|Year : 2022 | Volume
| Issue : 2 | Page : 61-66
Physician and patient satisfaction of otolaryngology virtual clinic during the COVID-19 pandemic: The qatif central hospital experience
Mohammad Al Eid1, Rana AlMuslem1, Suad AlMubarak1, Alia Al Naji2
1 Department of ENT, Qatif Central Hospital, Al Qatif, Saudi Arabia
2 Head of Preventive Medicine Administration at Public Health Administration, Qatif Health Network, Saudi Arabia
|Date of Submission||21-Jan-2022|
|Date of Acceptance||10-Feb-2022|
|Date of Web Publication||28-Jun-2022|
Dr. Mohammad Al Eid
Dhahran Jubail Branch Rd, Al Iskan, Al Qatif, 32654
Source of Support: None, Conflict of Interest: None
Introduction: A virtual clinic was implemented to replace routine outpatient visits for all specialties during the peak of COVID-19 in the area as a protective measure to patients and medical staff to limit the virus's spread. Objectives: The objective of the study was to determine the response and efficacy of the virtual clinic and measure patient and physician satisfaction. Methods: A study of virtual clinic response and patient and doctor satisfaction with telemedicine consultations was undertaken in the otolaryngology department of Qatif central hospital, where telemedicine consultations replaced scheduled outpatient consultations. Patient and doctor satisfaction was rated on a scale from 1 (least satisfied) to 5 (highly satisfied). Statistical analysis was conducted using SPSS 23.0 software. Results: During this study, there were 398 scheduled virtual clinic appointments. The response rate was 79%. Not answering the virtual clinic phone call was twice as likely to occur during morning clinics than during afternoon clinics (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.14–3.345, P value 0.015). Adults (15–60 years old) had higher odds of not answering appointment phone calls than children (≤14 years old) (OR 2.38, 95% CI 1.28–4.42, P value 0.006). Patients' satisfaction levels were obtained for 310 (98.7%) patients' virtual clinic consultations; 96.8% of these patients were satisfied (scale 4–5). Physicians' satisfaction levels were completed for 309 (98.4%) virtual clinic consultations, and 94.2% of physicians were satisfied (scale 4–5). Conclusion: Patients and doctors found the otolaryngology virtual clinic an acceptable solution for maintaining continuity of care during the COVID-19 peak in the area.
Keywords: COVID-19, otolaryngology, virtual clinic
|How to cite this article:|
Al Eid M, AlMuslem R, AlMubarak S, Al Naji A. Physician and patient satisfaction of otolaryngology virtual clinic during the COVID-19 pandemic: The qatif central hospital experience. Saudi J Otorhinolaryngol Head Neck Surg 2022;24:61-6
|How to cite this URL:|
Al Eid M, AlMuslem R, AlMubarak S, Al Naji A. Physician and patient satisfaction of otolaryngology virtual clinic during the COVID-19 pandemic: The qatif central hospital experience. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2022 [cited 2022 Aug 15];24:61-6. Available from: https://www.sjohns.org/text.asp?2022/24/2/61/348721
| Introduction|| |
COVID-19 is a rapidly spreading respiratory virus leading to severe acute respiratory syndrome coronavirus-2. The first case was reported in Wuhan, China, at the end of 2019. COVID-19 is highly virulent and contagious through droplet transmission; thus, it spread through China and subsequently worldwide, resulting in a global pandemic. The first case diagnosed in Saudi Arabia was on March 2, 2020, to which the government rapidly responded to stop the spread of the disease. COVID-19 impacted the economy, society, and health-care systems worldwide. One effect on the health-care system was the rapid development of telemedicine. According to the German Medical Association, telemedicine is “an umbrella term for different medical concepts of health-care provision that have in common the general approach of providing medical health-care services in the areas of diagnostic, therapy, and rehabilitation as well as supporting decision-making over spatial distances.” It originated in Australia in 1928 due to the long geographical distances between patients and clinics, which was the main reason for using telemedicine before this pandemic., Telemedicine improves access to information and services, provides rapid access to health care, and is cost-effective. It also limits unnecessary visits to the hospital a potential source of COVID-19 infection. However, telemedicine has some drawbacks, such as causing a breakdown in the relationship between the health-care provider and the patient and possibly affecting the quality of health information. In our center, a virtual clinic was implemented in June 2020 for all specialties as a protective measure for patients and medical staff to limit the spread of COVID-19. Consultations with new and follow-up patients and clinical evaluations were performed through a virtual clinic. Changes in treatment plans and refills of medication except for controlled drugs and health education for outpatients were also done virtually. Our study determined the response and efficacy of the virtual clinic and measured doctor and patient satisfaction.
| Methods|| |
Virtual clinic protocol
A text message was sent from the call center in Qatif Central Hospital (QCH) to all patients booked in the clinic 48 h before their appointments to inform them not to present to the hospital and to download Google Duo, which is a free application provided by Google Limited Liability Company (LLC) that can easily be downloaded on any smartphone. This application was used for patients to communicate with their physicians. Patients were also instructed to call the hospital landline for technical support if they had any problems downloading the application. The assigned nurse in the clinic received a tablet PC from the Department of Information Technology that had a SIM card, an Internet connection, and the Google Duo application.
The treating physician called the patient using Google Duo if it was available or a land or mobile number if the patient did not own a smartphone. The patient evaluation was performed through audio call. The physician who called documented patients' demographic data, the date and time of the evaluation, notes about the patients' condition, health instructions, investigations ordered, and treatment plans in the patients' electronic files. Each patient was called three times. If he or she did not answer, the patient's file was labeled “no response.”
If a patient's history was concerning and the patient required urgent medical attention, the patient was given an urgent appointment to visit the hospital the same day or the day after.
Upon patients' arrival at the outpatient gate, their temperature was taken, and their COVID-19 contact and symptom history were checked in a visual triage area. Patients were then instructed to sterilize their hands with hand sanitizer and wear surgical masks. All medical staff in the clinic wore personal protective equipment, including gloves, masks, and yellow gowns, and always considered the patient as having a suspected case of COVID-19. A sterilization of the clinic's doorknob and the patient's surroundings, such as the examination unit and chair, was performed after seeing each patient. Moreover, if scopes were used, nurses sterilized them with special sterilizing wipes, and all the instruments used were sent to the central sterile service department.
If the physician ordered a follow-up at an audiological clinic or a laboratory or a radiological testing of the patient, the director of the outpatient department (OPD) scheduled it after the clinic, and the call center informed the patient of it.
Patients' prescribed medications were delivered from the nearest primary health-care center to their addresses within 3–5 days of the virtual clinic appointments, and the patients received a text message informing them when to pick them up. Except for prescriptions for controlled drugs, patients could obtain prescriptions directly from the hospital pharmacy.
An assigned nurse in the ENT clinic filled out an OPD form with all orders for scheduled patients, including medication, lab tests, radiology imaging, and follow-up appointments. They then handed the form to the director to manage accordingly.
After each virtual interview with a patient, the physician (after obtaining verbal consent) filled out an electronic questionnaire on Google Docs. The physician added demographic data and the time of the clinic visit and noted whether the patient was new or if the visit was a follow-up. If the patient was new, the physician noted if there was a diagnosis. The form also included questions about how the patient was treated, if the patient was given an urgent appointment and the reason for it. Finally, it measured the satisfaction of both the patient and the doctor on a scale of one to five: one for least satisfied and five for most satisfied.
All the variables among the groups were analyzed statistically with SPSS 23.0 software (IBM, Armonk, New York, USA). The analysis included cell counts and percentages, which were reported for continuous data. The mean and standard deviations were reported for continuous data. Chi-square tests were used to analyze differences. A P ≤ 0.05 was considered statistically significant.
all patients contacted between July 1 and September 30, 2020.
Genders eligible for the study
males and females were eligible for this study.
all ages were included in this study.
all outpatients booked from July 1, to September 30, 2020.
patients who visited the clinic during this period as walk-in patients.
The study population consisted of males and females.
Method of assigning subjects to study groups
All patients booked for appointments in the ENT clinics from July 1, to September 30 were included whether or not they responded to the virtual clinic call.
- Dependent variables (the presumed effect)
- Independent or predictor variables (the presumed cause)
- Confounding variables.
All the variables among the groups were analyzed statistically with SPSS 23.0 software. These included cell counts and percentages, which were reported for continuous data. The mean and standard deviations were also reported for continuous data. The Chi-square tests were used to analyze differences. A P ≤ 0.05 was considered statistically significant.
| Results|| |
During this study, there were 398 scheduled virtual clinic appointments at the QCH ENT department. Morning clinic appointments were of longer duration; thus, more appointments were scheduled in the morning. There were 244 appointments in the morning clinics and 154 appointments in the afternoon clinics. A total of 314 appointments (79%) were for patients who had answered the virtual clinic phone consultation call, 245 who had answered after the first call, and 69 who had answered after multiple calls. Not answering the virtual clinic phone call was twice as likely to occur during morning clinics as it was during afternoon clinics (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.14–3.345, P value 0.015). Adults (15–60 years old) had higher odds of not answering the appointment phone call than children (≤14 years old and below) clinics (OR 2.38, 95% CI 1.28–4.42, P value 0.006) [Table 1],[Table 2],[Table 3],[Table 4],[Table 5].
|Table 1: Association between clinic time and age of the patients and odds of not answering the virtual clinic phone call|
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|Table 2: Characteristics of the 314 patients who had answered their scheduled appointments phone call|
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|Table 3: Patients and physicians ear, nose, and throat virtual clinic satisfaction levels|
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|Table 4: Logistic regression model of factors associated with physicians' satisfaction level|
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|Table 5: Logistic regression model of factors associated with patients' satisfaction level|
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Characteristics of patients who answered the appointment phone call
A total of 314 patients answered the appointment phone call and were thus included in the study. Of these patients, 55.7% were adults 15–60 years of age. Only 24.8% of the patients were new, and 75.1% were to have follow-up appointments. The majority of patients (74.8%) had already been diagnosed before the appointment. Physicians could not specify diagnoses for 29 patients (9.2% of the 314 patients) and 36% of the 79 patients had no previous diagnoses. After the consultation, 35 patients were discharged from the clinic, 32 patients were given urgent hospital clinic appointments, and the rest had regular follow-up appointments. Patients received urgent hospital clinic appointments for audiology tests (4), clinical examinations (19), and ENT scopes (9).
The patient satisfaction levels for virtual clinic consultations were reported for 310 (98.7%) patients and were not completed for four patients. The satisfaction levels ranged from 2 (least satisfied) to 5 (highly satisfied). Of the 310 patients, 96.8% were satisfied, 75.2% were highly satisfied (level 5), and 21.6% were satisfied (level 4).
Physicians' satisfaction levels for virtual clinic consultations were completed for 309 (98.4%) patients and were not completed for 5. The satisfaction levels ranged from 2 (least satisfied) to 5 (highly satisfied). Of the 309 patients, 94.2% of the physicians were satisfied, 70.9% were highly satisfied (level 5), and 23.3% were satisfied (level 4).
Factors associated with satisfaction levels
To evaluate factors associated with satisfaction levels for both patients and physicians, satisfaction levels were divided into two groups: highly satisfied (satisfaction level 5) and less satisfied (satisfaction level 4 and below). Logistic regression models were applied to study factors associated with lower satisfaction levels among patients and physicians.
Physicians were more likely to be less satisfied during the morning clinic (OR 2.11, 95% CI 1.21–3.69, P value 0.009) when they ordered follow-ups compared to when they ordered discharges from the clinic (OR 3.53, 95% CI 1.17–10.65, P value 0.025) and when they did not reach a diagnosis (OR 4.92, 95% CI 1.77–13.67, P value 0.002). The patients' ages did not influence the physicians' satisfaction.
Patients were more likely to be less satisfied during morning sessions (OR 2.16, 95% CI 1.21–3.85, P value 0.010) and if they were given a follow-up appointment rather than discharged from the clinic (OR 3.53, 95% CI 1.17–10.65, P value 0.046). The patients' ages and whether the physicians reached a diagnosis did not affect the patients' satisfaction levels.
| Discussion|| |
The evidence-based adoption of telehealth has been more limited in otolaryngology than it has in other specialties. This limitation is largely owing to a reliance on physical examinations and in-office technology, including endoscopy, for diagnosis and planning. In a study estimating the rate of telemedicine eligibility among outpatient consultations performed in a general otolaryngology practice, McCool and Davies found that 62% of consultations were likely to be eligible based on the need to perform a specialized procedure to reach a diagnosis.
With the onset of the COVID-19 pandemic, new policies were implemented to reduce the virus transmission rate and limit the exposure of health-care workers. Otolaryngologists are at a high risk of infection due to examinations focusing on the head-and-neck and aerosol-generating procedures such as endoscopy, which have a predilection for viral particles emanating from the nasal cavity and pharynx., Telemedicine services have been integrated to accommodate the need for continued patient care while allowing for the observance of social distancing practices.
The response of patients to shifting their visits to telemedicine was positive, with a 78% teleconsultation attendance rate. This positive response to telemedicine is in keeping with a study by Mishra, which concluded that patients perceived telemedicine to be useful and better suited to the delivery of health-care services during the COVID-19 outbreak than before it. Patients were found to be more likely to switch to telemedicine in such circumstances.
Regarding satisfaction rate, our study found that 96.8% of patients and 94.2% of physicians were satisfied with their experiences. The high levels of satisfaction were consistent with similar studies that Ning AY et al. cited in a systematic review. Riley et al. also reported a high level of patient satisfaction with telemedicine, with patients reporting either no negative impact or minor negative impact due to the lack of a physical examination or face-to-face interaction. Choi et al. found comparable satisfaction scores for patients who underwent pre-COVID 19 in-person visits and teleconsultations during COVID-19 restrictions. The high provider satisfaction rates were also consistent with the results of Ning AY et al.'s systematic review. Nevertheless, there is evidence of limited provider satisfaction, as Smith et al. reported. Virtual care was equivalent to traditional visits for obtaining a history of performing nonurgent new or follow-up visits, but it was limited for examining patients and created difficulty in establishing an effective doctor–patient relationship., Choi et al. found high provider satisfaction scores, although these scores were slightly lower than those for in-person encounters.
Owing to the limitations of teleconsultation for examinations, scopes, and audiological assessments, patients were given urgent in-person appointments as needed based on their doctors' assessments during teleconsultations. This protocol helped to overcome the limitations of telemedicine in our institute.
Our study analysis revealed higher satisfaction scores and a higher response rate among both providers and patients for afternoon clinics than for morning clinics, thus indicating that afternoon times could be more convenient. The satisfaction scores were higher when patients were discharged than when they were given follow-up appointments, therefore showing that reaching a diagnosis affected the providers' satisfaction scores but not the patients.'
Regarding limitations, the present study was limited to a single center with multiple otolaryngologists. Having the provider directly complete the survey ensured a high response rate; however, it allowed for the possibility of bias toward a positive response. This potential bias could be overcome using an online questionnaire.
| Conclusion|| |
Teleconsultation enabled the continuity of care during the COVID-19 pandemic for stable, nonurgent outpatients and provided high satisfaction for both providers and patients.
All patients were interviewed verbally by phone. Verbal consent was obtained from the patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]