CLOSING THE DIGITAL DIVIDE: IMPROVING TELEMEDICINE SATISFACTION THROUGH PRE-VISIT COMMUNICATION
Connie Shao*, Lauren Wood, Leah Lawler, Eric L. Wallace, Daniel I. Chu, Sushanth Reddy
The University of Alabama at Birmingham College of Arts and Sciences, Birmingham, AL
Introduction:
Telemedicine has been rapidly implemented since the COVID-19 pandemic, and we have previously shown significant disparities in telemedicine techniques (video, phone, or conversion from video to phone). The effectiveness of each telemedicine modality has not been rigorously studied. Therefore, we sought to examine patient satisfaction with telemedicine and identify potential avenues to reduce disparities in its use.
Methods:
Patient satisfaction data for patients older than 18 years were abstracted from telemedicine visit surveys at a tertiary care center in the Deep South Mar-Oct 2020. Each visit was preceded by a phone conversation from the clinic staff. Primary and secondary outcomes were conversion rate and satisfaction, respectively. Covariates collected included socio-demographic data and evaluation of the pre-clinic phone call. Both patient satisfaction and the usefulness of the pre-visit phone call were evaluated with a numeric 0-3 Likert scale. Chi-square t-tests were used to compare groups. Univariable and multivariable linear regressions were used to determine factors associated with conversion and satisfaction.
Results:
Of the 30,576 patients seen in the time period, 17,878 (58.5%) completed patient satisfaction surveys for the final analytical dataset. Most visits were video (43%) followed by phone (39%), and converted (18%). Patients with converted visits were older (mean age 58.1 vs 54.2 yr, p<0.0001), less likely to be commercially insured (45% vs 57%, p<0.0001), came from lower income areas ($57,239 vs $60,214, p<0.0001), and had less internet availability in their home ZIP (90.2% vs 92%, p<0.0001) than video visits. Importantly, patients experiencing conversion scored poorer pre-visit communication than those with video visits (2.33 vs 2.43, p<0.0001). Converted visits had worse (2.49) satisfaction than video (2.58) and phone (2.54) visits (figure, p<0.001). Patients with lower satisfaction were older (coeff: -0.004), more likely to have had a phone (-0.2) or converted (-0.3) visit. On multivariable analysis, increased age (coeff: -0.002), male gender (-0.2), phone (-0.1) and converted (-0.2) visits, and Black (-0.3) and Asian (-0.5) race were associated with decreased satisfaction. Only improved pre-visit communication (2.12) was associated with increased satisfaction.
Conclusion:
Historically vulnerable patients are experiencing more technical difficulty and decreased satisfaction with their telemedicine visits. Improved pre-visit communication is associated with improved satisfaction and may improve equity as telemedicine becomes pervasive and permanent.
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