Perceptions and barriers of telehealth services among trauma and acute care surgery patients

Abstract

Background: Patients admitted to tertiary centers are often transferred from long distances and thus follow-up care presents a significant challenge for these patients. The use of telehealth in outpatient visits has been shown to decrease travel costs and increase patient satisfaction, but many studies were performed in urban settings and did not address usability limitations for patients in rural settings. The purpose of the study was to understand the patient-perceived feasibility of utilizing telehealth in a large rural referral trauma center and assess patient's perceptions of telehealth. Prior studies on utilization of telehealth have been done at mostly urban locations and a true understanding of internet availability and accessibility for patients living in rural areas will enable successful implementation and utilization of telehealth in this population.

Methods: We administered a brief questionnaire to patients >16 years old admitted to a single Level 1 academic trauma center's Trauma and Acute Care Surgery services prior to discharge or at the first clinic visit from June 2021 to December 2021. All patients who were eligible and able to complete the questionnaire were approached for voluntary participation in the study. Consent was obtained by the research staff and the questionnaire was completed independently by the participants.

Results: 77 participants completed the questionnaire, 45 (58%) were male, 30 (39%) were female and 2 (3%) were missing and the mean age was 42 years (S.D =17.6). 46 (61%) were Black, 23 (32%) were White and 5 (7%) did not report a race. Regarding insurance status, 30 (40%) had commercial insurance, 8 (11%) had Medicare, 19 (25%) had Medicaid and 18 (24%) were uninsured. 87% of patients reported access to internet at home, and 87% use a smartphone as their primary device for internet access. 86% felt comfortable using telehealth at home. More than half of the respondents (59%) agreed or strongly agreed to use telehealth for their next health care provider visit. 16 (21%) of the respondents strongly agree that telehealth will improve the care they receive from their healthcare professional (HCP), 11(15%) of the respondents strongly disagree telehealth would decrease the care they receive from their HCP, and 14 (19%) of the respondents strongly agree that telehealth would provide faster access to an HCP. 9 (12%) of the respondents strongly agree that they would receive the same quality of care with telehealth compared to an office visit while 17 (23%) disagree. Blacks were more likely to report negative perceptions of telehealth compared to Whites patients.

Conclusion: Majority of our patients were willing to utilize telehealth for their next health care provider visit and had access to internet. Telehealth is very feasible in rural locations inlight of a concern for internet availability and accessibility and offers attractive options for patients. However, there are still some disparities in perceptions such as the quality of care received being equivocal to an office visit that might be a significant barrier to utilization. Such perceptions may be improved with increased familiarization and education on telehealth services.

Keywords: Acute care surgery; Perceptions of telehealth; Surgical quality; Telehealth; Telemedicine; Trauma.

Fig. 1

Perceptions (Panel A) and barriers (Panel B) of telehealth by all study respondents.

Fig. 2

Locations where study respondent access the internet (Panel A) and would feel comfortable using telehealth for health care provider visit (Panel B).

Fig. 3

Study Respondents’ willingness to use telehealth for the next health care provider visit stratified by race (Panel A), age (Panel B), and sex (Panel C).

Fig. 4

Study respondents’ perceived barriers to the use of telehealth stratified by race (Panel A), age (Panel B), and sex (Panel C).