"A day in the life" - telemedicine in family medicine and its relationship with practicing physicians' satisfaction: a cross-sectional study.
Burnout
Primary care
Remote visits
Satisfaction
Telemedicine
Journal
Israel journal of health policy research
ISSN: 2045-4015
Titre abrégé: Isr J Health Policy Res
Pays: England
ID NLM: 101584158
Informations de publication
Date de publication:
29 Jul 2024
29 Jul 2024
Historique:
received:
27
09
2023
accepted:
20
07
2024
medline:
30
7
2024
pubmed:
30
7
2024
entrez:
29
7
2024
Statut:
epublish
Résumé
Telemedicine has expanded rapidly in recent years, and many encounters that were conducted in person now take place remotely. This study aimed to assess primary care physicians' (PCPs) attitudes towards the different modalities of patient care. This is a cross-sectional nationwide descriptive study conducted in Israel. We asked PCPs to document an entire workday and answer a short questionnaire after each visit. The questions addressed the type of visit (face-to-face, remote synchronous [telephone/video], or remote asynchronous [online requests]), the perceived quality of the visit, and the physicians' feelings at the end of each visit. Before documenting their working day, we asked the participants to answer a questionnaire about their general attitudes toward different modalities of medical visits and how they affect their well-being and burnout. Sixty physicians documented 2,025 visits, of which 39% took place in person, 36% stemmed from online patient requests, 18% were telephone meetings, < 1% were video meetings, and 6% consisted of other types of contact. Mixed effects logistic regressions were used to model the visits' evaluation. The odds ratios (ORs) for perceived medical quality of visits focused on medical tasks were lower for non-face-to-face visits: OR = 0.39, 95% CI 0.25-0.59 for remote synchronous, and OR = 0.14, 95% CI 0.09-0.23 for remote asynchronous. The perceived medical quality of visits focused on administrative tasks was lower for remote asynchronous than for face-to-face visits (OR = 0.31, 95% CI 0.14-0.65). We found no association between medical quality and patients, physicians, or clinic characteristics. The inappropriateness of the visit modality was also associated with lower medical quality (OR = 0.13, 95% CI 0.09-0.18). We found a correlation between perception of medical quality and physicians' feelings at the end of the visits, Spearman's r = 0.82 (p < 0.001). A substantial portion of the visits was dedicated to administrative tasks and remote medicine. In comparison, physicians rated face-to-face visits' quality higher than remote visits. Policymakers should intervene to minimize administrative work, reduce PCPs' administrative workload, and direct patients to the optimal visit modality for their complaints. These steps would increase medical quality, reduce burnout, and mitigate the shortage of PCPs.
Sections du résumé
BACKGROUND
BACKGROUND
Telemedicine has expanded rapidly in recent years, and many encounters that were conducted in person now take place remotely. This study aimed to assess primary care physicians' (PCPs) attitudes towards the different modalities of patient care.
METHODS
METHODS
This is a cross-sectional nationwide descriptive study conducted in Israel. We asked PCPs to document an entire workday and answer a short questionnaire after each visit. The questions addressed the type of visit (face-to-face, remote synchronous [telephone/video], or remote asynchronous [online requests]), the perceived quality of the visit, and the physicians' feelings at the end of each visit. Before documenting their working day, we asked the participants to answer a questionnaire about their general attitudes toward different modalities of medical visits and how they affect their well-being and burnout.
RESULTS
RESULTS
Sixty physicians documented 2,025 visits, of which 39% took place in person, 36% stemmed from online patient requests, 18% were telephone meetings, < 1% were video meetings, and 6% consisted of other types of contact. Mixed effects logistic regressions were used to model the visits' evaluation. The odds ratios (ORs) for perceived medical quality of visits focused on medical tasks were lower for non-face-to-face visits: OR = 0.39, 95% CI 0.25-0.59 for remote synchronous, and OR = 0.14, 95% CI 0.09-0.23 for remote asynchronous. The perceived medical quality of visits focused on administrative tasks was lower for remote asynchronous than for face-to-face visits (OR = 0.31, 95% CI 0.14-0.65). We found no association between medical quality and patients, physicians, or clinic characteristics. The inappropriateness of the visit modality was also associated with lower medical quality (OR = 0.13, 95% CI 0.09-0.18). We found a correlation between perception of medical quality and physicians' feelings at the end of the visits, Spearman's r = 0.82 (p < 0.001).
CONCLUSIONS
CONCLUSIONS
A substantial portion of the visits was dedicated to administrative tasks and remote medicine. In comparison, physicians rated face-to-face visits' quality higher than remote visits. Policymakers should intervene to minimize administrative work, reduce PCPs' administrative workload, and direct patients to the optimal visit modality for their complaints. These steps would increase medical quality, reduce burnout, and mitigate the shortage of PCPs.
Identifiants
pubmed: 39075571
doi: 10.1186/s13584-024-00624-w
pii: 10.1186/s13584-024-00624-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
33Informations de copyright
© 2024. The Author(s).
Références
Chen HS, Guo FR, Lee RG, Lin CC, Chen JH, Chen CY et al. Recent advances: Telemedicine. BMJ: British Medical Journal [Internet]. 2001 Sep 9 [cited 2023 Feb 7];323(7312):557. /pmc/articles/PMC1121135/.
Reed T, Tuckson V, Edmunds M, Hodgkins ML. Telehealth. https://doi.org/101056/NEJMsr1503323 [Internet]. 2017 Oct 19 [cited 2023 Feb 7];377(16):1585–92. https://www.nejm.org/doi/ https://doi.org/10.1056/NEJMsr1503323 .
Ray KN, Shi Z, Poon SJ, Uscher-Pines L, Mehrotra A. Use of Commercial Direct-to-Consumer Telemedicine by Children. Acad Pediatr [Internet]. 2019 Aug 1 [cited 2023 Feb 7];19(6):665–9. https://pubmed.ncbi.nlm.nih.gov/30639759/ .
Khairat S, Haithcoat T, Liu S, Zaman T, Edson B, Gianforcaro R et al. Advancing health equity and access using telemedicine: a geospatial assessment. J Am Med Inform Assoc [Internet]. 2019 Apr 17 [cited 2023 Feb 7];26(8–9):796–805. https://pubmed.ncbi.nlm.nih.gov/31340022/ .
Cortez C, Mansour O, Qato DM, Stafford RS, Alexander GC. Changes in Short-term, Long-term, and Preventive Care Delivery in US Office-Based and Telemedicine Visits During the COVID-19 Pandemic. JAMA Health Forum [Internet]. 2021 Jul 9 [cited 2023 Feb 7];2(7):e211529. https://pubmed.ncbi.nlm.nih.gov/35977211/ .
Reges O, Feldhamer I, Wolff Sagy Y, Lavie G. Factors Associated with Using Telemedicine in the Primary Care Clinics during the COVID-19 Pandemic in Israel. Int J Environ Res Public Health [Internet]. 2022 Oct 1 [cited 2023 Feb 7];19(20). https://pubmed.ncbi.nlm.nih.gov/36293788/ .
Kaufman-Shriqui V, Shani M, Boaz M, Lahad A, Vinker S, Birk R. Opportunities and challenges in delivering remote primary care during the Coronavirus outbreak. BMC primary care [Internet]. 2022 Dec 1 [cited 2023 Feb 4];23(1). https://pubmed.ncbi.nlm.nih.gov/35641930/ .
Ryan BL, Brown JB, Freeman TR, Richard L, Stewart M, Meredith L et al. Virtual family physician care during COVID-19: a mixed methods study using health administrative data and qualitative interviews. BMC primary care [Internet]. 2022 Dec 1 [cited 2023 Feb 4];23(1). https://pubmed.ncbi.nlm.nih.gov/36434524/ .
Vosburg RW, Robinson KA. Telemedicine in Primary Care During the COVID-19 Pandemic: Provider and Patient Satisfaction Examined. Telemed J E Health [Internet]. 2022 Feb 1 [cited 2023 Feb 4];28(2):167–75. https://pubmed.ncbi.nlm.nih.gov/33999740/ .
Chang JE, Lai AY, Gupta A, Nguyen AM, Berry CA, Shelley DR. Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. Milbank Q [Internet]. 2021 Jun 1 [cited 2023 Feb 4];99(2):340–68. https://pubmed.ncbi.nlm.nih.gov/34075622/ .
Morgenstern-Kaplan D, Rocha-Haro A, Canales-Albarrán SJ, Núñez-Garciá E, León-Mayorga Y. An App-Based Telemedicine Program for Primary Care and Specialist Video Consultations During the COVID-19 Pandemic in Mexico. Telemed J E Health [Internet]. 2022 Jan 1 [cited 2023 Feb 4];28(1):60–5. https://pubmed.ncbi.nlm.nih.gov/33733868/ .
Gold KJ, Laurie AR, Kinney DR, Harmes KM, Serlin DC. Video Visits: Family Physician Experiences With Uptake During the COVID-19 Pandemic. Fam Med [Internet]. 2021 Mar 1 [cited 2023 Feb 4];53(3):207–10. https://pubmed.ncbi.nlm.nih.gov/33723819/ .
Woolhandler S, Himmelstein DU. Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction. Int J Health Serv [Internet]. 2014 Oct 1 [cited 2023 Feb 4];44(4):635–42. https://pubmed.ncbi.nlm.nih.gov/25626223/ .
Toscano F, O’Donnell E, Broderick JE, May M, Tucker P, Unruh MA et al. How Physicians Spend Their Work Time: an Ecological Momentary Assessment. J Gen Intern Med [Internet]. 2020 Nov 1 [cited 2023 Feb 4];35(11):3166–72. https://pubmed.ncbi.nlm.nih.gov/32808212/ .
29 physician specialties ranked. by 2021 burnout rates [Internet]. [cited 2023 Feb 7]. https://www.beckershospitalreview.com/hospital-physician-relationships/29-physician-specialties-ranked-by-2021-burnout-rates.html .
Dai M, Willard-Grace R, Knox M, Larson SA, Magill MK, Grumbach K et al. Team Configurations, Efficiency, and Family Physician Burnout. J Am Board Fam Med [Internet]. 2020 May 1 [cited 2023 Feb 4];33(3):368–77. https://pubmed.ncbi.nlm.nih.gov/32430368/ .
Ward ZD, Morgan ZJ, Peterson LE. Family Physician Burnout Does Not Differ With Rurality. J Rural Health [Internet]. 2021 Sep 1 [cited 2023 Feb 4];37(4):755–61. https://pubmed.ncbi.nlm.nih.gov/32929816/ .
Weidner AKH, Phillips RL, Fang B, Peterson LE. Burnout and Scope of Practice in New Family Physicians. Ann Fam Med [Internet]. 2018 May 1 [cited 2023 Feb 4];16(3):200–5. https://pubmed.ncbi.nlm.nih.gov/29760022/ .
Israeli Ministry of Health. Family medicine specialists and primary care physicians – 2018 (Hebrew). [last accessed 24 Jun 2024). https://www.health.gov.il/PublicationsFiles/FamilyHealth_2018.pdf .