70. Patient valuation of telemedicine in spine care: what do patients want?

Abstract

<h3>BACKGROUND CONTEXT</h3> Telemedicine was widely adopted to maintain a functioning health care system at the start of the COVID-19 global pandemic. The long-term viability of telemedicine will depend not only on its safety, efficiency, and cost-effectiveness from the physician and health system point of view, but also on patient perception of its benefits and limitations, as well as their willingness to continue using it as in-person visit restrictions are eased. <h3>PURPOSE</h3> The aims of this study were two-fold: 1. To characterize patient preference for telemedicine vs in-person evaluation and 2. To identify factors affecting telemedicine valuation through both quantitative and qualitative means. <h3>STUDY DESIGN/SETTING</h3> Survey-based study. <h3>PATIENT SAMPLE</h3> Using our institution's clinical registry and electronic health records, we identified both audiovisual and audio-only patient telemedicine encounters conducted within the Division of Spine Surgery in the Department of Orthopaedic Surgery between March 20, 2020 and September 1, 2020. <h3>OUTCOME MEASURES</h3> Survey responders were compared to nonresponders across key sociodemographic data. Categorical, Likert-scale, and free-form responses aimed at delineating and understanding specific influencers of patient use of and experience with telemedicine were analyzed. <h3>METHODS</h3> Between March 20, 2020 and September 1, 2020, patients who sought spine care via an audiovisual or audio-only telemedicine encounter were identified. Using a secure patient communication portal or telephone, patients were contacted and asked to participate in a survey-based study. Question format included categorical, Likert scale-based, and free-form response items. Bivariate analyses and Spearman correlation coefficients were calculated. For all analyses, p<0.05 was significant. <h3>RESULTS</h3> Of 457 patients, 139 (30%) completed the survey; responders were not significantly different from nonresponders across sociodemographic characteristics including age, gender, race, and insurance type (p>0.05 for all comparisons). Average age of the responders was 61.8 years (Standard Error = 1.2). Most patients had more than one telemedicine experience prior to completing the survey (n = 98 [70.5%]). Average travel time saved was 107.6 minutes (Standard Deviation = 81.3), and the average rating of difficulty with telemedicine technology was 2.9 out of 10 (SD = 2.7), with 1 signifying very easy and 10 signifying very challenging. High levels of patient-rated care and experience were seen across in-person and telemedicine visits; however, in-person visits were rated significantly higher in both respects (9.3 out of 10 vs 8.7 out of 10 for patient-rated care [p<0.05] and 9.0 out of 10 vs 8.4 out of 10 for patient-rated experience [p<0.05]). A preference for in-person first-time visits was found, which was not maintained for follow-up appointments. Lower patient age and less difficulty with technology significantly correlated with higher levels of patient satisfaction (p<0.05). Qualitative analysis of free-form responses provided by 113 patients (81%) uncovered several positive, negative, and neutral themes with respect to patient experiences with telemedicine. <h3>CONCLUSIONS</h3> While high levels of care and highly rated patient experience can be achieved through both virtual and in-person care, in-person care was significantly better in these respects. Furthermore, patients had a strong preference for in-person first-time visits, which was not maintained for follow-up visits. These ratings and preferences were evident despite overall little difficulty with telemedicine technology and significant travel time saved. Free-form responses supported and further contextualized these findings. Thus, while telemedicine may continue to be an important component of spine care moving forward, patients are ready to see and be seen by their physicians again. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.