Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3002 — Measurement of Physician-Patient Communication during Telemedicine- Results from a Randomized Clinical Trial

Agha Z (VAMC SAN DIEGO HSR&D & UNIVERSITY OF CALIFORNIA, SAN DIEGO) , Schapira R (VAMC MILWAUKEE & MEDICAL COLLEGE OF WISCONSIN), Roter DL (JOHNS HOPKINS UNIV), Laud P (MEDICAL COLLEGE OF WISCONSIN)

Objectives:
To determine whether the physical separation between patient and physician required during telemedicine has an effect on physician-patient communication. To validate the use of a communication tool, “Patient satisfaction with physician interpersonal and communication skills questionnaire,” during telemedicine consultations.

Methods:
This study is an ongoing randomized trial of 221 patients at the Milwaukee VAMC and its remote clinical site in Appleton, Wisconsin. Patients from one of 3 specialties (pulmonary, endocrine, or rheumatology) are randomly assigned to receive consultative care via in-person or telemedicine consultations provided by the same group of physicians (n = 9). Patient satisfaction with communication behaviors is measured and compared with a 60-item questionnaire.

Results:
Data are presented from 181 subjects who have completed the study protocol. Psychometric analysis of the satisfaction questionnaire shows excellent reliability for overall satisfaction with all items combined (alpha = 0.93) and high reliability for 4 of 5 previously identified subscales: task-directed skills (alpha = 0.78), interpersonal skills (alpha = 0.78), partnership building (alpha = 0.82), emotional support (alpha = 0.78), and attentiveness (alpha =0.53). The overall satisfaction score between telemedicine and in-person visits was similar (151 versus 148, p = 0.3). Patient satisfaction was statistically similar across each of the five sub-scales with a trend toward better satisfaction scores for partnership building (p = 0.07) and emotional support (p = 0.07) for telemedicine subjects. Patient satisfaction with convenience of visits was higher for telemedicine (p = 0.001).

Implications:
Telemedicine did not have a negative effect on physicians' interpersonal and communication skills. In the areas of “partnership building/shared decision making” and “emotional support,” patients rated telemedicine visits as slightly better than in-person visits. “Patient satisfaction with physician interpersonal and communication skills questionnaire” had high reliability in this study. Further validation, including content analyses of study visits and clinical outcomes, is underway.

Impacts:
Concerns over the quality of doctor-patient communication during telemedicine need to be re-evaluated. A comprehensive and reliable tool such as the “patient satisfaction with physician interpersonal and communication skills questionnaire” can be adopted to measure the quality of VHA clinical telemedicine programs.