Satisfaction with Psychiatric Teleconsultation Services During COVID-19 Pandemic: Perspective of Service Users.

To the Editor,

Since the onset of the COVID-19 pandemic, telemedicine is being used at a massive scale but without assessing the satisfaction and feedback of patients and their caregivers, i.e., the service users. Studies in the West have mostly reported positive feedback and acceptability toward telemedicine/teleconsultation services. However, positive feedback is not universal. The primary aim of this cross-sectional study was to assess satisfaction with psychiatric teleconsultation services and the ease/comfort of using teleconsultation among patients or their caregivers during the COVID-19 pandemic. The secondary aim was to assess savings in terms of cost and time while seeking teleconsultation.

Subjects and Methods

This cross-sectional study was carried out from July 20, 2020, to August 24, 2020, by approaching the participants through telephone calls, after approval from the Institutional Ethics Committee. Two hundred and fifty-one participants (patients or caregivers) were randomly selected from those who had availed teleconsultation in the psychiatry department (at the author’s institute) between 2 April and mid-June, 2020, who had received a prescription over teleconsultation, were aged ≥18 years, and were willing to participate in the study. Potential participants whose phone number recorded in the register was incorrect/nonfunctional or who did not respond to the call were excluded. The assessment was done using modified Hick’s questionnaire, comprising nine questions rated on a six-point Likert scale.

Results

Among the 251 participants, 54.6% were patients and the rest were caregivers. The majority of the participants were males (71.9%). Their mean age was 35.25 years (SD = 12.28), and the mean duration of formal education was 8.24 years (SD = 2.51). Most belonged to an urban area (61.9%). The majority were unskilled/semiskilled workers (43.5%), followed by homemakers (28.1%). Among the diagnostic profile, the highest proportion was of anxiety disorders (32%), followed by depression (25%), schizophrenia and related disorders (22%), and bipolar disorder (17%), and a small proportion was that of substance use disorders, dementia, and other disorders.

There was a high rate of satisfaction (~90%) with psychiatric teleconsultation (Table 1). The majority (>75%) found it easy and comfortable and were willing to continue with teleconsultation. The responses of patients and caregivers had no statistically significant difference.

Table 1.

Satisfaction with Teleconsultation Services (N = 251)

	Question	0 Not at all Satisfiedn (%)	1 Not Very Much Satisfiedn (%)	2 Neutral/Undecidedn (%)	3 Some-What Satisfied/likelyn (%)	4 Very Much Satisfied/Likelyn (%)	5 Highly Satisfied/Highly Likelyn (%)	Mean (SD)
	How satisfied were you with your teleconsultation session?	0	8 (3.2)	0	16 (6.4)	55 (21.9)	172 (68.5)	4.53 (0.88)
	How easy was it to talk with the teleconsultation provider?	0	8 (3.2)	0	31 (12.4)	31 (12.4)	181 (72.1)	4.50 (0.95)
	How much did the teleconsultation provider seem to care about you as a person?	0	8 (3.2)	0	24 (9.6)	47 (18.7)	172 (68.5)	4.50 (0.92)
	Did you feel relaxed during the teleconsultation session?	0	8 (3.2)	0	24 (9.6)	31 (12.4)	188 (74.9)	4.56 (0.91)
	Do you think teleconsultation improves your medical care?	0	8 (3.2)	0	39 (15.5)	94 (37.4)	110 (43.8)	4.19 (0.93)
	Do you think your teleconsultation session was as good as a regular in-person visit?	0	8 (3.2)	16 (6.4)	55 (21.9)	79 (31.5)	93 (37.1)	3.94 (1.08)
	How well did the mobile phone and connectivity work during the session?	0	8 (3.2)	0	31 (12.4)	55 (21.9)	157 (62.5)	4.41 (0.95)
	Would you want to use teleconsultation again?	0	8 (3.2)	8 (3.2)	31 (12.4)	63 (25.1)	141 (56.2)	4.28 (1.02)
	Were you able to procure medicines comfortably after teleconsultation?	0	8 (3.2)	0	39 (15.5)	24 (9.6)	180 (71.7)	4.47 (0.98)

Further, it was found that, approximately, on average, the patients/caregivers had to travel 130 km (SD = 10.46) and spend ₹1,125 (SD = 372.45) and 10 hours (SD = 3.78) for each in-person consultation. The expenditure included the cost of transportation and boarding/lodging of the patient and escort and did not include the cost of medicines. The time spent included the time taken to travel to and from the hospital and the time spent in registration and waiting for consultation.

Discussion

After the onset of the COVID-19 pandemic, a few studies have been conducted in India about the feedback/satisfaction of patients regarding teleconsultation services.[3-8] All of these papers have reported a high level of satisfaction with teleconsultation and willingness to continue teleconsultation in the future. However, these studies used self-designed questionnaires and did not assess the amount of time and money saved through teleconsultation. Studies from other parts of the world also report a high level of satisfaction with teleconsultation among the end-users of the service during the pandemic.[9-11]

This study is probably the first of its kind in the specialty of psychiatry to assess the satisfaction of patients/caregivers to teleconsultation after large-scale use of the same in view of the COVID-19 pandemic and after the advent of a legal framework for such services. Massive expansion in the use of mobiles/smartphones and good internet connectivity seems to be the key factor responsible for the high rate of satisfaction. Our participants represented the typical patient population seen in the outpatient department of a publicly funded tertiary care center in India—the majority belonged probably to the lower or lower middle socioeconomic strata of the society. Yet, they had a high level of satisfaction and acceptance toward teleconsultation. This clearly shows that teleconsultation can easily penetrate all sections of society, and by no means shall be limited to the rich or elite. The results also highlight the amount of time and money spent and the distance travelled that could be saved and avoided by using teleconsultation. The study by Das et al., was similar to our study and had similar findings. However, it was a pilot project with a smaller sample size conducted before the COVID-19 pandemic.

Limitations

The study pertained to a period when the nation was under lockdown, and routine in-person consultations were nearly impossible. During these times, medical consultation was mostly available through telemedium only. This could have contributed to the high rate of satisfaction to some extent. More studies, including subjects who seek their first consultation through telemedium, shall be needed once the pandemic is over and routine in-person consultations are easily available. The assessment was carried out over the phone using a brief questionnaire. An in-person interview using a detailed tool could have given more details of various aspects related to the topic. Reasons for dissatisfaction were not assessed. The study was carried out at a publicly funded academic institution, and the service was provided free of cost. Results may not apply to other settings/branches of medicine.

Conclusion

The service users had a high level of satisfaction and acceptance toward psychiatric teleconsultation services during the COVID-19 pandemic. This suggests that such services could be continued after the pandemic. Although in-person consultation is likely to remain the gold standard, greater application of teleconsultation can bring considerable savings to the patients/caregivers and help shorten the queues in large hospitals.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.