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25th June 2021
In a 2010 report from the World Health Organization (WHO), it was suggested that information and communication technologies (ICT) have a great potential to address some of the challenges faced by both developed and developing countries in the provision of accessible, cost-effective and high-quality health care. The WHO reported recommended that countries capitalise on the potential of ICT so that ultimately telemedicine strengthens, rather than competes with, other health services. While a 2012 observational study found that the value of virtual consultations was broadly similar to traditional face-to-face methods, a 2015 systemic review concluded that electronic consultations (or e-consults), are feasible in a variety of settings, flexible and facilitate timely speciality advice. Fast forward 10 years and in the midst of the global COVID-19 pandemic, health service providers have been forced into augmenting their ICT to enable continuity of clinical care. But what are today’s clinician’s perception of telemedicine consultations was a question addressed by a team from the department of medicine, Yale university, US. The team focused on physicians working in the area of infectious diseases (ID) and recruited two groups of participants: referring providers, i.e., physician assistants, advanced nurse practitioners and the ID consultants themselves based at the hospital.
The team created a web-based survey and defined an electronic consult or “e-consult” as a telemedicine consultation. The level of satisfaction with e-consults was assessed via perceptions of the quality, timeliness and amount of verbal communication compared with traditional face-to-face consultations, based on three categories: worse, the same or better. In addition, using the same three categories, respondents were asked “compared to traditional consults, e-consults provided good clinical care”.
A total of 130 surveys were analysed, representing a 23.6% response rate and completed by 107 referring providers and 23 ID consultants. Considering e-consults to traditional methods, in terms of quality, overall, 66.9% of respondents stated that these were either the same or better; with respect to timeliness, 95% reported that e-consults were the same or better and finally, 80% of respondents felt that communication was the same or better. In total, 80% of respondents agreed that e-consults provided good clinical care. However, there were some differences between the two groups of respondents. For instance, the majority (73.9%) of consultants rated the quality of care as being worse than face-to-face versus 24.3% for providers and 91.3% of consultants (versus 44.9% of referring providers) reported that timeliness was better for e-consults. Furthermore, a higher proportion of consultants felt that there were specific situations where face-to-face consultations were necessary (87% vs 33.6%).
In a discussion of their findings, the authors reported that it was reassuring to see an overall high level of agreement that e-consults provided good clinical care. While it was not explored in the study, they suspected that the poor rating for the quality of e-consults among consultants was probably a reflection of the need to undertake a physical examination of a patient with an infective disease. They concluded that future studies should explore the reasons for consultant dissatisfaction with telemedicine and the effect of virtual consultations on infectious disease outcomes.
Canterino JE, Wang K, Golden M. Provider Satisfaction with Infectious Diseases Telemedicine Consults for Hospitalised Patients During the COVID-19 Pandemic. Clin Infect Dis 2021