Telemedicine was found to elicit high levels of patient acceptance with no discernible changes in outcomes/care related to medical decision making, time to appointment, or patient satisfaction in a single-arm cross-over study, the results of which were published in Gastroenterology.
The coronavirus disease 2019 (COVID-19) pandemic has led to a rapid expansion of telemedicine (eg, video and telephone visits) to provide patients with continued access to care while minimizing in-person contact. The study authors evaluated the acceptance and outcomes of offering telemedicine as a first appointment option for initial gastroenterology appointments prior to the onset of the pandemic to inform decisions regarding telemedicine use during the pandemic and thereafter.
The study population included adults who were electronically referred to the San Francisco Medical Center from January 1, 2016 to September 30, 2019 for routine outpatient gastroenterology consultation. This period excluded a transition period of training, preparatory activities, and holidays, held from October 1, 2018 to December 31, 2018.
During the study period, 7146 appointments had new referrals for gastroenterology consultation and, of them, 4890 patients completed 5431 appointments via either an office or telemedicine visit. The pre-intervention analysis included 4260 visits from 3802 members; the post-intervention analysis, 1171 visits from 1088 members.
The intervention was associated with a substantial and significant increase in patients completing a telemedicine visit (6.6% vs 62.1% of visits, pre/post-intervention, respectively; P <.01). The average patient time to appointment, defined as the referral date to the visit date, was comparable pre/post-intervention (8.7 days vs 7.4 days, respectively; P =.19).
The percentage of patients with a subsequent return/follow-up in-person or telehealth appointment was also similar pre/post-intervention (16.2% vs 11.2%, respectively; P =.15), without trends for additional change post-intervention. The percentages of patients receiving prescriptions, secure messaging, radiology, gastrointestinal procedures, or subsequent laboratory testing continued this pattern of similarity pre/post-intervention.
Importantly, the telehealth intervention was not associated with marked changes in either composite or individual component patient satisfaction ratings. However, the investigators observed an “immediate increase” in the composite score among patients who were unfamiliar with their providers prior to their respective visits. Eighty percent and 90% of patients ranked their provider as “very good/excellent” pre- and post-intervention, respectively.
Evaluation of a patient population from a single medical center, combined with temporal changes such as general use of a remote medical assistant telephone service in 2019 and increasing use of physician assistants, constitute limiting factors, but these and other temporal shifts were likely adjusted for, according to the study authors. Nevertheless, the findings validate telehealth’s utility in the gastroenterological setting, they said.
“In conclusion, a rapid transition to telemedicine in gastroenterology can be successfully implemented and is associated with comparable measures of clinical decision making, post-visit healthcare utilization, and patient satisfaction” as in-person visits, the investigators asserted.
Munroe CA, Lin TY, Rouillard S, Fox J, Lee JK, Corley DA. Influence of telemedicine-first intervention on patient visit choice, post-visit care, and patient satisfaction in gastroenterology. Gastroenterology. Published online October 16, 2020. doi: 10.1053/j.gastro.2020.10.020