Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis.

Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.

The use of telemedicine in the PICU: A systematic review and meta-analysis.

The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis aimed to evaluate whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes. PubMed, Scopus, LILACS, and CINAHL electronic databases were searched to identify studies that assessed the impact of telemedicine on clinical outcomes, with no publication date restrictions. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. Studies were included if they had a cohort design, used telemedicine, were conducted in PICUs or specialized PICUs, and were published in Portuguese, English, or Spanish. Two groups of reviewers independently screened titles and abstracts for inclusion. The same group of reviewers independently assessed the full-text articles for eligibility and extracted the following information: telecommunication method, intervention characteristics, patient characteristics, sample size, and main results. Studies were meta-analyzed using a random-effects model to estimate the pooled prevalence of PICU mortality and length of PICU stay. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 2703 studies initially identified, 2226 had their titles and abstracts screened. Of these, 53 were selected for full-text reading, of which 10 were included and analyzed. The main results of interest were length of PICU stay, number of deaths or mortality rate, and satisfaction of health professionals and family members. The results of meta-analysis show that the mortality rate reduced by 34% with an increase of the length of PICU stay in the PICUs with the use of telemedicine. Family members and health professionals were satisfied with the use of telemedicine. Telemedicine has the potential to improve PICU outcomes, such as mortality rate and family and staff satisfaction. However, it extended length of PICU stay in the studies included in this systematic review.

Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy.

Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25-0.25], 0.01 [95%-LoA: -0.86-0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1-0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4-4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82-0.91]; 0.97 [0.96-0.98]; 0.96 [0.95-0.97] and 0.88 [0.84-0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.