Jennifer M. Polinski, ScD, MPH, Tobias Barker, MD, Nancy Gagliano, MD, Andrew Sussman, MD, Troyen A. Brennan, MD, JD, MPH, and William H. Shrank, MD, MSHS

CVS Health, Woonsocket, RI, USA.

BACKGROUND: One-quarter of U.S. patients do not have a primary care provider or do not have complete access to one. Work and personal responsibilities also compete with finding convenient, accessible care. Telehealth services facilitate patients’ access to care, but whether patients are satisfied with telehealth is unclear.

OBJECTIVE: We assessed patients’ satisfaction with and preference for telehealth visits in a telehealth program at CVS MinuteClinics.

DESIGN: Cross-sectional patient satisfaction survey.

PARTICIPANTS: Patients were aged ≥18 years, presented at a MinuteClinic offering telehealth in January–September 2014, had symptoms suitable for telehealth consultation, and agreed to a telehealth visit when the on-site practitioner was busy.

MAIN MEASURES: Patients reported their age, gender, and whether they had health insurance and/or a primary care provider. Patients rated their satisfaction with seeing diagnostic images, hearing and seeing the remote practitioner, the assisting on-site nurse’s capability, quality of care, convenience, and overall understanding. Patients ranked telehealth visits compared to traditional ones: better (defined as preferring telehealth), just as good (defined as liking telehealth), or worse. Predictors of preferring or liking telehealth were assessed via multivariate logistic

KEY RESULTS: In total, 1734 (54 %) of 3303 patients completed the survey: 70 % were women, and 41 % had no usual place of care. Between 94 and 99 % reported being Bvery satisfied^ with all telehealth attributes. Onethird preferred a telehealth visit to a traditional in-person visit. An additional 57 % liked telehealth. Lack of medical insurance increased the odds of preferring telehealth (OR=0.83, 95 % CI, 0.72–0.97). Predictors of liking telehealth were female gender (OR=1.68, 1.04–2.72) and being very satisfied with their overall understanding of telehealth (OR=2.76, 1.84–4.15), quality of care received (OR=2.34, 1.42–3.87), and telehealth’s convenience (OR=2.87, 1.09–7.94)

CONCLUSIONS: Patients reported high satisfaction with their telehealth experience. Convenience and perceived quality of care were important to patients, suggesting that telehealth may facilitate access to care.

KEY WORDS: telehealth; patient satisfaction; access to care.

Leslie A. Morland, PsyD,1 Michelle Raab, MA,1,2 Margaret-Anne Mackintosh, PhD,1,2 Craig S. Rosen, PhD,3,4 Clara E. Dismuke, PhD,5,6 Carolyn J. Greene, PhD,1,7 and B. Christopher Frueh, PhD8,9

1 Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii.

2 Pacific Health Research and Education Institute, Honolulu,

3 Dissemination and Training Division, National Center for PTSD, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.

4 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.

5 Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VAMC, Department of Veterans Affairs, Charleston, South Carolina.

6 Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.

7 Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.

8 The Menninger Clinic, Houston, Texas.

9 University of Hawaii, Hilo, Hawaii.

All views and opinions expressed herein are those of the authors and do not necessarily reflect those of the respective institutional affiliations or the Department of Veterans Affairs.

Abstract

       Background: Although effective psychotherapies for posttraumatic stress disorder (PTSD) exist, high percentages of Veterans in need of services are unable to access them. One particular challenge to providing cost-effective psychological treatments to Veterans with PTSD involves the difficulty and high cost of delivering in-person, specialized psychotherapy to Veterans residing in geographically remote locations. The delivery of these services via clinical video teleconferencing (CVT) has been presented as a potential solution to this access to care problem. Materials and Methods: This study is a retrospective cost analysis of a randomized controlled trial investigating telemedicine service delivery of an anger management therapy for Veterans with PTSD. The parent trial found that the CVT con dition provided clinical results that were comparable to the inperson condition. Several cost outcomes were calculated in order to investigate the clinical and cost outcomes associated with the CVT delivery modality relative to in-person delivery. Results: The CVT condition was significantly associated with lower total costs compared with the in-person delivery condition. The delivery of mental health services via CVT enables Veterans who would not normally receive these services access to empirically based treatments. Additional studies addressing long-term healthcare system costs, indirect cost factors at the patient and societal levels, and the use of CVT in other geographic regions of the United States are needed. Conclusions: The results of this study provide evidence that CVT is a costreducing mode of service delivery to Veterans with PTSD relative to in-person delivery.

Key words: medicine, military medicine, telehealth, telepsychiatry

A review of 1,000 videoconferencing consultations

ABSTRACT

Objective To examine the financial and organizational characteristics, demand for services, and satisfaction outcomes of a growing telemedicine program serving both urban or suburban and rural populations.

Design Retrospective review of 1,000 consecutive telemedicine consultations in the University of California (UC) Davis Telemedicine Program. 

Setting Telemedicine videoconferencing units, used to integrate care in the UC Davis Health System among the UC Davis Medical Center and several urban or suburban primary care clinics, rural hospitals, and clinic affiliates.

Subjects A total of 657 consecutive patients who consented to a telemedicine consultation.

Main outcome measures Demographic information about the patient population, the rural and urban or suburban clinics, the types of specialty consultations, and telemedicine equipment used in the UC Davis Health System. Patient and physician satisfaction were measured on a 5-point Likert scale.

Results Patients and primary care physicians reported high levels of satisfaction. Rural clinics requested more and a greater variety of specialist consultations than urban or suburban clinics.

Conclusion Although referring physicians and patients indicate a high level of satisfaction with telemedicine services and insurers are negotiating reimbursement policies, additional research must investigate the reasons why some payers, patients, and providers resist participation in these services.

James P. Marcin1 , Ulfat Shaikh1 and Robin H. Steinhorn1

       The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists’ geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.