Satisfaction of Telehealth in Patients With Established Neuromuscular Disorders

The development of evaluation scale of the patient satisfaction with telemedicine: a systematic review

BACKGROUND

Since the outbreak of the COVID-19 pandemic, telemedicine become more and more popular, patients attempt to use telemedicine to meet personal medical needs. Patient satisfaction is a key indicator of insight into the patient experience.

PURPOSE

This systematic review aims to explore the measurement factors of patient satisfaction with telemedicine and develop a more comprehensive and systematic scale of patient satisfaction with telemedicine.

METHODS

In February 2023, a literature search was conducted on the PubMed, EMBASE, and Web of Science, identifying measurement factors and tools of patient satisfaction with telemedicine. For inclusion, the studies had to have or make a questionnaire about patient satisfaction with telemedicine delivered through video/audio visits in English. The quality of the studies was evaluated according to the Critical Appraisal Tool for Analytical Cross-Sectional Studies of the Joanna Briggs Institute (JBI). The dimensions and items in each tool were also analyzed.

RESULTS

The initial search showed 14,020 studies. After eliminating duplicates and utilizing inclusion and exclusion criteria, 44 studies were included. This systematic review identified and integrated the measurement factors and develops a scale of patient satisfaction with telemedicine, which was divided into 9 dimensions and consists of 37 items.

CONCLUSION

Future measurement and evaluation of telemedicine will benefit from scale that was developed in this study, and it will more directly reflecting patient needs when patient satisfaction with telemedicine is evaluated.

Eye Segmentation Method for Telehealth: Application to the Myasthenia Gravis Physical Examination

Due to the precautions put in place during the COVID-19 pandemic, utilization of telemedicine has increased quickly for patient care and clinical trials. Unfortunately, teleconsultation is closer to a video conference than a medical consultation, with the current solutions setting the patient and doctor into an evaluation that relies entirely on a two-dimensional view of each other. We are developing a patented telehealth platform that assists with diagnostic testing of ocular manifestations of myasthenia gravis. We present a hybrid algorithm combining deep learning with computer vision to give quantitative metrics of ptosis and ocular muscle fatigue leading to eyelid droop and diplopia. The method works both on a fixed image and frame by frame of the video in real-time, allowing capture of dynamic muscular weakness during the examination. We then use signal processing and filtering to derive robust metrics of ptosis and l ocular misalignment. In our construction, we have prioritized the robustness of the method versus accuracy obtained in controlled conditions in order to provide a method that can operate in standard telehealth conditions. The approach is general and can be applied to many disorders of ocular motility and ptosis.

Assessment of the role of telemedicine in the outcome of multiple sclerosis patients

Background

Multiple sclerosis (MS) is a chronic autoimmune disease, affecting about 2.5 million people worldwide. Telemedicine is a relatively recent telecommunication tool that has multiple formats such as store-and-forward, interactive video conferencing, remote medical record access, and remote patient monitoring. Telemedicine can be used to assess individuals with MS regarding their disease process, the development and impact of new symptoms as well as inquire about health behaviors that promote effective self-management. In this study, we aimed to evaluate the effect of telemedicine on patient satisfaction, clinical outcome and financial feasibility for MS patients.

Results

Sixty MS patients from the MS unit, at Kafr Elshikh General Hospital, were recruited and divided into 2 groups; 30 in the telemedicine group and 30 in the control group. Both groups were followed up for 12 months. We found a significant difference between the telemedicine group compared to controls as it showed less severe visual symptoms (p 0.006), a smaller number of dropouts (p 0.034) and higher patient satisfaction, with no significant difference between the two groups in the number of relapses, gait, bowel and bladder, lower limb weakness.

Conclusion

Telemedicine was found to be a promising practice that can be used to promote, coordinate and adjust ongoing clinical services of MS patients.

Telehealth utilization and patient satisfaction in an ambulatory movement disorders center during the COVID-19 pandemic

INTRODUCTION

Studies suggest that patients are satisfied with telehealth in ambulatory settings. However, tele-neurology satisfaction data are limited by a small sample size and COVID-19-era data is not specific to movement disorders clinics. In this prospective observational study, telehealth utilization during the COVID-19 pandemic was assessed, and patient satisfaction was compared between telehealth and in-person visits in an outpatient movement disorders center.

METHODS

Patients ≥18 years who completed an appointment at Northwestern's Movement Disorders Clinic were invited to complete a post-visit Medallia survey. The primary outcomes of the survey were likelihood to recommend (LTR) provider, LTR location, and 'spent enough time,' on a 0-10 scale. Responses were categorized into in-person vs. telehealth groups.

RESULTS

Telehealth utilization significantly increased from a pre-COVID timeframe rate of 0.3% (Nov 2019 to Feb 2020) to 39.5% during the COVID-19 pandemic (March 2020 through April 2021) (p-value < 0.001). During the COVID-19 pandemic, 621 patients responded to the post-visit Medallia survey (response rate = 30%), including 365 in-person and 256 telehealth visits. No significant differences were observed between in-person and telehealth encounters in LTR provider (p = 0.892), LTR location (p = 0.659), and time spent (p = 0.395). Additional subgroup multivariable analysis did not support differences in satisfaction between different age groups.

DISCUSSION

With its large sample size, our study demonstrates that in the setting of increased TH utilization in movement disorders clinic during the COVID-19 pandemic, patients reported similar satisfaction with telehealth compared to in-person visits. This study supports the utility of telehealth to provide specialized neurologic clinic care.

Delivering multidisciplinary neuromuscular care for children via telehealth

Introduction/Aims

In response to coronavirus disease 2019 (COVID‐19) pandemic restrictions int 2020, our face‐to‐face (F2F) multidisciplinary neuromuscular clinic (NMC) transitioned to widespread use of telehealth (TH). This study aimed to (1) understand parent/guardian, child, and clinician perceptions of TH; (2) examine TH‐related changes in clinical activity; and (3) use these findings to inform a future model of care for the NMC.

Methods

A clinical audit was undertaken to examine clinical activity throughout 2018–2020. Online surveys were distributed to clinicians and parents of children attending the NMC via TH in 2020. A working group of clinicians created a checklist to guide a future hybrid model of TH and F2F care.

Results

Total clinical activity in 2020 was maintained from previous years; 62.8% of all appointments occurred via TH, and 82.3% of patients attended NMC by TH at least once. Ninety‐nine parents (30.6% response rate), 52 children, and 17 clinicians (77% response rate) responded to the survey. All groups reported better interaction when F2F compared to TH. Eighty percent of parents identified advantages of TH and reported lower levels of stress. A lack of “hands‐on” physical assessment was identified by parents and clinicians as a TH limitation. Most families (68.1% of parents; 58.8% of children) and all clinicians indicated a preference for a mix of TH and F2F NMC appointments in the future.

Discussion

This study has informed a checklist to guide future TH use in a new hybrid model of care. Further investigation is required to assess health impacts of TH use in pediatric neuromuscular care.

Telemedicine for outpatient palliative care during COVID-19 pandemics: a longitudinal study

Objectives

During the COVID-19 pandemic, telemedicine (TM) emerged as an important mean to reduce risks of transmission, yet delivering the necessary care to patients. Our aim was to evaluate feasibility, characteristics and satisfaction for a TM service based on phone/video consultations for patients with cancer attending an outpatient palliative care clinic during COVID-19 pandemics.

Methods

A longitudinal observational study was conducted from April to December 2020. Consecutive patients were screened for video consultations feasibility. Either patients or their caregivers received video/phone consultations registering reason and intervention performed. Those contacted at least twice were eligible for experience of care assessment.

Results

Video consultations were feasible in 282 of 572 screened patients (49%, 95% CI 45% to 52%); 112 patients among the 572 had at least two phone/video consultations and 12 of them had one or more video consultations. Consultations were carried out with patients (56%), caregivers (30%) or both (14%). 63% of the consultations were requested by the patients/caregivers. Reasons for consultation included uncontrolled (66%) or new symptom onset (20%), therapy clarifications (37%) and updates on diagnostic tests (28%). Most interventions were therapy modifications (70%) and appointments’ rescheduling (51%). 49 patients and 19 caregivers were interviewed, reporting good care experience (average of 1–5 satisfaction score of 3.9 and 4.2, respectively). The majority (83% and 84%) declared they would use TM after the pandemics.

Conclusions

Although feasibility is still limited for some patients, TM can be a satisfactory alternative to in-person visits for palliative care patients in need of limiting access to the hospital.