Telemedicine Well Accepted in Urogynecology Clinic Early in the COVID-19 Pandemic
Key findings
- On March 16, 2020, the Female Pelvic Medicine & Reconstructive Surgery Program at Massachusetts General Hospital underwent a mandated transition to synchronous telemedicine care for all non-urgent appointments
- Between March 16, 2020, and May 22, 2020, 135 patients with a mean age of 63, responded to a survey about their telemedicine visit. Of those surveyed, 89% reported that the overall quality of the visit was better than they expected
- Most patients thought telemedicine reduced waiting time (87%) and allowed more time with the provider (71%). 19% of patients reported difficulty with technology, and 10% reported difficulty finding a private place at home for the visit
- 89% (94% new consults and 87% established) of patients indicated a willingness to continue to receive urogynecology care through the telemedicine platform
- Willingness to continue was not significantly affected by age (<65 vs. ≥65), modality used (video vs. telephone), comorbidities, previous exposure to telemedicine, or distance from the hospital
On March 16, 2020, the Female Pelvic Medicine & Reconstructive Surgery Program in the Department of Obstetrics and Gynecology at Massachusetts General Hospital underwent a mandated transition to telemedicine care for all non-urgent appointments. The hospital had just implemented synchronous videoconferencing system-wide.
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Physicians in the clinic developed a survey to assess participants' perceptions of telemedicine and their willingness to continue that mode of healthcare delivery beyond the period of social distancing and government-recommended restrictions.
In Urogynecology, Emily Von Bargen, DO, and Youngwu Kim, MD, of the Division of Female Pelvic Medicine and Reconstructive Surgery, reported high rates of willingness to continue, regardless of age and telemedicine modality use.
Methods
Once telemedicine was mandated, all patients in the urogynecology clinic were encouraged to participate, even those predicted to need an in-person follow-up examination. Telephone calls were offered to patients whose visits could not be completed by videoconference.
An interpreter was made available by video or telephone as needed. In advance of the telemedicine visit, patients received written instructions, and on the day of the visit, they received phone-based technology support.
Patients who completed a telemedicine visit between March 16 and May 22, 2020, were invited afterward to participate in an online survey.
Respondent Characteristics
135 of 202 respondents completed the survey. Their mean age was 63; 56% were ≥65, and 44% were <65.
50% of patients used a smartphone, 26% a personal computer, 18% a conventional telephone, and 6% a tablet computer. 67% lived within a 20-mile radius of the hospital, and 95% lived within a 100-mile radius, but eight patients lived more than 100 miles away, and five lived more than 500 miles away.
Perceptions of Care
89% of patients indicated the telemedicine visit's overall quality was better than they expected. Other key responses were:
- 96% of patients said telemedicine decreased travel time
- 87% said telemedicine decreased waiting time
- 71% thought telemedicine allowed them to spend more time with their healthcare providers
- 19% reported difficulty with technology
- 10% reported difficulty finding a private place at home for the visit
Willingness to Continue
21 patients (16%) were told they needed an in-person evaluation after their telemedicine visit. They were excluded from the analysis of questions about willingness to continue telemedicine.
Of the 114 other patients, 89% indicated a willingness to continue to receive urogynecology care via telemedicine. Willingness was high among both new consults (94%) and established patients (87%).
Willingness to continue was not significantly influenced by age group (<65 vs. ≥65), modality used (video vs. telephone), comorbidities, previous exposure to telemedicine, or distance of the patient's home from the hospital.
Among the patients who said they were unwilling to continue telemedicine, the top reasons cited were missing in-person interaction with ancillary office staff members (27%) and difficulty forming a relationship with the healthcare provider (16%).
Limitations to Consider
It's worth emphasizing this study was conducted during the first two months of the COVID-19 pandemic when telemedicine was novel for most people. Patient perceptions may have become even more favorable as the efficiency of telemedicine evolved—or they may have become less favorable as social distancing orders and other restrictions were lifted.
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