Patient Experiences of Telemedicine in Spine Care

A Mixed Methods Study

Harry M. Lightsey IV, MD; Caleb M. Yeung, MD; David N. Bernstein, MD, MBA, MEI; Marissa G. Sumathipala; Antonia F. Chen, MD, MBA; Andrew J. Schoenfeld, MD, MSc; Melvin C. Makhni, MD, MBA

Disclosures

Spine. 2022;47(1):27-33. 

In This Article

Abstract and Introduction

Abstract

Study Design: Survey-based study.

Objective: We performed a mixed methods study involving patients using telemedicine for spine care. We sought to understand factors influencing the utilization and evaluation of this modality.

Summary of Background Data: Telemedicine has been integrated into routine spine care; its long-term viability will depend not only on optimizing its safety, efficiency, and cost-effectiveness, but also on understanding patient valuation of its benefits and limitations.

Methods: We used a clinical registry to identify spine patients seen virtually by providers at our tertiary academic medical center between March and September of 2020. We distributed an online survey that queried patients' experiences with telemedicine. We performed statistical analyses of Likert-scale questions and a thematic analysis of free-form responses. Sociodemographic data were abstracted and analyzed.

Results: Overall, we evaluated 139 patient surveys. High levels of patient-rated care and patient-rated experience were observed for both in-person and telemedicine visits; however, in-person visits were rated significantly higher in both respects (9.3/10 vs. 8.7/10 for patient-rated care, P < 0.001; 9.0/10 vs. 8.4/10 for patient-rated experience, P = 0.006). A preference for in-person first-time visits was observed which was not maintained for follow up appointments. Both patient and clinical factors influenced perceptions of telemedicine. Thematic analysis of free-form responses provided by 113 patients (81%) generated favorable, unfavorable, and reflective themes, each further contextualized by subthemes. Responders were not significantly different from nonresponders across sociodemographic characteristics.

Conclusion: Our quantitative and qualitative findings yield insight into the patient experience of telemedicine in spine care. A preference for in-person visits was notable, particularly for new patient evaluations. This preference was not maintained for follow-up care. Patients acknowledged the benefits of telemedicine and reflected on its effective integration with in-person care. These results may guide best practices to improve access and patient satisfaction in the future.

Level of Evidence: 4

Introduction

Optimizing telemedicine for the delivery of effective spine care has become a primary focus since the widespread adoption of this technology in 2020. Transitioning out of necessity-based implementation, a critical determinant of telemedicine's viability is patient valuation of virtual care. As in-person visits increase into the first quarter of 2021, the balance between in-person and virtual care continues to evolve.

Though historically underutilized in orthopedics due to legislative barriers, technological limitations, and physician hesitation,[1] telemedicine's efficacy,[2–5] cost-effectiveness,[6–10] and high levels of patient satisfaction[3,10–14] have been demonstrated in emerging literature. More recently, within in the realm of spine care, telemedicine was shown to be both safe and effective,[15–17] and groups began proposing standardized virtual neurologic exams.[18–21] Furthermore, telemedicine-based spine surgical plans were found to be accurate.[22] Studies specific to spine care have largely supported telemedicine's cost-effectiveness[16,23] and high levels of patient satisfaction.[17,24,25]

In this context, the value of telemedicine takes form. However, while the above considerations are important factors to telemedicine's success, the longevity of this modality will depend largely on patient assessment of its utility. In a recent survey of neurosurgical patients, Maurer et al[26] found that only 15.3% of patients preferred video telehealth appointments. With this in mind, we sought to characterize patient preference for telemedicine versus in-person care and identify factors influencing patient valuation of telemedicine using a mixed-methods approach.

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