dr
Evidence-Based Answer[PS1] :
Yes. Patients rate video telemedicine visits comparably to face-to-face visits for satisfaction and quality of care. (SOR: B, systematic review and cross-sectional studies) Time saved is an advantage; video communication and technical concerns are disadvantages. (SOR: B, systematic review and cross-sectional study) Predictors of higher satisfaction with telemedicine include patient understanding of telehealth, female gender, and uninsured status. (SOR: B, cross-sectional study) Cross-sectional studies included patients agreeable to telehealth visits and may be subject to selection bias. More studies are needed in primary care.
Evidence Summary:
A 2000 systematic review assessed 32 studies[PS2] with more than 2,300 patients from 1966 to 1998 that measured patient satisfaction after video telehealth consultations with healthcare providers.1 The review included 1 RCT (N=104), 1 case control study (N=50), and 30 cross sectional studies with participant inclusion via random selection, referrals, convenience samples, volunteers, or unspecified techniques). Included studies ranged over varying healthcare provider settings from family medicine to a range of differing specialties. Studies were excluded if they used telecommunication technology for educational or administrative purposes not involving provision of care to patients. The primary outcome was overall participant satisfaction with telemedicine. There was no standardized outcome measure used; 26 studies used survey instruments, while 1 used qualitative analysis and 5 did not specify. Methodological heterogeneity therefore precluded formal statistical analysis and there were no numbers to report in this study. The authors conducted qualitative analysis of the data and findings with no standardized scoring method. The qualitative analysis revealed that video telemedicine was generally well-accepted in all studies; specific advantages were access to specialist care, less travel, and reduced wait times; disadvantages were video communication. Authors critically appraised each study using a checklist and found several concerns related to validity and generalizability of individual studies. This study is limited by the subjective nature of qualitative analysis and unclear methodology of the analysis; the largest study in this review (N=585) was conducted in a prison setting, limiting generalizability of results to the general patient population.
A 2018 cross-sectional study surveyed adults (N=764) who completed video telehealth visits at an urban academic hospital system in Philadelphia during 2015 to 2016 to evaluate their satisfaction after a non-urgent video telehealth visit.2 Participants had concerns suitable for telehealth (as determined by the provider), agreed to download an electronic application, and remotely attend a scheduled video telehealth visit with a physician or advanced nurse practitioner in one of various specialties; 32 of 3018 visits were in family medicine. A few of the participants (15%) had prior experience with video telehealth visits[PS3] (other baseline characteristics were not provided). Primary outcomes included participant
[PS1]Can you give an example of how to quantify conclusions as you had suggested?
[PS2]In response to the editor’s criteria about pertinent studies, all studies included interactive video (that was an inclusion criteria of this systematic review). The appendix only details 17 of the 32 studies (they included the ones with patient numbers >20); 14 of those do compare telehealth with face-to-face visits, and 13 out of those 14 studies demonstrate that participants rate telehealth as same or better than face-to-face consultations. I’m not sure why the appendix doesn’t include the other studies that had patient numbers <20. Should I look into each of those individually?
[PS3]I deleted the social media background information on the participants, as it looks like not all 764 respondents got this question (only 88 answered this)
Ryan Gorji MD
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