JMIR Publications

ABSTRACT

Background:

The rise of COVID-19 and the issue of a mandatory stay at home order in March 2020 led to the utilization of a direct to consumer model for cardiology telehealth. Kentucky serves as a unique study location. Besides practice specific restrictions, Kentucky contributes to the states’ top 10 ranking in age adjusted total cardiovascular deaths per 100,000 persons. This is further compounded by the fact that Kentucky is in the bottom 10 states in the country for household income and about 1 in every 4 households do not have a broadband internet connection. The utilization of cardiology telehealth in this unique setting is not well represented.

Objective:

We aimed to address the following questions: (1) how receptive were patients to moving to a telehealth model; (2) what was the level of patient satisfaction with telehealth relative to traditional visits; and (3) what do the findings suggest about future application of a telehealth model in specialty fields such as cardiology?

Methods:

We constructed an online survey through Qualtrics and invited all patients who had a visit scheduled during the COVID-19 telehealth only time frame to participate. Questions included factors for declining telehealth appointments, advantages and disadvantages associated with telehealth, and patient satisfaction ratings of telehealth and in-person visits in the key areas of patient-centered communication, clinical competence, interpersonal skills and supportive environments. We had 193 responses to our survey (9.6% response rate).

Results:

Advantages and Disadvantages of Telehealth: Reduced travel time, lower visit wait time and cost savings were seen as big advantages. Fewer than 10% rated any of the potential issues as a big disadvantage. Privacy concerns were the least problematic, with only 14.2% of respondents reporting this as at least somewhat of a disadvantage. Poor internet connectivity was of most concern rated as at least somewhat of a factor by 33.0% of respondents. Comparison of In-Person and Telehealth: Both in-person and telehealth were viewed favorably, but in-person rated somewhat higher across all 11 domains. Only the clinical competence domain generated a significantly lower mean score for tele (3.7 Vs 4.2, p=0.007), and this was driven entirely by the low rating on the thoroughness of the clinical exam. No significant differences were seen for Patient-Centered Communication (Cronbach’s alpha: Tele = 0.920; IP = 0.973), Supportive Environment, & Interpersonal Skills (Cronbach’s alpha: Tele = 0.931; In-P = 0.927). There was also high reliability among items within each survey domain, as Cronbach’s alpha values ranged from 0.879 to 0.973.

Conclusions:

This study takes advantage of the natural experiment provided by the COVID-19 pandemic to provide a comparative assessment of patient satisfaction with telehealth and in-person appointments. Patterns of satisfaction are consistent across modalities. Telehealth is a viable alternative to in-person cardiology appointments.