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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3074 — Patient Assessment of Physician-Patient Communication during Telemedicine versus In-Person Medical Consultation: Results from a Randomized Trial

Agha Z (VA San Diego Healthcare System), Schapira R (Clement J. Zablocki Veterans Affairs Medical Center), Laud P (Medical College of Wisconsin), McNutt G (Clement J. Zablocki Veterans Affairs Medical Center), Roter D (Johns Hopkins University)

Objectives:
The quality of physician-patient communication is a critical and predictive factor of treatment outcomes, including patient satisfaction with care. To date, there is little research to document the effect of telemedicine videoconference on communication in the medical setting. Our aim was to determine whether the physical separation and use of technology during telemedicine have a negative effect on physician-patient communication

Methods:
We conducted a RCT of 221 patients at the Milwaukee VA Medical Center. Patients from pulmonary, endocrine, and rheumatology clinics received consultative care with one of 9 physicians, either in person (IP) or via telemedicine (TM). Physician-patient communication was measured using the “Patient Assessment of Communication during Telemedicine” (PACT), a validated self-report questionnaire

Results:
We randomly assigned 221 subjects to receive TM (n = 111) or IP (n =110) visits. Noninferiority t-statistics were calculated using a linear mixed model while accounting for any clustering by physician factor. The total patient satisfaction score was higher for TM than for IP visits (192 versus 185.3, p = 0.02). The null hypothesis of inferiority (i.e., TM is inferior to IP), using an inferiority margin of 0.5 SD, was rejected (p = 0.001). Patient satisfaction with physician’s Task-Directed Skills, Interpersonal Skills, Attentiveness, and Emotional Support were similar for TM and IP groups (inferiority null hypothesis rejected p = 0.001). Patients reported higher satisfaction with Shared Decision Making (p = 0.025) and the convenience of TM (p = 0.001) as compared to IP visit

Implications:
Telemedicine did not have a negative effect on physician-patient communication in this study. Patients were very satisfied with their physician’s ability to develop rapport, use shared decision making, and promote patient-centered communication during TM consultations. Patients rated TM as significantly more convenient than IP visits

Impacts:
The quality of physician-patient communication is a predictive factor of treatment outcomes. Our data suggest that despite physical separation, physician-patient communication during telemedicine consultations is as good as during in-person consultations


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