the need for randomized controlled trials to truly evaluate differences between in-person and telehealth experiences.
The overall level of satisfaction expressed with telehealth and perceived time- and cost-saving benefits identified by patient indicate that it can play an increasing role in providing health care access and services beyond COVID-19, particularly in rural areas. As such, the efficacy of telehealth needs to be better examined, especially in medical specialty fields, and patient and provider perception of telehealth needs to be evaluated to determine if it is worth expanding into regular practice. Increased literature on telehealth use in rural populations will hopefully aid in determining the best course of action in addressing health care disparities in a substantial part of the United States.
electronic medical record
Kruskal-Wallis
Patient Assessment of Communication During Telemedicine
Western Kentucky Heart and Lung
The authors would like to acknowledge the efforts of Dr Muhammad Akbar, Dr Jacqueline Dawson, Dr Mohammed Kazimuddin, Nick Dylan, and Dr Patrick Jones for their help with literature review and developing the survey, and John Michael Mills in preparation of this manuscript.
None declared.