Office of Patient Experience, Clinical Transformation, Cleveland Clinic, Cleveland, OH, United States.
Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, United States.
J Med Internet Res. 2021 Jun 21;23(6):e18488. doi: 10.2196/18488.
Patient satisfaction with in-person medical visits includes patient-clinician engagement. However, communication, empathy, and other relationship-centered care measures in virtual visits have not been adequately investigated.
This study aims to comprehensively consider patient experience, including relationship-centered care measures, to assess patient satisfaction during virtual visits.
We conducted a large survey study with open-ended questions to comprehensively assess patients' experiences with virtual visits in a diverse patient population. Adults with a virtual visit between June 21, 2017, and July 12, 2017, were invited to complete a survey of 21 Likert-scale items and textboxes for comments following their visit. Factor analysis of the survey items revealed three factors: experience with technology, patient-clinician engagement, and overall satisfaction. Multivariable logistic regression was used to test the associations among the three factors and patient demographics, clinician type, and prior relationship with the clinician. Using qualitative framework analysis, we identified recurrent themes in survey comments, quantitatively coded comments, and computed descriptive statistics of the coded comments.
A total of 65.7% (426/648) of the patients completed the survey; 64.1% (273/426) of the respondents were women, and the average age was 46 (range 18-86) years. The sample was geographically diverse: 70.2% (299/426) from Ohio, 6.8% (29/426) from Florida, 4.2% (18/426) from Pennsylvania, and 18.7% (80/426) from other states. With regard to insurance coverage, 57.5% (245/426) were undetermined, 23.7% (101/426) had the hospital's employee health insurance, and 18.7% (80/426) had other private insurance. Types of virtual visits and clinicians varied. Overall, 58.4% (249/426) of patients had an on-demand visit, whereas 41.5% (177/426) had a scheduled visit. A total of 41.8% (178/426) of patients had a virtual visit with a family physician, 20.9% (89/426) with an advanced practice provider, and the rest had a visit with a specialist. Most patients (393/423, 92.9%) agreed that their virtual visit clinician was interested in them as a person, and their virtual visit made it easy to get the care they needed (383/421, 90.9%). A total of 81.9% (344/420) of respondents agreed or strongly agreed that their virtual visit was as good as an in-person visit by a clinician. Having a prior relationship with their virtual visit clinician was associated with less comfort and ease with virtual technology among patients (odds ratio 0.58, 95% CI 0.35-0.98). In terms of technology, patients found the interface easy to use (392/423, 92.7%) and felt comfortable using it (401/423, 94.8%). Technical difficulties were associated with lower odds of overall satisfaction (odds ratio 0.46, 95% CI 0.28-0.76).
Patient-clinician engagement in virtual visits was comparable with in-person visits. This study supports the value and acceptance of virtual visits. Evaluations of virtual visits should include assessments of technology and patient-clinician engagement, as both are likely to influence patient satisfaction.
患者对面对面医疗就诊的满意度包括医患互动。然而，虚拟就诊中的沟通、同理心和其他以关系为中心的护理措施尚未得到充分研究。
本研究旨在全面考虑患者体验，包括以关系为中心的护理措施，以评估虚拟就诊期间患者的满意度。
我们进行了一项大型调查研究，使用开放式问题全面评估了不同患者群体在虚拟就诊中的体验。邀请 2017 年 6 月 21 日至 7 月 12 日期间进行虚拟就诊的成年人在就诊后完成一项包含 21 个李克特量表项目的调查和评论框。对调查项目进行因子分析，揭示了三个因素：技术体验、医患互动和总体满意度。多变量逻辑回归用于测试这三个因素与患者人口统计学、临床医生类型和与临床医生的先前关系之间的关联。使用定性框架分析，我们在调查评论中识别出反复出现的主题，对评论进行定量编码，并计算编码评论的描述性统计数据。
共有 65.7%（426/648）的患者完成了调查；64.1%（273/426）的受访者为女性，平均年龄为 46 岁（范围 18-86 岁）。样本在地域上具有多样性：70.2%（299/426）来自俄亥俄州，6.8%（29/426）来自佛罗里达州，4.2%（18/426）来自宾夕法尼亚州，18.7%（80/426）来自其他州。在保险覆盖方面，57.5%（245/426）不确定，23.7%（101/426）拥有医院员工健康保险，18.7%（80/426）拥有其他私人保险。虚拟就诊类型和临床医生各不相同。总体而言，58.4%（249/426）的患者进行了按需就诊，而 41.5%（177/426）进行了预约就诊。41.8%（178/426）的患者与家庭医生进行了虚拟就诊，20.9%（89/426）与高级实践提供者进行了虚拟就诊，其余的则与专科医生进行了虚拟就诊。大多数患者（393/423，92.9%）认为他们的虚拟就诊临床医生对他们个人感兴趣，他们的虚拟就诊使他们能够轻松获得所需的护理（383/421，90.9%）。81.9%（344/420）的受访者同意或强烈同意他们的虚拟就诊与临床医生的面对面就诊一样好。与虚拟就诊临床医生有先前关系的患者在虚拟技术方面的舒适度和易用性较低（比值比 0.58，95%CI 0.35-0.98）。在技术方面，患者发现界面易于使用（392/423，92.7%）且使用舒适（401/423，94.8%）。技术困难与总体满意度较低的几率相关（比值比 0.46，95%CI 0.28-0.76）。
虚拟就诊中的医患互动与面对面就诊相当。本研究支持虚拟就诊的价值和接受度。虚拟就诊评估应包括技术和医患互动评估，因为两者都可能影响患者满意度。
