Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study.

BACKGROUND: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. OBJECTIVE: The aim of this study is to examine correlates of patients' satisfaction with a telemedicine visit. METHODS: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. RESULTS: Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients' satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). CONCLUSIONS: There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients' satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed.

Physical activity participation among Caribbean Hispanic women living in New York: relation to education, income, and age.

BACKGROUND: Inadequate participation in physical activity is a serious public health issue in the United States, with significant disparities among population groups. In particular, there is a scarcity of information about physical activity among Caribbean Hispanics, a group on the rise. METHODS: Our goal was to accumulate data on physical activity among Caribbean Hispanic women living in New York and determine the relation between physical activity and age, marital status, education, income, primary language, and children in the household. To this end, a survey adapted from the National Health Interview Survey of the National Center for Health Statistics assessing type, frequency, and duration of physical activity was administered. RESULTS: There were 318 self-identified Hispanic women who participated. Total activity time, mean 385 +/- 26 minutes, and education (r = 0.14, p < 0.01) were significantly related. Women who had attended some college had greater total activity time than those with some high school education (p = 0.046) or < 8th grade education (p = 0.022). Walking as a form of transportation was the most frequent pursuit, 285 +/- 21 minutes. Age (r = -0.34, p < 0.001) and education (r = 0.25, p < 0.001) correlated with nonwalking activity time (leisure time). Nonwalking activity times were greater in younger, that is, 18-29 years (p < 0.001) and college-educated women (p < 0.001). Physical activity recommendations were met by 11%; and 17% reported no physical activity. CONCLUSIONS: Among Caribbean Hispanic women living in New York City, the current recommendations for physical activity are met by 11%, and physical activity and education are significantly related. Our observation that education is a critical factor related to physical activity suggests that programs to address the promotion of a physically active lifestyle are needed.

Association of education and race/ethnicity with physical activity in insured urban women.

BACKGROUND: Physical inactivity is a growing problem facing American women. As little as 150 minutes of moderate physical activity (PA) weekly can reduce the risk of chronic diseases, such as heart disease and stroke. We developed a survey to determine levels and predictors of PA in a diverse population of urban women with access to healthcare. METHODS: From February to September 2004, women visiting an academic health center completed a self-administered PA survey. Total activity time (TAT) was calculated as the sum of all activity (walking, jogging or running, dancing, calisthenics, bicycling, aerobics, swimming) recorded over the preceding 2 weeks. Analysis of variance (ANOVA) models were used to assess the effect of different variables on TAT. RESULTS: The survey was completed by 242 women, mean age of 43.4 years. Ninety percent were insured; 66% were non-Hispanic white, 16% were Hispanic, and 10% were African American. Seventy-six percent of women were college graduates. Only 58% of participants recorded >or=150 minutes of PA/week. TAT was related to education, with a significant difference between high school and college graduates (290 +/- 80 vs. 502 +/- 40 min [SEM], p < 0.05). CONCLUSIONS: Education was strongly associated with TAT among these insured, diverse, and well-educated women. Only 58% exercised >or=150 minutes/week, underscoring the need to target exercise programs for all women and to close the gap between women of lower and higher educational attainment.

Reflections on a decade of experience in implementing a Center for Women's Health at an Academic Medical Center.

On the 10th anniversary of the establishment of a Center for Women's Health (CWH) program, the opportunity to share the successes and limitations in developing a centralized approach to women's healthcare is provided. The development of the CWH at the Columbia University Medical Center, New York-Presbyterian Hospital was prompted by concerns that the health status for women is worse than for men in terms of disability, morbidity, and chronic illness. Moreover, women move through cycles of health and illness differently from men, and gender inequalities in research design and implementation and underrepresentation of women in clinical studies contributed to knowledge gaps concerning women's health, possibly leading to suboptimal care. The goal in developing a program was (1) to provide outstanding medical care to women based on prevention and treatment of unique aspects of women's health, (2) to develop professional training and multidisciplinary educational programs promoting knowledge, understanding, and credible scientific efforts, and (3) to foster collaborative research and communication among researchers, practitioners, policymakers, and organizations. In this paper, the clinical and educational programmatic activities and lessons learned are described.