Our study showed that patients are generally satisfied with the services provided through telemedicine applications and platforms. This is consistent with previous studies that report high levels of patient satisfaction (23–25). Telemedicine was perceived to be similar to in-person consultations in that the participants were able to obtain medical advice and have their health concerns addressed regardless of the mode of delivery. Some perceived it to be better primarily because of convenience and accessibility. However, the inherent limitations of telemedicine restrict its utility, especially for health conditions that require physical assessments and laboratory tests.
We found that telemedicine use and satisfaction are influenced by a number of factors including: safety during the pandemic, privacy, affordability, convenience and accessibility, and availability of more avenues of communication. Safety was a major concern that prompted participants to use telemedicine. Telemedicine enables patients to avoid situations that would expose them to SARS-CoV-2, the causative agent of COVID-19, such as traveling and staying for long periods in high-risk environments. These safety concerns, together with lockdown restrictions, resulted to significant declines in hospital admissions for non-urgent procedures (2). Innovative solutions through telemedicine have been introduced including video visits (25). Participants also mentioned that telemedicine assisted in maintaining privacy. The benefits of anonymity are especially important with regards to sensitive and potentially stigmatizing health issues such as mental or sexual health conditions (29). Because telemedicine removes the need to travel, participants also viewed it as more affordable and convenient. This was noted by participants as an enabling factor to use telemedicine, especially since a third of our participants are full-time employees, while a quarter are students. Traveling for healthcare purposes could mean missing work or school (26), and telemedicine therefore gives them greater ability to manage their time around consultations. Similarly, the variety of communication modes and platforms available contributed to patient use and satisfaction (27). This enables patients to continuously communicate with physicians should technical difficulties arise.
Meanwhile, barriers identified were perceptions on poor service quality arising from lack of prior physician-patient relationship, lack of experience, and inherent limitations of telemedicine; perceived unreasonable costs; and poor internet connectivity and other technological barriers (e.g., gadget availability and specification). Reduced trust in the physician can leave the patient unsatisfied with the service provided and affects patient compliance with the doctor’s advice (28). Established relationships are an important factor in telemedicine use, as patients are less willing to use telemedicine to see a provider that they do not know (29, 30). While some participants in our study, as well as published literature, noted cost as a factor contributing to patient satisfaction (25, 31, 32), we also found cost to be a reason for dissatisfaction among our participants. This may be due to the significant proportion of participants in our sample who were not employed with almost a half not enrolled in any health insurance plan. The Implementing Rules and Regulations (IRR) of the Universal Health Care (UHC) Act stipulates that the Philippine Health Insurance Corporation or PhilHealth shall use its contracts to incentivize the integration and use of telemedicine (33). The PhilHealth Konsulta package is a comprehensive outpatient benefit that integrates telemedicine to ensure access to services (34). According to a PhilHealth circular released in 2021 (35), home isolation services including telemedicine will be incentivized as long as Konsulta providers have accomplished all necessary documents. In addition, several health maintenance organizations in the Philippines reimburse telemedicine consultations which lessens the burden on patients (36–38). This statement is supported by Polinski et al. (39), stating that medical insurance provides care at lower costs. However, because of the pandemic, the rollout of the Konsulta package has been significantly delayed and therefore, patients are unable to avail of the services at a lesser cost. In addition to issues of cost, poor network connectivity and technological barriers decrease levels of patient satisfaction (40). These barriers are especially significant in the Philippines, where service delivery and resources are inequitably distributed (41). Because the country is archipelagic, there are communities with limited access to the Internet and technology. As a result, telemedicine is not widely adopted in these resource-limited communities and these barriers need to be addressed to provide services to patients where physicians and/or specialists are few (26).
A number of limitations need to be considered when interpreting our findings. First, the results of the study are influenced by the social context and implications of the COVID-19 pandemic during the time the study was conducted. Because of this, scores provided by the participants are not indicative of telemedicine alone, but rather, indicative of patient satisfaction when using telemedicine in the context of the COVID-19 pandemic. Further, patient telemedicine satisfaction studies generally report high ratings reflective of their experiences with healthcare and service delivery (40). However, we addressed this issue by including a measure on preference between telemedicine and face-to-face consultation (40). A considerable proportion of participants reported the same level of satisfaction for both modes of service delivery and a few interview participants reported less satisfaction for telemedicine. This confirms in part that telemedicine satisfaction is high in our study because of their experience with telemedicine itself, and not only because of the general care they receive from the health system. Second, our use of convenience sampling and online data collection methods potentially excluded participants from low-resource and remote communities. Patients from these areas may have other experiences, particularly barriers, in their use of telemedicine services. While we attempted to interview participants with different backgrounds and experiences, majority of those who were willing and consented were mainly from urban areas. However, we were still able to capture issues of cost and technology. Third, we asked their general experience and satisfaction to telemedicine regardless of platforms used. We are therefore unable to disentangle the effect of specific telemedicine platforms on satisfaction and use. Despite these limitations, our study provides a rich source of data, contributing to the evidence that telemedicine can be integrated into routine care during and beyond the pandemic while offering insights into use and satisfaction through the lens of patients in a low-and-middle income country.