Patient satisfaction with virtual clinic during Coronavirus disease (COVID-19) pandemic in primary healthcare, Riyadh, Saudi Arabia

Examination of Factors Influencing Patient Satisfaction with Virtual Clinic Experience During COVID-19 in MNGHA, Saudi Arabia

Introduction: The COVID-19 pandemic crisis brought great challenges on health care systems around the world, forcing many services to slow or temporarily shut down, including medical services in Saudi Arabia (SA). Health care institutions had to adapt new strategies such as virtual clinics to continue delivering care in light of the situation. Virtual clinics and telemedicine are relatively new and limited literature is available regarding patient's experience in SA. Therefore, the aim of this study is to assess and evaluate the levels of patients' satisfaction with the experience of services provided by virtual clinics at the Ministry of National Guard Health Affairs. Method: A retrospective cross-sectional study based on secondary data collected by the corporate patient experience department at MNGHA. The analysis included all virtual clinics' visits from four MNGHA regions (Central, Eastern, Western, and AlMadinah) between April 19 and May 15, 2020. Findings: The results showed that more than half of our study participants were females (57%) (N = 7,803) and (64%) (N = 8,696) were between the age of 21-64 years. Most of the participants were from the Central region (73%) (N = 10,026). More than half of virtual visits were to hospitals (66%) (N = 9,098). Results from the ordinal regression showed that age, gender, region and, survey method were significantly associated with extreme satisfaction score (4.21-5.0). Males were more likely to be extremely satisfied than females (OR = 1.088), and patients between the ages of 6-20 were extremely satisfied compared with the age group 41-64 (OR = 1.309). Eastern region was more likely to be extremely satisfied than central region (OR = 1.121). Patients surveyed by calls were more likely to be extremely satisfied compared with SMS surveys (OR = 1.808), whereas facility type showed no significance. The overall satisfaction score was 4.1 out of 5. Interpretation: According to our findings, the majority of patients were satisfied with the experiences of virtual clinics at MNGHA. Therefore, we recommend exploring more frequent use of virtual clinics when appropriate beyond the pandemic. Virtual clinics can minimize the risk of disease transmission, save travel time, and is considered a cost-effective alternative to traditional clinics.

Development and Validation of the Saudi Telehealth Acceptance Scale Based on the Unified Theory of Acceptance and Use of Technology

Background

Telehealth is in early stages in the Kingdom of Saudi Arabia (KSA). Identifying barriers to using telehealth is an essential step prior to its implementation; however, no theoretically based scales exist for the same purpose.

Objective

To design a theory-based scale capable of measuring telehealth users' perceptions of benefits, barriers, and social influence in the KSA.

Methods

The Saudi Telehealth Acceptance Scale (STAS) was constructed based on the Unified Theory of Acceptance and Use of Technology and its content validity was determined by eight experts using the modified Delphi process. Only items with a content validity index score of ≥0.83 were chosen. Finally, the face validity of the questionnaire for healthcare professionals, which was in English, was determined by eight healthcare professionals, and for the patient version, which was in Arabic, by six patients.

Results

Initially, 37 items were identified; however, after Round 1, 29 items remained and after Round 2, 24 items were included in the STAS for both healthcare professionals and patients. In the healthcare professionals scale, there were 7 performance expectancy (PE) items, 6 effort expectancy (EE) items, 3 social influence (SI) items, 4 facilitating conditions (FC) items, and 4 behavioral intention (BI) items, while in the scale for patients, there were 9 PE items, 4 EE items, 3 SI items, 4 FC items, and 4 BI items.

Conclusions

The two new scales showed evidence of content and face validity. The significance of the two scales is that they were both designed in the context of the healthcare system in the KSA and could provide standardized data collection tools to measure the acceptance of telehealth among HCPs and patients.

Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis

Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.

Patient Opinions about Virtual Consultations in Saudi Arabia: A Nationwide Cross-Sectional Study

There have been no nationwide studies of patient opinions regarding telehealth in Saudi Arabia to identify the factors that might influence patients' perceptions and satisfaction. This was a prospective cross-sectional study of adults in the general population who last engaged with a healthcare practitioner via a virtual appointment. The participants were recruited by convenience sampling across Saudi Arabia between November 2023 and January 2024, completing a questionnaire that gathered data on (i) basic demographic and virtual consultation information and (ii) telehealth service delivery and technology based on the Telehealth Usability Questionnaire. Of the 916 participants, 53.7% were female, with a mean age of 47.2 (14.1) years. Nearly half attended primary care appointments, with the remainder attending a range of hospital specialties. Over 90% preferred having a virtual appointment over an in-person visit. About half had telephone consultations, while about a third had video calls through hospital-provided platforms; >90% found virtual appointments useful and convenient, easy to use, effective, reliable, and produced a favorable clinical interaction; and 97.4% were satisfied with their remote consultation experience despite the technical interruptions. The individuals who were less happy with their virtual consultation were significantly younger, lived in urban areas, attended specialty clinics, were seen by a psychologist, preferred in-person appointments, and had consultations by telephone. These data provide momentum to continue with and expand telehealth, especially through video calls, supported by educational initiatives.

A Delphi Study on Identifying Competencies in Virtual Healthcare for Healthcare Professionals

BACKGROUND

Virtual care adoption accelerated during the COVID-19 pandemic, highlighting the need for healthcare professionals to develop relevant competencies. However, limited evidence exists on the core competencies required for quality virtual care delivery.

OBJECTIVE

This study aimed to identify the critical competencies physicians, nurses, and other health professionals need for adequate virtual care provision in Saudi Arabia using a Delphi method.

METHODS

A 3-round Delphi technique was applied with a panel of 42 experts, including policymakers, healthcare professionals, academicians, and telehealth specialists. In Round 1, an open-ended questionnaire elicited competencies needed for virtual care. The competencies were distilled and rated for importance in Rounds 2 and 3 until consensus was achieved.

RESULTS

Consensus emerged on 151 competencies across 33 domains. The most prominent domains were communication (15 competencies), professionalism (13), leadership (12), health informatics (5), digital literacy (5), and clinical expertise (11).

The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study

BACKGROUND

The global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman.

METHODS

A retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments.

RESULTS

A total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments.

CONCLUSION

The rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments.

Telemedicine in non-communicable chronic diseases care during the COVID-19 pandemic: exploring patients' perspectives

Purpose

This study aimed to explore challenges facing patients using Telemedicine consultations in non-communicable chronic disease clinics in primary care settings and to evaluate their satisfaction and willingness to use this service in the future.

Methods

This is an analytical cross-sectional study enrolling participants who were randomly selected from representative primary care centers in Bahrain and providing Telemedicine consultations. A semi-structured questionnaire permitted data collection using telephone interviews.

Results

A total of 251 individuals participated in the study of whom the majority were Bahraini (90.04%), and the mean age was 54.48 ± 10.78 years. Most of the participants 231 (92.03%) were satisfied with the Telemedicine consultation while only 142 (56.80%) were willing to use this service in the future. The main perceived challenges related to Teleconsultations were the lack of physical examination, inadequate time of TM consultation, fear of medical errors, and lack of privacy. The willingness to use TM consultation in the future was mainly determined by the degree of comfort to tell private information (p < 0.01) and to less extent the ease of the communication tool (p = 0.005) on multivariate analysis.

Conclusion

TM consultations could be a good complement to conventional consultation formats in the future. The sustainability of this innovative healthcare delivery tool requires addressing acceptability by users, ease of use, patient-centeredness, and technological advances to ensure privacy.

The impact of COVID-19 on patient engagement with primary healthcare: lessons from the saudi primary care setting

BACKGROUND

There have been significant achievements in controlling COVID-19 in Saudi Arabia (SA), but as in most healthcare settings worldwide, health services have been seriously disrupted. Also, with pandemic control measures such as lockdowns and curfews, and innovations such as digital health services, the delivery of primary healthcare (PHC) services has dramatically changed. However, little is known about patients' experiences of PHCs during the pandemic, their views on the pandemic-related interventions in SA, and patient views on impact on their medical care.

METHODS

Qualitative semi-structured online interviews were conducted for twenty-four Saudi patients across SA aged 18 and above who were diverse in terms of age, gender, education and health status. Data were analysed using thematic analysis yielding four major themes as an impact of COVID-19 on patient engagement with PHCs.

RESULTS

The COVID-19 pandemic has had profound mixed impacts on patient engagement with PHC in SA. Fear of infection or of breaking lockdown rules has negatively impacted the utilisation of PHCs but positively changed patients' attitudes towards seeking medical help for self-limiting conditions. The pandemic has also negatively impacted routine preventive care at PHCs, especially for patients with long-term health conditions. The mandatory use of some digital health services in SA that existed pre-pandemic has provided patients with a perception of better care during the pandemic. Yet, a lack of awareness of optional digital health services, such as virtual clinics, hindered optimal use. Despite pandemic-related disruption of patient engagement with PHCs, the reduced waiting time in PHC centres and healthcare providers' communication and empathy during the pandemic contributed to patients' perceptions of better care compared to pre-pandemic. However, patients living outside the main cities in SA perceived care quality as less good during the pandemic compared to PHCs in the main cities in SA.

CONCLUSION

The lessons learned from patients' experiences and views of PHCs during the pandemic were beneficial in promoting patient engagement with PHCs. The digital health services mandated in response to the pandemic have accelerated digital health innovation in SA and allowed patients to recognise the benefits of digital health. This has huge potential for increasing continuous patient engagement with PHCs. Yet, patients' experiences of digital health services during the pandemic are essential for informing appropriate implementation and utilisation of e-health services. Patients' positive experiences of PHCs during the pandemic, such as the reduction in waiting times and the perception of improved healthcare providers' professionalism, communication and empathy, can be built on to sustain engagement with PHC services. These findings might have significance for clinicians and policymakers to support patient engagement with PHCs, particularly in healthcare systems like SA that struggle with the overuse of emergency departments (EDs) for PHC-treatable conditions.

Telemedicine Breastfeeding Consultation: The Saudi Experience

Background Telemedicine is widely used in health specialties. Yet, the experience of telemedicine use and its effectiveness in breastfeeding support is a research gap. The purpose of this study was to describe the pattern of telemedicine use for breastfeeding support in Saudi Arabia and to explore patients' satisfaction with the service. Methods A cross-sectional survey was conducted in outpatient settings at Ministry of Health facilities in several Saudi regions. The number of breastfeeding consultations over one year (2021) was analyzed in terms of region, month, method of consultation, and women's maternity status. Data on patient satisfaction and telemedicine techniques were gathered during 2022. Results Across the 16 regions enrolled in the project, 51,571 remote breastfeeding consultations were conducted, representing 28.2% of the total consultations. The eastern region reported the highest percentage (40.7%), and the southern region reported the lowest (2.4%). Almost two-thirds of the consultations were provided to lactating mothers (62.91%). Most data (90%) were collected from breastfeeding clinics in hospitals, and nurses were the main primary health care providers. The mean was 4,255 consultations per month. In terms of technology, telemedicine consultations were mostly conducted by phone (50%) and WhatsApp (38%). Satisfaction with telemedicine was reported by 80% of the participants, with a statistical difference found in those favoring telemedicine over in-person care (p=0.032), particularly for those using phone consultations and Telegram (p<0.001). WhatsApp respondents had the commonest neutral responses (p<0.001). Conclusion Telemedicine breastfeeding care has been widely established with high patient satisfaction. A national protocol outpatient lactation services with an intergrated hospital and primary care services and involvement of different health care professionals are recommended. Although breastfeeding counselling is proven to have a positive change on breastfeeding indicators, telemedicine tool per se needs further work on its role in breastfeeding indicators. Triage of cases to be evaluated face-to-face or referral to a specialist after telemedicine lactation care is an area for future work.

Patient Perceptions and Satisfaction With Virtual Clinics During the COVID-19 Pandemic: A Cross-Sectional Study

Background Virtual clinics played an important role for many patients during the COVID-19 pandemic. We conducted this cross-sectional study to evaluate patient perceptions and their satisfaction with virtual clinics during and after COVID-19 in Saudi Arabia. Methods An online questionnaire-based survey with questions in both Arabic and English was conducted among patients who attended outpatient clinics at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia from May 2021 to September 2021. Demographic variables, the clinic type, and the level of satisfaction with the remote appointments were recorded. Descriptive statistics and logistic regression analysis were used to analyze the data.  Results A total of 1274 participants filled out the survey. Of them, 831 (65.23%) were females, and 749 (58.79%) were aged 18 to 30 years old. Of the sample studied, 411 (32.26%) had appointments with their healthcare provider remotely since the beginning of the pandemic; 311 (75.67%) were satisfied or highly satisfied with the remote appointments; and 198 (48.18%) participants desired to continue using virtual services post-COVID-19 pandemic. Logistic regression analysis showed that females were more satisfied with virtual clinics than males (OR= 1.18, 95% CI (1.01, 1.40), p=0.04). The age group of 18 to 30 was more satisfied than other age groups (OR= 53.23, 95% CI (2.01, 1347.18), p=0.02). Conclusion The majority of the participants who used virtual clinics were satisfied with the service. Nearly half of the participants wanted to continue using virtual services even after the COVID-19 pandemic was over. More effort should be made to increase patient awareness and knowledge about virtual clinics.

Awareness and acceptance of teleclinic services during COVID-19 in the general population in Riyadh: Cross-sectional study

BACKGROUND

The first COVID-19 case in Saudi Arabia was reported on March 2, 2020. The Saudi government introduced the "937" service number as one of the telemedicine services for COVID-19 information. Telemedicine uses telecommunication and information technologies in the medical field to deliver healthcare services and improve patients' health status. This study aims to estimate the frequency of teleclinics usage during COVID-19, assess awareness of teleclinics, and assess acceptance of teleclinics during COVID-19 in the Saudi population.

MATERIALS AND METHODS

The cross-sectional study used a convenient sample encompassing the 1,583 Saudi and non-Saudi adult population of Riyadh, Saudi Arabia, and was conducted online between August 2020 and April 2021. A self-administrated online questionnaire was distributed to all participants and data were collected on sociodemographics, knowledge of use of teleclinics, and its acceptance. Analysis of quantitative data by t-test and association of qualitative variables by Chi-square test was conducted. Regression analysis was performed on the significant values of univariate analysis. Data were analyzed by SPSS 25.

RESULTS

Most (92.5%) participants were female and had a university education (65.9%). The main reason for using teleclinic was experiencing a new complaint (27.3%), next, for medications refill (13.2%), with COVID-19-related issues being the least common reason for using teleclinic (8.2%). The result shows that 77.1% of participants had a good level of acceptance of teleclinic. The regression analysis showed that number of teleclinics utilization, as an advantage it is more convenient, and recommending this service to someone else was significantly associated with acceptance of teleclinics in future.

CONCLUSION

As per the findings, the experience of using teleclinic positively impacts the level of acceptance of teleclinic among the population. The adoption of telemedicine for healthcare delivery during the COVID-19 pandemic helped limit the spread of the infection and reduce the risk of exposure to COVID-19 for both patients and healthcare providers. In the future, telemedicine can be used as an alternative to minor complaints and follow-up checkups. In this way, the burden of healthcare system can also be overcome.

Awareness and Use of Virtual Clinics following the COVID-19 Pandemic in Saudi Arabia

Studies have shown that virtual clinics enjoyed high use and high patient satisfaction during the COVID-19 pandemic. Thus, virtual clinics are expected to be the new normal mode of receiving care after the COVID-19 pandemic. This study aimed to assess public awareness and use of virtual clinics following the pandemic and identify factors associated with virtual clinic use. Methods: A cross-sectional design was employed in which data were collected via a structured online questionnaire based on the Technology Acceptance Model (TAM) domains: perceived usefulness, perceived ease of use, and social influence. Participants were selected based on the non-probability sampling of convenience. Univariate, bivariate, and binary logistic regression models were used for analysis. Results: A total of 405 responses were received; of those, 286 (70.6%) were aware of the existence of virtual clinics and 99 (34.6%) were post-pandemic users. Among users, 50% used virtual clinics more than two times, 72% used virtual clinics to seek care for themselves, with the vast majority using it via voice calls (83.8%), and for visits to the family medicine clinic (55%). Young adults, females, single adults, those with a higher level of education, the employed, and those with lower income were more likely to use virtual clinics (p < 0.05). The logistic regression model showed that 20% of the variation in virtual clinic use was explained by perceived usefulness and perceived use (p < 0.001). Conclusion: This study showed high awareness of virtual clinics among the population following the COVID-19 pandemic, with one-third being active users. Age, gender, marital status, education, income, employment status, perceived usefulness, and ease of use are associated with virtual clinics’ awareness and use. Considering those factors is important when planning for sustained use of e-health and virtual care.

Strength, Weakness, Opportunities, and Threats (SWOT) Analysis of Virtual Outpatient Department Under Telemedicine Department During the COVID-19 Pandemic

Background

COVID-19 pandemic has challenged all current management tools used for patient care. This study aims to determine strength, weakness, opportunities and threats (SWOT) to virtual OPD and consultants' perceptions of teleconsultation virtual OPD during the COVID-19 pandemic, adapting to newer technologies for successfully handling this situation.

Material and methods

A facility-based cross-sectional study was conducted at the Virtual OPD of All India Institute of Medical Sciences Rishikesh among patients availing Telemedicine consultation during the COVID-19 pandemic. All patients availing services from April 2020 to October 2020 were included in this study. Method for SWOT analysis: A checklist was prepared, and investigators assessed SWOT. An external evaluator was invited to evaluate the SWOT analysis conducted by the investigators. For numeric variables, the mean ± SD was used, and for categorical variables, percentages and proportions were used.

Results

 Around 22% of the patients who approached virtual OPDs were ≥ 60 years of age. More than half (55.3%) of the patients or their attendants who consulted Telemedicine OPD were from Uttarakhand, followed by Uttar Pradesh (42.6%). The proportions of male patients were 54.4%. Around 17.6% of teleconsultations were performed for radiotherapy. General medicine and cardiology consultations were (15.2%) and (12.8%), respectively.

Conclusion

Telemedicine can be effective if certain requirements had been provided. Maintaining privacy of the patient's data was a challenge.

COVID-19 Patients’ Satisfaction Levels with Nursing Care: A Cross-Sectional Study

Introduction

COVID-19 is the most recent coronavirus diseases that was first identified in December 2019 and began its exponential spread globally. The critical role of nurses can be severely impacted during pandemics such as COVID-19 when the world is less prepared.

Objective

To investigate and measure COVID-19 patients’ satisfaction levels with the quality of nursing care provided in the Riyadh Province of Saudi Arabia.

Methods

The study used a cross-sectional questionnaire to collect data from COVID-19 patients who were hospitalized or quarantined for at least 48 h or more. The study utilized the Arabic version of the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ-Ar) to assess patients’ satisfaction levels with nursing care. Descriptive statistics, Mann-Whitney U, and Kruskal-Wallis tests were performed to examine the objectives of the study.

Results

Ninety-six patients reported relatively high satisfaction levels with the overall nursing care. Patients also reported high satisfaction levels with the provided care, and the information that was provided. There were statistically significant differences in the mean score of patients satisfaction in relation to age, educational level, where patients are originally from, and patients recommendation of the hospitals.

Conclusions

Individual characteristics and attributes played a role in the process of evaluating nursing care services. Measuring nursing care quality clarified the significant role of nurses during the COVID-19 pandemic. This study provides valuable information that could help in identifying weaknesses and reinforcing strengths about nursing care to be fully prepared against pandemics and other health-related crises and emergencies in the future.

Dentistry during COVID-19: patients' knowledge and satisfaction toward health protocols COVID-19 during dental treatment

BACKGROUND

Coronavirus disease 2019 (COVID-19) as an infectious disease primarily spreading through droplet infection in dental treatment. Patient satisfaction is an indicator of healthcare quality service. Quality of healthcare service and patient satisfaction has been affected by the COVID‑19 pandemic. This study aims to assess the knowledge and satisfaction toward health protocols COVID-19 during dental treatment among dental patients.

METHODS

An institutional-based cross-sectional study was conducted on 270 dental patients using a self‑designed questionnaire consisting of knowledge and satisfaction about health protocols COVID-19 during dental treatment through a random sampling technique. Data were imported to SPSS version 21 for analysis. Descriptive and analytical statistics were used to identify the factors associated with their knowledge and satisfaction. A p value < 0.05 was considered statistical significance.

RESULTS

Totally, 270 dental patients with mean age of 37.6 ± 6.7 years participated in the study. The mean knowledge score was 36.7 ± 3.5, as considerable number of participants were unaware about the risk associated with dental treatment as well as restrictions imposed on dental procedures. About 18% of participants experienced one or other form of dental complaints during the lockdown period. The overall level of patient satisfaction was 44.6%.

CONCLUSION

It can be concluded that, public knowledge is to be improved about risk of virus transmission that can be related with dental treatment and also people should be encouraged to use virtual facilities, such as teledentistry, so that no dental emergencies is left untreated during the pandemic time. In addition, the level of satisfaction was in a medium level for dental patients in the study area. Specifically, we deduced from the results that social/physical distancing measures are one of the mechanisms to decrease the fear of exposure to the COVID-19.

Physicians’ Perceptions of Telemedicine Use During the COVID-19 Pandemic in Riyadh, Saudi Arabia: Cross-sectional Study (Preprint)

Background

Objective

Methods

Results

Conclusions

Patients' Perceptions and Satisfaction with the Outpatient Telemedicine Clinics during COVID-19 Era in Saudi Arabia: A Cross-Sectional Study

Successful implementation of virtual healthcare depends immensely on patients’ perceptions and satisfaction. This cross-sectional study assessed patients’ perceptions of, and factors associated with, poor and average satisfaction with the outpatient telemedicine clinics in the Kingdom of Saudi Arabia (KSA). This questionnaire-based survey was conducted among 720 patients who attended outpatient telemedicine clinics from different regions of the KSA. Of the sample studied, 54.7% of the participants had high satisfaction and the most common disadvantage perceived by patients was technical issues (53.1%), followed by fewer personal interactions (30.4%). Around 75% of the participants desired to use telemedicine services even after the COVID-19 pandemic. Logistic regression analysis revealed that age group more than 40 years (OR = 1.59; 95% CI = 1.04–2.44, p = 0.031), education less than university level (OR = 1.68; 95% CI = 1.07–2.15, p = 0.025), and first-time participants (OR = 3.28; 95% CI = 2.32–4.65, p < 0.001) were significantly associated with poor and average satisfaction ratings. The concerned authorities must make targeted action plans to circumvent the disadvantages perceived by patients accessing telemedicine. Furthermore, a multicenter, exploratory study that compares the virtual clinic with other telemedicine services in the KSA is warranted.

Digital health opportunities to improve Primary Health Care in the context of COVID-19: A Scoping Review (Preprint)

Background

The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown.

Objective

The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic.

Methods

We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis.

Results

A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies.

Conclusions

The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service.

Cost-effectiveness of telemedicine care for patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia

Background and aim:

Telemedicine could be used to provide diabetes care with positive clinical outcomes. Consequently, this study evaluated the cost-effectiveness of telemedicine for patients with uncontrolled type 2 diabetes mellitus (i.e. HbA1c >9).

Patients and methods:

This was a retrospective chart review of patients with uncontrolled type 2 diabetes attending an outpatient integrated care clinic. The study consisted of two arms, namely a telemedicine care model and a traditional care model with 100 patients in each. The clinical effectiveness (i.e. reduction in HbA1c) and the total cost in both arms were determined, and the incremental cost-effectiveness ratio was calculated. This study adopted propensity score matching.

Results:

The patients in the telemedicine care model had a mean reduction in their HbA1c level of 1.82 (95% CI = 1.56–2.09, p < 0.001), while those in the traditional care model had a mean reduction of 1.54 (95% CI = 1.23–1.85, p < 0.001). Consequently, the incremental effect was 0.28 (95% CI = −0.194 to 0.546). The mean total costs were SAR 4819.76 (US$1285.27) and SAR 4150.69 (US$1106.85) for patients in the telemedicine and traditional care models, respectively. Consequently, the incremental cost was SAR 669.07 (US$178.42) [95% CI = SAR 593.7 (US$158.32)–SAR 1013.64 (US$270.30)]. The ICER was estimated to be SAR 2372.52 (US$632.67) per 1% reduction in the level of HbA1c. Moreover, the telemedicine care model resulted in a higher cost and better outcome (i.e. reduction in the HbA1c level) with an 81.80% confidence level.

Conclusion:

Telemedicine care is cost-effective in managing type 2 patients with poorly controlled diabetes. Consequently, we believe that telemedicine care can be further expanded and incorporated into routine diabetes care.

Utilization of Health Applications Among Patients Diagnosed with Chronic Diseases in Jazan, Saudi Arabia During the COVID-19 Pandemic

PURPOSE

Health applications are employed to aid patients with chronic diseases in effective long-term disease management. This investigation aims to measure the utilization of health applications among patients diagnosed with chronic conditions during the COVID-19 pandemic.

METHODS

This cross-sectional investigation was conducted in the Jazan region in Saudi Arabia between October 2020 and March 2021. Data were collected during interviews using a semi-structured questionnaire. The questionnaire collected items about the patients' demographics, morbidity, and use of electronic devices and health applications developed by the Saudi MoH. Logistic regression was used to assess factors associated with odds of reporting use of applications.

RESULTS

A total of 658 patients were recruited. The mean age of the patients was 51 years, and 59% of them were females. The most frequently reported diagnosed condition was diabetes (53.5%), followed by hypertension (42.7%). Majority of the patients reported not using any health applications developed by the Saudi MoH (68.2%). Patients with higher educational levels and younger patients were more likely to report use of the applications (ORs: 4.2, 2.6 respectively). Comorbidity history and disease duration did not seem to influence the probability of reporting use of health applications (P-values >0.05).

CONCLUSION

Patients diagnosed with chronic diseases in Jazan had low utilization of health applications developed by the Saudi MoH. This indicates a need to encourage the use of these health applications, particularly among patients with chronic diseases and to consider use restriction among older patients with lower educational levels.