We observed consistently high satisfaction scores across all parameters, in both elective and fracture clinics, culminating in a mean score of 9.08/10 on the Likert scale. In the qualitative component of the questionnaire, patients frequently acknowledged a high quality of care despite adverse circumstances.
Telemedicine satisfaction rates are comparable to those of conventional orthopaedic outpatient visits.(6, 11-15) Patients who experience telemedicine consultations are more likely to opt for this mode of orthopaedic care in the future.(6, 7) A study by Buvik et al.(2019) performed a randomised control trial comparing in person or videoconference review.(6) Of the 389 patients 99% of patients rated their consultation satisfactory or very satisfactory, regardless of how they were seen.(6) In addition, 86% of patients assigned to the videoconference arm expressed a preference for telemedicine for future consultations. Similarly, a non-randomised study in Pennsylvania in 2018 found comparable satisfaction rates between face-to-face and telemedicine visits, while only 8% of telemedicine patients requested in-person care for their next visit.(14)
The majority of these studies took place at tertiary orthopaedic centres in Europe, with patients teleconferencing from a regional facility, closer to their homes. An economic evaluation performed on the Norwegian randomised control trial found patients were required to travel a mean one-way distance of 248km, with a mean one-way travel time of 4 hours and 37 minutes, in order to attend face-to-face consultations.(5, 12) In contrast, Rockingham General Hospital is a regional orthopaedic centre, with patients in this study having a mean one-way travel time of only 21 minutes. In addition, 13% of patients were required to attend the hospital on the day of their telemedicine. Cost-effectiveness for both healthcare providers and patients, including reduced travel costs, is frequently described in the literature as a major benefit of telemedicine. Due to the reduced distances compared with other studies this may explain why only 47% of patients in our study expressed a preference for telemedicine for future visits despite achieving very high satisfaction rates.(14)
Lack of technology literacy and access, as well as high implementation and maintenance costs are cited as barriers to telemedicine.(16, 17) Consultation delays due to technical difficulties can also significantly reduce the efficiency and patient satisfaction associated with the modality.(6, 15) Due to the need for a rapid implementation of remote consultations in our study, as well as a lack of internet and video-conferencing facilities at the hospital, all telemedicine visits were carried out over phone. However, our results show that patients found this modality to be convenient and accessible. Patients were not required to attend a remote site for video-conferencing facilities, were not faced with the frustration of technical delays and experienced minimal disruption of their daily activities. We recommend further cost-benefit analyses be carried out into videoconferencing versus standard phone consultations.
In the qualitative component of the study, constructive feedback was encouraged to highlight aspects of the telemedicine service that warranted modification. Consequently, we would recommend assigning patients with a broader time range during which they would be called, as opposed to a specific appointment time. In other cases, patients disclosed frustration with an inability of the physician to arrive at a definite diagnosis due to a lack of physical examination during the consultation. Although this is certainly a major drawback to telemedicine as a healthcare modality, the phone consultation acted as a valuable tool in initiating a diagnostic and therapeutic care plan, whilst also minimising patients’ risk of acquiring COVID-19 infection.
While patient satisfaction was the primary focus of our study, a review of the pertinent literature reveals several additional benefits of telemedicine in the provision of orthopaedic care. Telemedicine poses a significant economic benefit with numerous financial analyses indicating the cost-effectiveness of the modality when compared with conventional visits.(4, 5, 9, 18-20) Virtual clinics are not only cost-efficient, but time-efficient for both patients and physicians. Travel and consultation times are decreased, while the utilisation of telemedicine as a triage tool reduces the number of emergency department referrals requiring a face-to-face consult.(21) Access to specialist care is consistently cited as a significant benefit of telemedicine, removing many of the geographical and logistical barriers that would otherwise prevent patients from availing of such services.(6, 7, 20) In addition to the well-documented health benefits of decreased exposure to the hospital environment, telemedicine poses the theoretical benefit of reduced mobilisation on the often-compromised musculoskeletal system in orthopaedic patients. With virtual orthopaedic care in its relative infancy, it is difficult to conclude emphatically on the long-term accuracy of this style of care. However, early research reveals efficacy and accuracy levels comparable to those of face-to-face consults.(6, 7, 15)