Patient and Provider Experience of Widespread Telemedicine Adoption in Ambulatory Pulmonary Practice During the COVID-19 Pandemic: A Cross-Sectional Study

Abstract

RATIONALE: The COVID-19 pandemic prompted broad implementation of telemedicine in the United States, accounting for nearly 50-60% of ambulatory encounters. Little is known about the experience of patients with chronic lung disease and their providers with this transition. We examined the impact of widespread telemedicine expansion on patients and providers within an academic ambulatory pulmonary practice. METHODS: This cross-sectional study included patients and providers from the UCSF Ambulatory Pulmonary Practices. Visits were conducted in-person or by telemedicine consultation between August 2019-September 2020. Patient experience was evaluated using the Press Ganey survey, which is administered to all patients after the visit. For this study, likelihood of recommending the provider's office and provider communication domains were assessed. We compared responses before widespread adoption of telemedicine (pre-TM, August 2019-February 2020) and after (post-TM, March 2020-September 2020). Providers who completed at least one telehealth visit during the study period were invited to participate in a survey assessing satisfaction, barriers and facilitators to telehealth, and the scope of pulmonary practice amenable to telemedicine. Patient and provider experiences were analyzed using a two sample t-test of difference in means. RESULTS: Pre-TM, 5% (167/3435) of visits were done by telemedicine, compared to 75% (2721/3635) post-TM. Press Ganey surveys were completed by 391 and 477 patients pre-TM and post-TM, respectively. There were no significant differences pre-TM vs post-TM for provider communication (p=0.78) or likelihood of referral (p=0.55), or between in-person and telemedicine consultation between August 2019- September 2020 for either provider communication (p=0.06) or likelihood of referral (p=0.31). 33 of 36 (92%) providers from general pulmonary, interstitial lung disease, cystic fibrosis, severe asthma, and lung transplant clinics completed the survey. 51% of responders were in practice for ≥10 years and providers spent an average of 13 hours per week ± 2.55 (SD) in clinic. Comparing telemedicine and office visits, providers reported no difference in visit comfort, and 60% reported no difference in quality. Most providers rated telemedicine and office visits equally among the patient evaluation, provider workflows/logistics, and overall experience domains, though telemedicine was preferred for short-term follow-up, providing access, and efficiency, and in-person visits were preferred for the ability to assess exam findings (Figure 1). CONCLUSIONS: After rapid adoption of telemedicine, patients rated visits highly and most would recommend their provider's office. Providers perceived telemedicine visits improved care access and efficiency. These findings are important for ongoing integration of telemedicine into our healthcare delivery models.