Patient and physician satisfaction with telemedicine for monitoring vital signs

We evaluated user satisfaction with realtime telemedicine for monitoring vital signs. Over eight weeks, 20 patients and 12 residents in family medicine participated in the study. At the end of the study, the patients and doctors completed a questionnaire detailing satisfaction with the service. Responses were obtained from 18 of the 20 patients and were generally positive: 61% were comfortable using the system and 94% did not believe that the technology had a negative effect on their relationship with the health-care provider. Eleven physician responses were obtained. Physicians were more uncertain about the benefits of the service: only 45% felt that telemedicine could adequately assess patients, although 82% felt that telemedicine would be an important part of primary-care services. From a user perspective, our study showed that patients were more satisfied with the telemedicine service than were doctors.     

Patient and physician satisfaction in a clinical study of telemedicine in a hypertensive patient population

We studied patient and physician satisfaction with telemedicine for the care of a hypertensive population. Once recruited, participants were seen both in person and via telemedicine (in random order) on the same day. After each meeting, patient and physician satisfaction surveys were completed. In the 12-month study, there were 107 pairs of visits. The physicians reported a small but significant increase in workload, mental effort, technical skills and visit duration for telemedicine when compared with face-to-face consultations. They noted that the telemedicine system worked well in the majority of cases and could reduce the need for future treatment. Patients reported slightly but significantly higher satisfaction scores for the following for in-person than for telemedicine meetings: technical quality, interpersonal care and time spent. Patients reported high satisfaction scores for both telemedicine and in-person visits.     

Determining clinician satisfaction with telemedicine

We compared two methods of assessing clinician satisfaction with telemedicine. Clinicians completed a self-administered questionnaire with a preference ranking scale and a discrete choice method. Sixty-three clinicians completed the questionnaire (a 78% response rate). The preference ranking method showed that clinicians ranked the level of skill of the other clinician as the most important (55%) attribute of a teleconsultation and the completeness of the history as the second most important attribute (42%). The discrete choice method showed that clinicians ranked completeness of the patient's history as the most important attribute and risk of receiving wrong advice as the second most important. The use of discrete choice preferences provides an alternative and more objective method for collecting data about preferences in telemedicine. However, its use is not simple and requires the participants to be engaged in person rather than sent a questionnaire by post.     

User satisfaction with a telemedicine amputee clinic in Saskatchewan

A group of 15 patients with amputee-related diagnoses were given a satisfaction survey after telemedicine assessment. Most of the videoconferencing sessions used an IP connection at 768 kbit/s. The patients were seen at four sites. The average connection time was less than 5 min and the average time for a session was approximately 40 min. Thirteen questions required scaled responses (poor, fair, good, excellent) and two required yes/no answers. The 13 categories broadly related to satisfaction with the telemedicine service and the quality of specialist care. In all categories, 97% of the responses fell in the good to excellent range. Concerns were raised about ease of access to local telemedicine sites, connection waiting times and lack of familiarity with telemedicine technology. The study showed that telemedicine was acceptable to patients with amputations and provided a reliable assessment of the amputee.     

Developing prison telemedicine systems: the Greek experience

Prison telemedicine systems operate in circumstances in which the provision of medical care is very expensive. In 1999 the Greek Ministry of Justice decided to use telemedicine to improve health services in the largest prison in Greece (Korydallos Prison, in Athens). The Nikea Hospital in Piraeus undertook to support the effort in order: to enable prison paramedics and guards to call for remote evaluation of inmates when the prison's doctors were off duty; to provide second opinions; and to allow screening and primary care coverage for inmates through teleconsultations with Nikea Hospital specialists. For 12 months following installation, intensive 'hands-on' training on the use of the system was offered to the staff of both the Korydallos Prison and the Nikea Hospital. In all, 400 physicians, nurses and paramedics were trained. Despite all this effort, there were serious operational problems related either to prison bureaucracy or to the inflexibility of the Greek national health system, which annulled the effectiveness of the prison telemedicine system. The experience suggests that prison telemedicine is a viable option if freed from bureaucratic and labour-related obstacles, and can improve the quality of care available to prisoners.     

Physician satisfaction in a managed care environment.

BACKGROUND. The professional literature suggests that changes toward the bureaucratization of medical practice have led to increasing job dissatisfaction, especially in primary care. To investigate this claim, we surveyed physicians in Dane County, Wisconsin, who practice in a bureaucratic setting. Dane County has experienced essentially a demise in independent practice, ie, most physicians practice in organizational settings where expenses and total patient income are pooled. About 85% of physicians have joined one of the six competing health maintenance organizations (HMOs). METHODS. In 1986 all 850 physicians in Dane County were surveyed to determine their perceptions of clinical freedom, satisfaction with income, status in their profession, autonomy, resources, and professional relations, and their overall satisfaction. RESULTS. We found that over 69% of primary care physicians were very satisfied or satisfied with their practices overall compared with 68% of physicians in all specialties. Differences between family practice and other primary care specialties were not statistically significant. Our regression analysis showed that only for satisfaction with income were responses from primary care physicians significantly different from those of physicians in surgical specialties. Perceptions of clinical autonomy and specific organizational settings were more important to predicting satisfaction. Also, age and sex contributed to differences in satisfaction with resources and status, respectively. CONCLUSIONS. We conclude that satisfaction can be fairly high for primary care physicians in bureaucratic settings similar to that of Dane County.     

Patient satisfaction with telediabetes education in Hong Kong.

Forty-one patients suffering from type 2 diabetes mellitus were selected to receive diabetes education at a local health centre via low-cost videoconferencing equipment. The educational material was transmitted from the diabetic centre of a district hospital. Four educational sessions were carried out over 4.5 months. Satisfaction was measured using a self-administered questionnaire on the completion of the programme. Of the 41 subjects who participated in the study, 36 (88%) completed the questionnaire. Patients reported a high level of satisfaction with most aspects of the education process. The mean total score on the questionnaire was 61.9 (SD 9.4); the highest possible total score was 75. There was a significant positive correlation between age and satisfaction level (r=0.39). The results showed that diabetes education conducted via telemedicine was highly acceptable to diabetic patients.     

Patient satisfaction in developing countries.

Efforts to obtain useful information on patient satisfaction in Indonesia have been frustrated by a tendency of respondents to withhold critical comment. A survey of 75 patients in eleven health centers on three islands attempted to obtain credible information on satisfaction by asking for information on events, not opinions, and on the relative importance of the factors surveyed. Unlike previous research where 95% of respondents typically answered they were 'fully satisfied', 28% of the respondents replied that their consultation had not been conducted in private (ranked first in importance among the nonmedical factors), 65% said the facility could be cleaner (ranked second in importance) and 19-48% reported not receiving various kinds of information (ranked third). Lending credence to these results, the respondents were able to support their positive answers with corroborative information in a high percentage of instances. The ranking of relative importance of satisfaction factors was unexpected. At the bottom of the list were continuity of provider, waiting time, availability of amenities, cost and social interaction with the provider. Despite the diversity among cultures that is characteristic of Indonesia, there was a high degree of similarity in the importance rankings among respondents on the three islands which were chosen to represent cultural divisions in the nation. The only notable differences in the rankings of relative importance appeared to be a function of the purpose of the visit to the facility.     

Patient age and satisfaction with home care.

Hawaii's Medicaid-sponsored comprehensive home care program serves disabled people of all ages. A client survey explored the relationship between age and satisfaction with services. Most younger clients had become disabled through accidents, while older clients were disabled from multiple chronic conditions. Although satisfaction ratings were generally high, a statistically difference between ratings by age group occurred with the youngest patients expressing the least amount of satisfaction. Reasons for these findings and implications for program operation are discussed.     

An evaluation of satisfaction with telemedicine among health-care professionals

A survey was conducted among non-doctor health-care professionals in six rural counties in Missouri. The purpose of the survey was to establish baseline data to evaluate the effect of changes in the health-care sector, especially technology changes, on the job satisfaction, career satisfaction, relationships and communication activities of health professionals. The survey included three rural counties in which integrated telecommunication and interactive video telemedicine services were being installed, but before significant activities had begun, and three comparator counties without substantial integrated telecommunications infrastructure and telemedicine services. During a one-month study period, 1108 questionnaires were distributed. The total response rate was 50.1% (n = 555). Of the respondents, 30.3% indicated that technology in health-care was having a large effect on their work, although only 18.2% indicated that telemedicine and telecommunications were having a large effect. No systematic differences were found among the health professionals in the two communities at the time telemedicine equipment was being installed.     

The environment for telemedicine in the Canary Islands.

We studied the environment for telemedicine in the Canary Islands. The population's attitude to telemedicine was surveyed in 503 questionnaire interviews with doctors, nurses, paramedical staff and patients on the seven islands. Almost half the respondents (46-50% across groups) had a positive opinion of telemedicine. We also collected data about telephone medicine. A total of 479 medical-support telephone calls were made to four doctors, in psychiatry, ophthalmology and paediatrics. The telephone calls resolved the problem in 73% of cases and 86% would have come to the doctor if not made. Therapy was prescribed in 11% and 10% were just for information. The number of telephone calls per day was highest in psychiatry. Finally, we carried out a detailed analysis of the number of transfers between the islands (14,942 people in 1995 and 22,418 in 1996). According to the number of transfers and location of the referral hospital, oncology, psychiatry, dermatology and traumatology were the specialties that would be most likely to benefit from telemedicine.     

Patient satisfaction with store-and-forward teledermatology

We assessed patient satisfaction with a nurse-led store-and-forward teledermatology service in Manchester. A teledermatology nurse obtained the patient's history, took digital photographs of the patient's skin lesion and then sent the information to a hospital dermatologist, who responded with management advice the following week. Of 141 patients who attended their teledermatology appointment, 123 (50 male, 73 female) completed the study questionnaire (87%). The average age of respondents was 42 years (SD 17, range 18-90 years). Ninety-three per cent reported that they were happy with the teleconsultation while 86% reported that it was more convenient than going to the outpatient clinic. Forty per cent agreed that they would feel more comfortable seeing the dermatologist in person while only 58% were comfortable with not speaking to the dermatologist about their skin condition. The absence of interaction with the dermatologist and the delay in receiving management advice may have contributed to the somewhat low satisfaction rates.     

Patient satisfaction with obstetric care

Patient satisfaction with obstetric care was studied in a cohort of postpartum women from a rural midwestern county. Birth certificate data defined the population, and satisfaction data were acquired through a mailed questionnaire. An indirect measure (satisfaction scale) was derived with acceptable construct validity and internal consistency. A direct measure (open-ended questions) elicited specific comments about each woman's recent experience with obstetric care. Satisfied women, as described by the scale, were more likely to have had good physician continuity and to have attended childbirth classes. The open-ended responses most frequently described problems relating to the physician-patient relationship. In comparing the indirect and direct measures, women with high satisfaction scores were more likely to make no critical comments about their obstetric care (chi 2 = 9.16, P less than .003). The patient's perception of the physician's attitude of concern emerged as an important issue in both measures. The data demonstrate that perceived physician concern is an important component of patient satisfaction with obstetric care.