Purpose
The COVID-19 pandemic required an emergent transition to telemedicine and away from traditional in-office visits with little preparation. In 2020, telemedicine use grew by over 150% compared to pre-pandemic levels (Koonin et al., 2020). Rapid implementation affected metrics commonly assessed with standard practice (in-person visits), including patient satisfaction, safety, and health care costs. An understanding of this impact and an exploration of telemedicine can improve future use.
Methodology
A descriptive study was conducted to evaluate telemedicine compared to in-office visits at an ambulatory clinic. A comprehensive literature review and synthesis were completed for emerging telemedicine research. TAM and RE-AIM conceptual models were used. Organizational metrics measuring telemedicine and in-office visit volumes throughout the pandemic were compared. Patient satisfaction/experience, patient safety, and patient and departmental costs were also compared through organizational data. The five RE-AIM dimensions (Reach, Effectiveness, Acceptance, Implementation, and Maintenance) were applied throughout the project. An interview with a national telemedicine expert was conducted to inform the project. Recommendations for telemedicine visits were developed.
Results
Advanced practice providers in the clinic conducted nearly 18,000 telemedicine visits over the last two and a half years. At the height of the pandemic, telemedicine averaged between 98-100%. Use rates have declined as conditions have improved with COVID-19 but currently trending at approximately 20% of the total clinic volume, consistent with national averages. Patient satisfaction scores were slightly higher for in-office visits. Reported telemedicine-related safety incidents/occurrences were null. Telemedicine-related costs were not increased for patients. Indirect cost-savings in travel, fuel time, and reduced missed work time were realized. Departmental costs were not significantly impacted by telemedicine, but federal guidelines affected telemedicine reimbursement in certain circumstances.
Implications
The unprecedented telemedicine resurgence during the COVID-19 pandemic demonstrated a safe, effective, and satisfying alternative for patients. Future telemedicine can address health equity through flexible access. Telemedicine expansion in telepsychiatry has already been extremely transformative. Additional policy, training, and research are needed for optimal clinical and patient use. Close monitoring of federal and state policy is necessary to ensure compliance with changing regulations.