System-wide Accelerated Implementation of Telemedicine in Response to COVID-19: A Mixed-Methods Evaluation

J Med Internet Res. 2020 Aug 17. doi: 10.2196/22146. Online ahead of print.


Background: As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is unknown how patients and physicians respond to an accelerated implementation of this model of medical care.

Objective: To report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions.

Methods: A convergent parallel mixed-methods study design consisting of simultaneous use of both qualitative and quantitative methods. This study was conducted at the UC-Christus Health Network, a large private academic health network in Santiago, Chile. Satisfaction of patients receiving telemedicine care between March and April, 2020, was compared to those receiving in-person care during the same period (concurrent control group) and during March and April, 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Satisfaction with telemedicine was assessed by patients using an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies to address them, the diagnostic process, treatment, and the patient-provider relationship.

Results: A total of 3,962 patients receiving telemedicine, 1,187 patients from the concurrent control group, and 1,848 from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% vs 50.9%, P = .002). Surgeons, obstetricians and gynecologists felt their clinical skills were challenged the least, compared to providers from non-surgical specialties (P < .001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed according to the provider's specialty (P = .046, P < .001, and P = .022, respectively).

Conclusions: Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceive the impact of this new mode of clinical practice differently.