Discussion
Telemedicine has become increasingly important over the past several
years and even more so during the COVID-19 pandemic. Telemedicine
provides an option for providers and patients to connect in a way that
limits possible exposure and conserves personal protective equipment.
Without a vaccine candidate, SARS-CoV-2 will likely continue to be a
clinical concern even after the immediate pandemic
ends.28 Otolaryngologists in particular are at
increased risk for occupational exposure to the
virus.29–31 It is thus important to consider the
broader role telemedicine could fulfill in otolaryngology practices.
However, it is equally important to examine how patients view their
experience, as patient satisfaction is an important metric of healthcare
quality and can play a major role in the long-term acceptance and
success of a telemedicine program.32
Previous studies of patient satisfaction with telemedicine across
medical specialties have shown that patients are generally
satisfied.6,33The few studies in the otolaryngology
literature on patient satisfaction with telemedicine also demonstrated a
high degree of satisfaction but are limited by small sample sizes and
methodology, often using single measures of
satisfaction,19,23 non-validated
surveys,20 or a selection of items from various
satisfaction surveys without independent, final
validation.21 To our knowledge, this is the largest
study addressing patient satisfaction with telemedicine in
otolaryngology and the only study utilizing a validated survey from the
larger telemedicine literature. Moreover, this is the first study to
examine otolaryngology head and neck patient satisfaction with
telemedicine during the COVID-19 pandemic.
The majority of patients reported high satisfaction with telehealth
visits, with average scores higher than 5 in the majority of components
of the survey. This finding echoes the results of previous telemedicine
patient satisfaction studies in
otolaryngology.20,23Specifically, patients noted that
telemedicine increased access to healthcare services, saved time, and
overall met their healthcare needs. Patients also frequently mentioned
cost savings.
While the interface quality component of the survey generally received
high scores across all three platforms, Item 10 (This system is able to
do everything I would want it to be able to do) received one of the
lowest averages scores with an average score of 5.27. Several
patients who gave it a low score reported that they did so because
telehealth visits do not allow for in-depth physical examinations
including flexible laryngoscopy rather than considering the capabilities
of the platform itself. On this topic, some patients noted that the
ability to screen share through one of the platforms (BlueJeans) was an
asset in that it allowed the physician to show and explain imaging
findings similarly to an in-person visit, a feature not available on the
other two platforms. Despite this, the high scores in the three other
questions of this component suggest that patients were generally
satisfied with the interface quality. As patients complete virtual
consultations across a variety of clinical circumstances, platforms, and
specialists, patients will likely become aware of additional ways
telemedicine addresses their needs. Careful needs analyses will be
necessary in future studies to better capture this component as
telemedicine evolves and patient familiarity with telemedicine
capabilities increases.
Patients also reported high satisfaction with interaction quality,
indicating that the telemedicine visit was effective for
provider-patient interactions. Patients indicated that they were able to
both easily talk to (average score 6.60, item 11) hear (average score
6.63, item 12), and see (average score 5.91, item 14) the physician. This stands in contrast to previous work that has found the
patient’s ability to clearly hear the clinician is often
poor.33,34Notably, the most commonly reported issue
with the telemedicine visits was an issue with audio. Once
troubleshooted and resolved, patients highly rated the quality of the
audio component. In 4 cases, poor interaction quality secondary to
issues with connectivity or technical difficulties resulted in the
conversion of a video-based telemedicine visits to a telephone call.
The reliability subsection, designed to assess if the telemedicine visit
is as reliable as in-person service, also had a low average score. Part
of this score is explained by Item 15 (I think the visits provided over
the telehealth system are the same as in-person visits), which had the
lowest average score (4.02) of the survey. Many patients, after hearing
this question added additional narrative comments that visits by
telemedicine were not the same due to limitations on physical exam and
lack of “human touch”. The other two questions of this section (Items
16 and 17) were commonly answered as not applicable, with many patients
indicating that they had no issues or problems at all. Thus, the
patients who did rate these statements were the ones with problems,
contributing to the lower average score. Other studies have also found
low scores on the reliability subsection.33,34This
could be explained by the same phenomena observed by the present study
or related to other studies that introduced patients to new software
that necessitated specific computers and fast internet speeds, which
participants did not have.34 By contrast, patients in
the present study used Facetime, a platform many routinely use,
or relatively simple videoconferencing software on personal electronic
devices.
Interestingly, no patients expressed doubts regarding security or
quality of care provided by the telemedicine visit. Patients with high
satisfaction with quality of care speculated that not all complaints
would be appropriate for virtual consultation and that quality is thus
circumstance dependent. This is in contrast to consumer market surveys
that have demonstrated consumer concerns primarily around security of
health information and the quality of care delivered through
telemedicine.35 This shift in attitude could represent
increasing patient utilization of and comfort with technology as it
becomes more prevalent or may be secondary to increased acceptance of
the necessity of virtual visits during COVID-19.