Patient Perceptions of Drive-Through Medical Treatment Facilities During the COVID-19 Pandemic

Sean Stuart, DO, LCDR, MC, USN; Sally Mandichak, MD, LT, MC, USN; Julianne Davison, MD, LT, MC, USN; Shai Ansell, MD, LT, MC, USN; Timothy Parker, MD, LT, MC, USN

Disclosures

Western J Emerg Med. 2021;22(5):1032-1036. 

In This Article

Discussion

The COVID-19 pandemic has placed further strain on a medical system already struggling with access-to-care issues. In addition to the potential burden of new disease, the challenge of how to deliver healthcare in a way that is both efficient and effective while minimizing transmission risk to both healthcare workers and patients poses a challenge. This challenge has contributed to the rapid growth of pre-pandemic healthcare delivery mechanisms such as telemedicine. A report by the US Department of Health and Human Services found that telehealth adoption increased by nearly 50% in primary care from January through early June 2020.[5] Likewise, countless drive-through COVID-19 screening centers were erected to facilitate mass population testing. Only a limited number appear to have offered traditional medical evaluation. While there is increasing evidence demonstrating the feasibility of these systems, there is limited evidence evaluating the quality of care provided and no consensus as to how patients perceive these dramatic changes in their healthcare delivery.

Our study sought to aid in the understanding of how patients perceive medical care delivered in a drive-through venue. In our study, the vast majority of patients evaluated in our DMEF reported positive experiences as denoted by high marks in the areas of quality of provider evaluation, explanation of diagnosis and treatment plan, and overall level of care. Additionally, the DMEF was felt to be significantly more convenient than a visit to the ED. Overall, in our study the patients had positive impressions of the use of a drive-through system for medical evaluations.

Satisfaction studies have repeatedly found wait times to be a key component in a patient's impression of their medical experience.[6] Perhaps more noteworthy is evidence suggesting that increased wait time induced emotional disutility in already ill patients.[7] This fourfold reduction in time was likely a prime contributor to the high ratings especially in the area of convenience. Interestingly, not only was convenience the highest rated item on the survey (mean 4.39/5), but even the vast majority of people who were not satisfied with other aspects of their care still positively endorsed the convenience of the drive-through system.

Patient satisfaction is a complex and multifactorial process. However, it alone does not validate the quality of medical care provided nor is it directly linked to outcomes.[8] However, patient satisfaction has become an increasingly used proxy indicator of the quality of healthcare delivery. Since the late 1990s the Centers for Medicare and Medicaid (CMS) has mandated the use of Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. The CMS then ties reimbursement to performance on this survey. However, it has been mentioned before that there is a noticeable absence of a single question pertaining to whether a patient felt they received adequate medical care.[9] Our questionnaire attempted a cursory look at this gap by addressing the patient's perception of their medical evaluation, their treatment plan explanation, and overall level of medical care. Here we found that despite the non-traditional setting and method, patients still felt they were receiving comparable levels of care from the providers.

While all measures in our survey received positive responses, the lowest mean satisfaction value (4.33) was associated with the perception of providers' explanations, which would entail diagnosis, expected course, return precautions, and follow-up planning. This correlates with the subjective comments as well: although predominantly positive, negative comments were largely centered on the patients not fully understanding what they should do next or their follow-up plan. While the unconventional setting of drive-through care may very well contribute to communication lapses, effective communication and transitions of care have been longstanding challenges in healthcare. In the 2020 CMS report on HCAHPS, transitions of care received by far the lowest overall ranking. Additionally, numerous studies have cited communication disconnects as a source of poor outcomes and periods of care transition as vulnerable periods.[8] A consumer survey by Kyruus (Kyruus Inc., Boston, MA) found issues with communication during virtual appointments, in which less than half of respondents said they left their visits knowing what the next steps were.[11]

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