Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic.

Introduction: The unprecedented COVID-19 pandemic has thrust telehealth into the center stage of health care, leading to a dramatic increase in utilization of telehealth services. The impact of telehealth on patient satisfaction during the current pandemic is yet to be fully understood. Objective: This study aimed to identify patient perspectives and behaviors toward virtual primary care appointments at a telehealth-naïve institution during the COVID-19 pandemic and establish the rate of missed appointments to help guide future implementation of telehealth services. Methods: Patients at a primary and specialty care clinic, seen between March and May 2020, completed a survey analyzing nine commonly used satisfaction metrics. The rate of missed appointments was recorded and compared with analogous cohorts of in-person office visits. Results: The no-show rate of telehealth visits during the COVID-19 pandemic was 7.5% (14/186), lower than both the no-show rate of 36.1% for in-office visits (56/155) (p < 0.0001) and a pre-pandemic in-office no-show rate of 29.8% (129/433) (p < 0.0001). Surveyed patients who experienced telehealth visits (n = 65) had similar satisfaction compared with those surveyed who attended in-office visits (n = 36) in seven of nine metrics. No statistically significant differences were identified in the satisfaction metrics with telehealth visits performed on video (n = 26) versus the phone-only format (n = 38). Patients aged 65 years or over were less likely to have a video component to their virtual visit (1/12, 8.3%) than those under age 65 (25/44, 56.8%) (p = 0.0031). Discussion/Conclusions: Telehealth offers significant benefits for both patients and providers, strongly supporting its widespread utilization both during and following the COVID-19 pandemic.

Refusal of emergency medical care: An analysis of patients who left without being seen, eloped, and left against medical advice.

OBJECTIVE: Emergency department (ED) patients may elect to refuse any aspect of medical care. They may leave prior to physician evaluation, elope during treatment, or leave against medical advice during treatment. This study was undertaken to identify patient perspectives and reasons for refusal of care. METHODS: This prospective study was conducted at an urban Level 1 Trauma Center. This study examined ED patients who left without being seen (LWBS), eloped during treatment, or left against medical advice during September to December 2018. This project included both chart review and a prospective patient survey. RESULTS: Among 298 participants, the majority were female (54%). Most participants were White (61%) or African American (36%). Thirty-eight percent of participants left against medical advice, 23% eloped, and 39% left without being seen by a provider. When compared to the general ED population, patients who refused care were significantly younger (p < 0.001). When comparing by groups, patients who left AMA were significantly older than those who eloped or left without being seen (p < 0.001). Among 68 patients interviewed by telephone, the most common stated reasons for refusal of care included wait time (23%), unmet expectations (23%), and negative interactions with ED staff (15%). CONCLUSION: ED patients who refused care were significantly younger than the general ED population. Common reasons cited by patients for refusal of care included wait time, unmet expectations, and negative interactions with ED staff.