Patient Perspectives on Telemedicine During the COVID-19 Pandemic

Background Patients received care over telemedicine during the COVID-19 pandemic, and their perspective is useful for hand surgeons. Methods Online surveys were sent October-November 2020 to 497 patients who received telemedicine care. Questions were free-response and multi-item Likert scales asking about telehealth in general, limitations, benefits, comparisons to in-person visits, and opinions on future use. Results The response rate was 26% (n = 130). Prior to the pandemic, 55% had not used telemedicine for hand surgery consultation. Patients liked their telemedicine visit and felt their provider spent enough time with them (means = 9/10). In all, 48% would have preferred in-person visits despite the pandemic, and 69% would prefer in-person visits once the pandemic concludes. While 43% had no concerns with telemedicine, 36% had difficulties explaining their symptoms. Telemedicine was easy to access and navigate (M = 9/10). However, 23% saw telemedicine of limited value due to the need for an in-person visit soon afterward. Of these patients, 46% needed an in-person visit due to inadequate physical examination. Factors that make telemedicine more favorable to patients included convenience, lack of travel, scheduling ease, and time saved. Factors making telemedicine less favorable included need for in-person examination or procedure, pain assessment, and poor connectivity. There was no specific appointment time the cohort preferred. Patient recommendations to improve telemedicine included decreasing wait times and showing patient queue, wait time, or physician status online. Conclusions Telemedicine was strongly liked by patients during the COVID-19 pandemic. However, nearly 70% of patients still preferred in-person visits for the future.

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Towards Consensus on Essential Components of Physical Examination in Primary Care-based Memory Clinics*

Canadian Geriatrics Journal ◽

10.5770/cgj.21.296 ◽

2018 ◽

Vol 21 (2) ◽

pp. 143-151 ◽

Cited By ~ 1

Author(s):

George A. Heckman ◽

Bryan B. Franco ◽

Linda Lee ◽

Loretta Hillier ◽

Veronique Boscart ◽

...

Keyword(s):

Primary Care ◽

Physical Examination ◽

Overall Response Rate ◽

Response Rate ◽

Vital Signs ◽

Online Surveys ◽

Essential Components ◽

Memory Clinics ◽

Memory Concerns ◽

With Memory

BackgroundPrimary care-based memory clinics were established to meet the needs of persons with memory concerns. We aimed to identify: 1) physical examination maneuvers required to assess persons with possible dementia in specialist-supported primary care-based memory clinics, and 2) the best-suited clinicians to perform these maneuvers in this setting.MethodsWe distributed in-person and online surveys of clinicians in a network of 67 primary care-based memory clinics in Ontario, Canada.Results90 surveys were completed for an overall response rate of 66.7%. Assessments of vital signs, gait, and for features of Parkinsonism were identified as essential by most respondents. There was little consensus on which clinician should be responsible for specific physical examination maneuvers.ConclusionsWhile we identified specific physical examination maneuvers deemed by providers to be both necessary and feasible to perform in the context of primary care-based memory clinics, further research is needed to clarify interprofessional roles related to the examination.

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Wait Times in Musculoskeletal Patients: What Contributes to Patient Satisfaction

Journal of Patient Experience ◽

10.1177/2374373519864828 ◽

2019 ◽

Vol 7 (4) ◽

pp. 549-553

Author(s):

Georgina Glogovac ◽

Mark E Kennedy ◽

Maria R Weisgerber ◽

Rafael Kakazu ◽

Brian M Grawe

Keyword(s):

Patient Satisfaction ◽

Orthopedic Surgery ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Wait Time ◽

Wait Times ◽

Time Duration ◽

X Ray ◽

Appointment Time ◽

Office Location

Introduction: The purpose of this study was to determine how wait time duration is associated with patient satisfaction and how appointment characteristics relate to wait time duration and patient satisfaction in the orthopedic surgery clinic. Methods: Two hundred sixty-four patients visiting one of 3 ambulatory orthopedic surgery clinics were asked to estimate their wait time and to rate their satisfaction with the visit. The associations between appointment characteristics, wait time, and satisfaction were analyzed using t tests, 1-way analysis of variance, and Pearson correlation coefficients. Results: Wait times were significantly different based on visit type, appointment time, whether an X-ray was required, and whether a trainee was involved ( P < .001). Patients with wait times less than 30 minutes had higher satisfaction scores ( P < .001). Satisfaction ratings were significantly different based on the surgeon’s management recommendation ( P = .0211), but were not significantly different based on sex, age, office location, visit type, appointment time subsection, or time spent with the physician ( P > .05). Conclusion: Wait times negatively correlated with satisfaction. New patient visits, appointment times in the later third of the day, appointments requiring an X-ray, and appointments involving a trainee had significantly longer wait times. Care should be taken to inform patients with visits involving these characteristics that they may experience longer than average wait times.

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Exploring and Understanding Participants’ Perceptions of Facial Emoji Likert Scales in Online Surveys

ACM Transactions on Social Computing ◽

10.1145/3382505 ◽

2020 ◽

Vol 3 (2) ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Sarah Alismail ◽

Hengwei Zhang

Keyword(s):

Online Surveys ◽

Likert Scales

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Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

Journal of Patient Experience ◽

10.1177/23743735211007700 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110077

Author(s):

Daliah Wachs ◽

Victoria Lorah ◽

Allison Boynton ◽

Amanda Hertzler ◽

Brandon Nichols ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Waiting Times ◽

Wait Time ◽

Primary Care Providers ◽

Wait Times ◽

Care Providers ◽

Female Physicians ◽

Online Ratings ◽

And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

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Determinants of Long Immunization Clinic Wait Times in a Sub-Saharan African Country

Global Pediatric Health ◽

10.1177/2333794x211028211 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110282

Author(s):

Osayame Austine Ekhaguere ◽

Rosena Olubanke Oluwafemi ◽

Angela Oyo-Ita ◽

Burke Mamlin ◽

Paul Bondich ◽

...

Keyword(s):

Focus Group ◽

Critical Mass ◽

Wait Time ◽

Wait Times ◽

Group Discussions ◽

Middle Income ◽

Middle Income Countries ◽

Group Data ◽

Focus Group Data ◽

Sub Saharan

The wait time clients spend during immunization clinic visits in low- and middle-income countries is a not well-understood reported barrier to vaccine completion. We used a prospective, observational design to document the total time from client arrival-to-discharge and all sequential provider-client activities in 1 urban, semi-urban, and rural immunization clinic in Nigeria. We also conducted caregiver and provider focus group discussions to identify perceived determinants of long clinic wait times. Our findings show that the time from arrival-to-discharge varied significantly by the clinic and ranged between 57 and 235 minutes, as did arrival-to-all providers-client activities. Focus group data attributed workflow delays to clinic staff waiting for a critical mass of clients to arrive for their immunization appointment before starting the essential health education talk or opening specific vaccine vials. Additionally, respondents indicated that complex documentation processes caused system delays. Research on clinic workflow transformation and simplification of immunization documentation is needed.

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Dynamic Question Ordering in Online Surveys

Journal of Official Statistics ◽

10.1515/jos-2017-0030 ◽

2017 ◽

Vol 33 (3) ◽

pp. 625-657 ◽

Cited By ~ 2

Author(s):

Kirstin Early ◽

Jennifer Mankoff ◽

Stephen E. Fienberg

Keyword(s):

Case Studies ◽

Survey Methodology ◽

Response Rate ◽

General Survey ◽

Online Surveys ◽

Rule Based ◽

Past Work ◽

National Surveys ◽

Question Order ◽

Rule Based Approach

Abstract Online surveys have the potential to support adaptive questions, where later questions depend on earlier responses. Past work has taken a rule-based approach, uniformly across all respondents. We envision a richer interpretation of adaptive questions, which we call Dynamic Question Ordering (DQO), where question order is personalized. Such an approach could increase engagement, and therefore response rate, as well as imputation quality. We present a DQO framework to improve survey completion and imputation. In the general survey-taking setting, we want to maximize survey completion, and so we focus on ordering questions to engage the respondent and collect hopefully all information, or at least the information that most characterizes the respondent, for accurate imputations. In another scenario, our goal is to provide a personalized prediction. Since it is possible to give reasonable predictions with only a subset of questions, we are not concerned with motivating users to answer all questions. Instead, we want to order questions to get information that reduces prediction uncertainty, while not being too burdensome. We illustrate this framework with two case studies, for the prediction and survey-taking settings. We also discuss DQO for national surveys and consider connections between our statistics-based question-ordering approach and cognitive survey methodology.

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The impact of seasonal operating room closures on wait times for oral cancer surgery

Current Oncology ◽

10.3747/co.25.3726 ◽

2018 ◽

Vol 25 (1) ◽

pp. 67 ◽

Cited By ~ 4

Author(s):

N. Mundi ◽

J. Theurer ◽

A. Warner ◽

J. Yoo ◽

K. Fung ◽

...

Keyword(s):

Oral Cavity ◽

Cancer Patients ◽

Operating Room ◽

Oral Cavity Cancer ◽

Tertiary Care ◽

Wait Time ◽

Disease Recurrence ◽

Health Science ◽

Wait Times ◽

The Impact

Background Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre.Methods A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated. Our primary endpoint was the wait time from consultation to definitive surgery. Exposure variables were defined according to wait time intervals occurring during time periods with reduced operating room hours.Results Overall case volume rose significantly from 2006 to 2014 (p < 0.001), while operating room hours remained stable (p = 0.555). Patient wait times for surgery increased from 16.3 days prior to 2003 to 25.5 days in 2015 (p = 0.008). Significant variability in operating room hours was observed by month, with lowest reported for July and August (p = 0.002). The greater the exposure to these months, the more likely patients were to wait longer than 28 days for surgery (odds ratio per day [or]: 1.07, 95% confidence interval [ci]: 1.05 to 1.10, p < 0.001). Individuals seen in consultation preceding a month with below average operating room hours had a higher risk of disease recurrence and/or death (hazard ratio [hr]: 1.59, 95% ci: 1.10 to 2.30, p = 0.014).Conclusions Scheduled reductions in available operating room hours contribute to prolonged wait times and higher disease recurrence. Further work is needed to identify strategies maximizing efficient use of health care resources without negatively affecting patient outcomes.

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Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit

Current Oncology ◽

10.3747/co.23.3017 ◽

2016 ◽

Vol 23 (3) ◽

pp. 260 ◽

Cited By ~ 8

Author(s):

J.M. Racz ◽

C.M.B. Holloway ◽

W. Huang ◽

N.J. Look Hong

Keyword(s):

Care Delivery ◽

Patient Flow ◽

Wait Time ◽

Definitive Treatment ◽

Wait Times ◽

Fisher Exact Test ◽

Patient Anxiety ◽

Diagnostic Unit ◽

Clinical Investigations ◽

The Impact

Background Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (RDU) on wait times to clinical investigations and definitive treatment.Methods A retrospective before–after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the RDU. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test.Results The non-RDU group included 287 patients with 164 invasive breast carcinomas. The RDU group included 260 patients with 154 invasive carcinomas. The RDU patients had more single visits for biopsy (92% RDU vs. 78% non-RDU, p < 0.0001). The RDU group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the RDU vs. 50 days without the RDU, p = 0.3806).Conclusions Introduction of a RDU appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.

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Medical readiness: evaluating the robustness of medical clinic staffing solutions

The Journal of Defense Modeling and Simulation Applications Methodology Technology ◽

10.1177/1548512916650996 ◽

2016 ◽

Vol 14 (4) ◽

pp. 407-419

Author(s):

Michael Q Corpuz ◽

Christina F Rusnock ◽

Vhance V Valencia ◽

Kyle Oyama

Keyword(s):

Negative Impact ◽

Cost Benefit Analysis ◽

Relative Effectiveness ◽

Discrete Event ◽

Cost Savings ◽

Cost Benefit ◽

Wait Time ◽

Cost Effective ◽

Wait Times ◽

Staffing Mix

Medical readiness requires Department of Defense medical clinics to be robust to changes in patient demand. Minor fluctuations in patient demand occur on a regular basis, but major increases can also occur. Major demand increases can result from a number of occurrences, including mass military deployments, medical incidents, outbreaks, and overflow from Veterans’ Affairs clinics. This research evaluates a system of clinics at Wright-Patterson Air Force Base in order to determine its ability to handle a 200% surge in patient demand. In addition, this study evaluates the relative effectiveness of six different staffing mix options to minimize patient wait times, also under the surge demand conditions. This evaluation is conducted using discrete-event simulation to estimate patient wait times and includes a sensitivity analysis of the increased patient demand, as well as a cost–benefit analysis to determine the most cost-effective alternative scenario. The study finds that adjustments to staffing mix enable cost savings while meeting current demands. In addition, the study finds that adjusting the staffing mix will not have a negative impact on patient wait time in the surge conditions, relative to the current staffing mix.

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