ABSTRACT
Introduction: A shift in the practice of medicine to include telemedicine modalities has been gaining momentum, being accelerated even further by the current pandemic. There is a paucity of data regarding patient-perceived barriers to telemedicine in urogynecology patients, a unique and complex population, In a previous study at our institution, we found that conversion to telemedicine in FPMRS during the first 11 weeks of the COVID-19 related shut-down was very low. Objective: The aim of this study is to understand patient-perceived barriers to telemedicine and examine why some patients did not convert to telemedicine. Methods: This was a qualitative study using both a questionnaire and one-onone semi-structured interviews with patients from our institution's urogynecology practice who were scheduled for appointments from March 17th through June 9th, 2020, a time period when our office was closed to meet social distancing guidelines. Informed consent was obtained verbally and interpretation services were used when necessary. All interviews were recorded, transcribed, and coded by two readers. The data was analyzed in a 3-phase coding process and the manifest context analysis method was used to analyze, summarize and refine interview data. Inductive codes were then applied to text fragments. A codebook was developed through serial discussions and triangulated amongst the research team. The codebook was saturated at 30 interviews and the final six interviews were cross-referenced to confirm findings. Results: 36 interviews were conducted. Participants represented a wide age range (39 to 75 years), with 30.6% of participants ranging in age between 45 and 54 years. 66.7% of patients stated English was their preferred language. While some patients (25%) recalled being offered a virtual visit, others reported that this option was not offered (44.4%) or were unsure (19.4%). The majority of participants reported having a smartphone (97.2%). Codes from interviews were organized into four categories (Table 1). Three themes were identified: (1) Patients seemed amenable to telemedicine, yet there was reservation about the use of this modality for FPMRS specific patients. The participants felt concerned with the inability for physicians to examine them, and seemed to equate physical evaluation and diagnostic testing with an optimal experience. (2) The majority of participants felt comfortable using the technology and had minimal concerns regarding costs of cellular data or access to internet connectivity. Although some participants voiced reservations with this technological advancement, most seemed agreeable to using telemedicine in some capacity in the future. (3) There was a willingness to forgo certain comforts of in-person visits, in order to preserve safety, especially given simplicity and ease of accessibility. However, the overarching perception was that telemedicine could lend itself to be more impersonal, and should be used for more straightforward and follow-up visits. Conclusions: While there are certain challenges to incorporating telemedicine into urogynecology practice, many of our patients felt that tele-visits were practical and helpful. However, the concern for loss of human touch and testing obviates that the desire for in-person visits remains. Further patient education and development of systems to streamline telemedicine practices will help those who remain hesitant (Table Presented).
ABSTRACT
Study Objective To determine rate of conversion of in-person visits, scheduled before COVID-19 pandemic, to televisits in a minimally invasive gynecology surgery (MIGS) practice and identify factors that predict successful conversion. Design Retrospective review of appointments scheduled over a 11-week period between March 17th and May 29th, 2020, in the MIGS division of an academic obstetrics and gynecology department. During this period, the office was closed except for emergency visits due to the restrictions secondary to COVID-19. Successful conversion from in-person to televisits was defined as appointments rescheduled within 2 months of the initial in-person visit. Setting N/A. Patients or Participants All patients scheduled for in-person visits during this time were included. Patients were excluded from the analysis if they were seen emergently in person or newly scheduled as a televisit. Interventions N/A. Measurements and Main Results Data extracted included age, race/ethnicity, primary language, insurance type, appointment type, reason for visit, and time to rescheduled visit. 132 patients were originally scheduled during 11 weeks. 32 (24.2%) appointments were newly scheduled televisits and 20 (15.2%) were emergent in-person visits, leaving 87 visits. 21 (24%) appointments were rescheduled as televisits;14 (66.7%) via telephone and 7 (33.3)% of these as video. There were no significant differences between age, race, primary language. insurance type, appointment type and the reason seen between the converted and non-converted groups. Median time to rescheduled appointments was sooner in successful conversions (16 days (-7 to 73) versus 96 days (8-234), p<.001). Conclusion Conversion to televisits was reasonable for a telemedicine naïve practice, despite having an overall low conversion rate to televisits. Utilizing telemedicine allowed patients to receive care sooner when compared to the non-converted group. The lack of difference in demographic/clinical factors between the two groups provides hope that technology can be utilized by diverse groups of MIGS patients.