JMIR Publications

ABSTRACT

Background:

The use of telemedicine has increased dramatically through the COVID-19 pandemic. While data is available about patient satisfaction with healthcare through telemedicine, little is known about the immigrant patient experience.

Objective:

We sought to determine whether immigrant patients would prefer in-person visits and have higher ratings for interpersonal communication during in-person compared to telemedicine visits. We hoped to identify the reasons behind immigrant visit preferences and use these reasons to guide suggestions for more equitable use of and access to visit options.

Methods:

Two hundred and seventy patients including 122 immigrants and 148 non-immigrants were seen by four Internal Medicine providers in either an in-person (n=132) or telemedicine (n=138) university practice setting. Immigrants were defined as having been born outside of the US. Patients were queried between February and April of 2021 utilizing an adaptation of a previously validated patient satisfaction survey containing standard questions developed by the Consumer Assessment of Healthcare Providers and Systems Program (CAHPS). Patients seen via in-person visits completed a paper copy of the survey. The same survey was administered by a follow-up phone call for telemedicine visits. Patients surveyed spoke English, Spanish or Arabic and were surveyed in their preferred language. For televisits, the same survey was read to the patient by a certified translator. The survey consisted of 9 questions on a Likert scale of 1-5 assessing satisfaction under the categories of access to care, interpersonal interaction, quality of care, and next visit preference. An additional write-in question assessed reasons for next visit type preferences. Survey question responses were compared by paired t-tests.

Results:

Across both immigrant and nonimmigrant patient populations, satisfaction with perceived quality of care was universally high regardless of visit type (P=.80,P=.60 for televisits and P=.76 and P=.37 for in-person visits). During televisits immigrants were more likely than nonimmigrants to feel providers spent sufficient time with them (P<.001). Different perceptions were noted among nonimmigrant patients. Nonimmigrants tended to perceive more provider time during in-person visits (P=.006). When asked to comment on reasons behind next visit preference, nonimmigrant patients prioritized convenience; whereas immigrants noted the telemedicine advantage of not having to navigate other office logistics.

Conclusions:

While satisfaction was high for both telemedicine and in-person visits across immigrant and nonimmigrant populations, significant differences in patient priorities were identified. Immigrants found televisits desirable because they felt they spent more time with their providers and were able to avoid additional office logistics that are often challenging barriers for non-English speakers. This suggests opportunities to utilize information technology to provide cultural and language-appropriate information throughout the immigrant in-person and telemedicine visit experience such as assistance with call-in scheduling, appointment reminders, and portal access. A focus on diminishing these barriers will help to reduce health care inequities among immigrant patients.