Telehealth during the coronavirus pandemic: access, attitude and experience of gynecology and gynecologic oncology patients in a large public safety-net hospital system

Objectives: The coronavirus pandemic and need for social distancing has led to a requisite shift in healthcare delivery towards telemedicine, particularly for non-urgent outpatient visits. Little data exists around the efficacy of telemedicine in meeting patient care needs and satisfaction indices. This is particularly true for non-White, predominantly non-English-speaking patients who already experience many barriers to healthcare access and now face the highest risk of severe morbidity and mortality from Covid-19. We thus sought to assess the telehealth access, attitudes and experiences of gynecology and gynecologic oncology patients cared for in a large public safety-net hospital system during the coronavirus pandemic. Methods: Anonymous patient surveys were developed in both English and Spanish using an adaptable previously-published CHCF survey instrument. Surveys were directed at both face-to-face and telehealth visits using a 4-point Likert scale for single and composite scores. These were supplemented by categorical questions addressing telehealth access variables. Surveys were administered to all gynecology and gynecologic oncology patients presenting for care in a public safety-net hospital system from September through October 2020 during the coronavirus pandemic. Questionnaire responses were collected anonymously through SurveyMonkey with virtual or in-person assistance of clinic staff as needed. Survey results were tabulated and exported from SurveyMonkey for qualitative and quantitative analysis. Results: Over the 2-month study period, 219 completed questionnaires were received with 117 (53%) in Spanish and 102 (47%) in English. One hundred eighty-four (84%) patients completed the questionnaire following a face-to-face (FTF) visit and 35 (16%) following a telehealth visit. Prior telehealth experience was reported by 65% of FTF patients and 57% of telehealth patients. Of Spanish-speaking patients, 74% reported use of an interpreter or Spanish-speaking provider during FTF visits compared to 100% during telehealth visits. Overall, 80% of patients reported having access to Wi-Fi, and 82% to a smart phone or tablet. Nearly one third of patients reported having to take time off work for their visit, regardless of visit type, and 34% reported requiring county-provided transportation for in-person clinic appointments. Overall, 90% of patients felt they were listened to, their healthcare needs were met, and provider explanations were clear, regardless of visit type. Approximately half of FTF patients, compared to less than 20% of telehealth patients, expressed the belief that telehealth appointments were not of equal quality to FTF visits. However, approximately half of FTF patients also reported they would have felt safer seeing a medical professional by telehealth due to Covid-19. Conclusions: In a representative sample of primarily non-White, non-English-speaking patients receiving care at a public safety-net hospital, telehealth is an acceptable form of healthcare provision. Over 90% of patients in telehealth and FTF cohorts felt their healthcare needs were met. However, lack of reliable smartphone and Wi-Fi access for nearly 20% of patients may present a particular challenge for instituting effective telehealth for these underserved communities. Regular solicitation of patient feedback around telehealth systems will continue to be important.