Virtual and In-Person Pediatric Visits Get Similar Family Ratings

Marcia Frellick

March 28, 2022

CHICAGO — Satisfaction ratings for virtual outpatient visits for pediatric orthopedic patients were similar to those for in-person office visits across most categories in an analysis of post-encounter surveys completed by patients at the Cleveland Clinic in Ohio.

Satisfaction ratings for both virtual and office visits were consistently higher than 85% across all measured parameters, according to the data presented at the American Academy of Orthopaedic Surgeons (AAOS) 2022 Annual Meeting.

Ahmed Emara, MD, a clinical research fellow in adult joint reconstruction at the Cleveland Clinic, led the study, which included data from all patients or guardians at the clinic who experienced such visits from March 2020 to March 2021.

A total of 1686 responses were received, of which 226 (13.4%) involved virtual visits and 1460 (86.6%) involved in-office visits. The primary endpoint was a patient-reported satisfaction score of good or excellent.

Analysis included ratings for access, care provider, telemedicine technology, and overall assessment/perception of satisfaction.

Target Areas for Improvement

In some areas, the virtual visits were less satisfactory than the in-office visits.

Patients had lower odds of reporting good/excellent satisfaction regarding their ability to schedule at a particularly convenient time (odds ratio [OR]: 0.1; 95% CI: 0.08 – 0.18; P < .001). Study authors said scheduling more virtual time slots may help increase satisfaction in that area.

Satisfaction was also lower than with in-office visits with respect to providers' explanations of patients' conditions (OR: 0.4; 95% CI: 0.17 – 0.91; P = .03). Providers may need to find ways to better provide educational material in addition to the virtual consultation, the authors write.

No Significant Differences in Categories of Satisfaction

The researchers accounted for age, sex, traumatic etiology, and anatomic location of the complaint in multivariate regression analysis and found no significant differences between the two types of visits in the odds of getting a good/excellent rating for the following areas:

  • patient inclusion in treatment decision (P = .562)

  • discussion of proposed treatment (P = .222)

  • concern by the provider (P = .189)

  • degree of care for the patient as a person (P = .208)

  • adequacy of teamwork in care provision (P = .053)

  • likelihood of recommending the practice to others (P = .108)

  • ease of receiving care at a particular practice (P = .109)

  • ease of contacting the clinic (P = .177)

  • likelihood of recommending a particular provider (P = .218)

Anna Dimitriovna Vergun, MD, a pediatric orthopedist at the University of North Carolina at Chapel Hill (UNC), who was not involved in the study, told Medscape Medical News she had been conducting virtual visits even before the pandemic, when she worked for several years at a Shriner's children's hospital in Los Angeles, California, before coming to UNC. The virtual visits were necessary because the hospital offered charity care and covered an area that included several states.

She said that during the height of the pandemic, 80% of her visits at UNC were virtual; it is down to about 5% now.

Some consultations don't need physical visits at all, Vergun noted. For example, UNC is starting a clinic for prenatal counseling in cases in which ultrasound detects a limb deformity. Without a virtual option, she said, pregnant mothers in all parts of the state may have to drive long distances when no physical exam is necessary.

And sometimes, a visit simply involves checking in with families to see whether pain is being controlled, which is done well virtually.

"Those are particularly useful for telemedicine," Vergun said. "There's a lot of space for this to be useful. You sometimes don't realize it until you start doing it and getting feedback from the families that they like it."

Other exams may be better suited to office visits, she said. These include spine and hip exams and exams in which providers need to check reflexes.

She said she sees many cases of club feet, for which an in-person exam is needed to determine flexibility.

Expert Says Virtual Misses Nuances

Ryan Fitzgerald, MD, an orthopedic expert with Children's Orthopaedic and Scoliosis Surgery Associates (COSSA) in St. Petersburg, Florida, who also was not involved in the study, told Medscape Medical News he doesn't offer the virtual option now because he thinks those visits usually miss too much.

Dr Ryan Fitzgerald

COSSA is a private practice that provides orthopedic services for Johns Hopkins All Children's Hospital.

"I think physicians' perspective vs the families' perspective may be quite a bit different," he said.

While families like the convenience, "a lot of what we do is watching the patient walk, looking at their hip range of motion, and virtually, that's a really difficult thing to do," he said.

You can instruct a family on how to turn a camera on the patient, but "it doesn't always translate," he said.

He said virtual visits also highlight disparities in access, because many families don't own the hardware needed for such visits, and internet connections can be spotty or images pixilated.

Fitzgerald said virtual visits were helpful during the pandemic and would be beneficial for yearly checkups "if you know [the patient] well and it's a fairly run-of-the-mill thing."

However, he said, "Everything we do is about human interaction, and I think that's a downfall of the virtual platform right now. While it is helpful in situations like COVID and where it is a very basic follow-up, it still has a ways to go."

Fitzgerald is a consultant for OrthoPediatrics, Medtronic and Depuy Synthes. Vergun has disclosed no relevant financial relationships.

American Academy of Orthopaedic Surgeons (AAOS) 2022 Annual Meeting: Abstract 434. Presented March 24, 2022.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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