Patient satisfaction with the inflammatory bowel disease specialist telephone consultation

ABSTRACT

Background and Aim: Transition of the Liverpool Hospital Inflammatory Bowel Disease (IBD) Unit to telehealth specialist consultation as a result of the coronavirus disease 2019 (COVID-19) pandemic warranted the development of this survey study to investigate patients' satisfaction with the specialist telephone consultation service. We aim to report the interim results of the questionnaire development and describe the plan going forward. Methods: Considering the possible effect of the COVID-19 pandemic on patients' evaluation of convenience and acceptability if measured through scales developed before the pandemic, we designed a new telehealth satisfaction questionnaire with specific COVID-19-related questions. The new questionnaire was designed with guidance from the literature1-4 and was intended to assess three main constructs of 'usefulness' (seven items), 'reliability' or comparability with the face-to-face consultation (five items), and 'attitude' (two items). It was administered to patients with a confirmed diagnosis of IBD after their telephone IBD consultation at Liverpool Hospital. Item response theory (IRT) was used to evaluate the psychometric properties of the survey and accordingly guide further revisions to the survey. The IRT results for the usefulness construct are reported here. Results: A total of 51 patients who had their most recent IBD appointment via telephone completed the questionnaire. Of these, 29 (56.9%) had Crohn's disease and 10 (19.6%) had ulcerative colitis. Diagnosis data were missing for 12 participants (23.5%). Disease duration was less than 5 years in seven participants (13.7%), 10 (19.6%) were diagnosed with IBD between 5 and 10 years before survey completion, and 22 (43.1%) were diagnosed more than 10 years previously. Disease duration data were missing for 12 participants (23.5%). There were 20 female participants (39.2%), with missing data relating to sex in 17 participants (33.3%). Patients with a tertiary qualification constituted 33.3% (n = 17) of the study population, similar to patients with an occupation from groups two and three in the Australian Curriculum, Assessment and Reporting Authority occupation list (associate professional, tradesperson, skilled office worker, or sales and service staff). The results of the 'usefulness' scale showed that 37 participants (72.5%) found telephone consultation useful in terms of improving access to care, 42 (82.3%) stated that it addressed their health needs, 49 (96.1%) found it beneficial to their IBD management during the COVID-19 pandemic, 38 (74.5%) found it beneficial to their IBD management beyond the pandemic, 48 (94.2%) stated that the telephone consultations saved them time, and 46 (90.2%) found it cost-effective. From a communication perspective, 44 participants (86.3%) noted that they were able to express themselves effectively during their recent telephone consultation. The IRT analysis of the seven items representing 'usefulness' found the scale to have a reliability coefficient of greater than 0.8 from theta of -3 to 0.8 based on a z-score scale. Model fit statistics results were mixed, with root mean square error of approximation of 0.2, suggesting not a great model fit (i.e. the scale requires further improvement), while comparative fit index and Tucker-Lewis index were 0.974 and 0.961, respectively, suggesting good model fit. Conclusion: The results of the interim analysis are consistent with the literature5,6 patients are generally satisfied with the use of telehealth. However, to ensure that the newly developed questionnaire is reliable, and considering the mixed results of model fit statistics, further nuanced items will be added to the 'usefulness' construct to ensure that the survey has the power to discriminate among patients with theta values above 0.8. A similar process will be undertaken for the other two constructs ('reliability' and 'attitude'). The revised questionnaire will be tested with another group of 50 patients with IBD to establish its reliability and discrimination.