|Year : 2022 | Volume
| Issue : 2 | Page : 132-135
A survey of patient satisfaction with telepsychiatry services delivered at a tertiary care hospital in western punjab during the COVID-19 pandemic
Jitender Aneja, Gurpreet Kaur, Bharat Udey
Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab, India
|Date of Submission||21-Aug-2022|
|Date of Decision||10-Oct-2022|
|Date of Acceptance||28-Oct-2022|
|Date of Web Publication||13-Jan-2023|
Dr. Jitender Aneja
Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab
Source of Support: None, Conflict of Interest: None
Background: Previous research has shown promising results of telepsychiatry in the form of patient satisfaction. However, its utilization in the wake of the COVID-19 pandemic and with bare minimum resources in the Indian context is scarcely studied. Aim: To evaluate patient satisfaction with telepsychiatry services delivered at a tertiary care hospital in Western Punjab. Methods: This study was done among 114 patients who had availed of telepsychiatry services between September and November 2021. The patients were interviewed telephonically using a pretested semi-structured tool that measured patient satisfaction on a 5-point Likert Scale. Results: The satisfaction rate was very high for various aspects of telepsychiatry services such as ease of seeking appointments, video quality, attending doctor's concern for the patient, time given, ability to procure medicines using the e-prescription and so on. Conclusion: Telepsychiatry services delivered through an easy medium encourage us to further strengthen and undertake more research into this aspect of health-care delivery.
Keywords: COVID-19, India, pandemic, patient care, satisfaction, telepsychiatry
|How to cite this article:|
Aneja J, Kaur G, Udey B. A survey of patient satisfaction with telepsychiatry services delivered at a tertiary care hospital in western punjab during the COVID-19 pandemic. J Mental Health Hum Behav 2022;27:132-5
|How to cite this URL:|
Aneja J, Kaur G, Udey B. A survey of patient satisfaction with telepsychiatry services delivered at a tertiary care hospital in western punjab during the COVID-19 pandemic. J Mental Health Hum Behav [serial online] 2022 [cited 2023 Jun 4];27:132-5. Available from: https://www.jmhhb.org/text.asp?2022/27/2/132/367737
| Introduction|| |
Before the onset of the COVID-19 pandemic, telepsychiatry was infrequently used in routine clinical practice. Evidence from real-world studies, however, had highlighted the promising results of telepsychiatry and its effectiveness and acceptability among patients and clinicians alike., Nevertheless, in the wake of the COVID-19 pandemic, telepsychiatry emerged as an important interface between the health-care providers and patients.
Curtailing the systemic barriers such as government regulations, administrative and legal challenges, hardware requirements, etc., the Indian government brought out the Telemedicine Practice Guidelines (2020), which provided a major push for the utilization of telemedicine in India. Consequent on this and with a very basic information technology infrastructure, we also initiated telepsychiatry services for the patients in the Malwa region of Punjab and nearby districts of Haryana and Rajasthan. We utilized WhatsApp messenger and landline telephone as tools to deliver telemedicine services. These basic digital facilities are nowadays easily accessible to anyone having a smartphone with an Internet connection. Yet the level of acceptance and satisfaction of this technology for seeking mental health care among patients is not clear. Therefore, this study was undertaken to evaluate patient satisfaction with telepsychiatry services.
| Materials and Methods|| |
This cross-sectional study was carried out from September to November 2021 after seeking approval from Institutional Ethics Committee (IEC/*****/BTI/128 dated August 18, 2021). One hundred and fourteen participants (out of a total of 216 telepsychiatry consultations) who had sought telepsychiatry services at this hospital during the study period consented to provide their feedback. A semi-structured questionnaire was used to obtain the sociodemographic details, basic details of awareness about telepsychiatry services, source of information about telepsychiatry services at our institute, and the time and money saved from telepsychiatry services. The second part of the questionnaire (with modifications in the original tool) enquired about the ease of obtaining telepsychiatry appointment, satisfaction with these services, satisfaction level with postconsultation services, for example, generation of the prescription, and the overall satisfaction with the teleconsultation services and their willingness to use such services in future. Level of satisfaction was assessed on a five-point Likert scale, categorized as very dissatisfied, dissatisfied, neither satisfied nor dissatisfied, satisfied, or very satisfied. Oral informed consent was taken from all the participants before the questionnaire was delivered. The participants who could not be reached despite two calls, denied consent, or for whom the survey form was partly filled were excluded from the study.
Data were analyzed using the SPSS Statistics for Windows, Version 19.0 (2011). IBM Corp., Armonk, NY. Descriptive statistics were used to summarize the demographic details of the patients as well as the satisfaction parameters. Pearson Chi-square was utilized to evaluate any difference between the two groups who utilized video consultation only or both audio and video consultation. Significance levels of < 0.05 were considered statistically relevant.
| Results|| |
A total of 114 participants were included in this study with a mean age of 41.35 (standard deviation [SD] = 15.50) years; half of them in the age group of 21–40 years (50.56%), were males (56.17%) who were married (74.15%) and formally educated (92.13%; 43.82% were graduate or above). Majority of the participants followed Sikhism (55.05%), lived in the urban locality (53.93%), sought consultation for self (74.56%), belonged to Punjab (85.08%) and two-thirds of them lived in <100 km of distance from the study center. The average monthly income was less than INR 20,000 for most of the study participants (59.64%), and all the participants acknowledged that they saved money by seeking teleconsultation. The source of information regarding the availability of telepsychiatry services at this hospital were family/friends (31.57%), social media (24.56%), print media (5.61%), television (2.24%), and others (37.71%). The psychiatric diagnosis of the patients were affective disorders (52.63%), anxiety disorders (20.17%), schizophrenia spectrum disorders (11.40%), and a small number of those with substance use disorders, mental disorders due to known physiological conditions, diseases of the nervous system (such as headache, epilepsy) and in some the diagnosis was deferred. Anxiety disorders were the most common comorbid conditions.
The average number of telepsychiatry consultations sought by the participants was 3.90 (SD = 3.19; range = 1–19) and videoconferencing was predominantly utilized (Mean = 4.02, SD = 3.33 vs. Mean = 3.48, SD = 2.67 for audio/+video consult). There were no socio-demographic or clinical differences between the participants who sought videoconferencing or audio/+video consultation. The satisfaction rate was very high vis a vis various aspects of telepsychiatry consultations such as ease of seeking appointment (99.2%), voice/video quality (99.2%), attending doctor's concern for the patient (99.2%), time given to listen to their problems (98.3%) and so on [details provided in [Table 1]]. Three participants were either dissatisfied/very much dissatisfied with the last teleconsultation session and two participants reported that it was not useful for reliving their problems. Nearly 8% did not want to avail of telepsychiatry again and 6% reported that they may not recommend it to others as well. However, we were unable to elicit the reasons of such a feedback despite keeping an open-ended question at the end of the questionnaire for other comments/suggestions. On an average, the mean time saved was 15 h (Range = 2–72 h) and a mean amount of INR 2129.95 was saved (Range = 200–9800) through teleconsultation. The amount saved included that for transporatation, lodging and loss of income due to absence from work.
| Discussion|| |
The COVID-19 pandemic has led to a rapid transformation of the delivery of psychiatry services from a traditional in-person consultations to teleconsultations. This phenomenon was observed worldwide, and various non-/government hospitals in India started telepsychiatry services. Two recent reviews (one systematic review of patient satisfaction from telehealth services before COVID-19 and another review of telemental health services during the pandemic), showed positive results and patient satisfaction with telepsychiatry services from Western and European countries. However, limited research is available from low- and middle-income countries, including India. With the best of our efforts, we could retrieve three Indian studies which have evaluated patient satisfaction from telepsychiatry services.,,
The sociodemographic profile of the participants in the index study is somewhat similar to previous Indian studies in that mostly people in the age range of 35–40 years sought telepsychiatry services, had at least 10 years of education, were married and belonged to an urban locality.,, The clinical profile of participants in the index study was similar to the one from Raipur, as mood and anxiety disorders were the most common diagnosis. However, in two other studies, bipolar disorders, depressive disorders, and schizophrenia were the most common ailments. The difference is partly due to one being an aftercare study for those who were recently discharged from the hospital.
The patient satisfaction in the index study is comparable to two previous studies, wherein there was very high satisfaction with the telepsychiatry services and acceptability. The assessment tool for evaluation of patient satisfaction in the index study and an earlier study was modified from Hicks et al., and therefore bear significant resemblance. The overall satisfaction was also comparable with another study conducted in Chandigarh but only half of the patients reported the telepsychiatry consultations to be good/very good/excellent in the later study. The ease of participation in the teleconsultations, as reported by subjects in the two studies, was also comparable, but more than 99% of patients were able to procure their medicines in the index study.
Finally, the participants were able to save time and money by seeking telepsychiatry services, and this was highest in the study from NIMHANS, Bangalore because most of the patients hailed from states other than Karnataka. The participants in the index study and two others, mainly lived within 100–150 km distance from the hospital but still saved significant time and money spent on traveling and lodging.
The findings of the index study and the other Indian studies are in keeping with international research. The overall patient satisfaction with telepsychiatry services has been reported to be in the range of 80%–90%.,, Satisfaction has been reported for the means utilized for delivery of teleservices, quality of audio-video, ability to express themselves, needs of privacy, assessment of the needs of the patient by the doctor, as well as understanding the recommendations of the doctor. Time and money saved in traveling for each visit and the ease of access to the psychiatrist were some of the significant positive feedbacks in the previous research, while technological hassles have been the predominant negative aspects for the patients.
Limitations of the study
The study is limited by lack of a control group, short span of the study, small sample size, conduction of study during a period when in-person health services were mostly unavailable, and interviews were done very closely after teleconsultation and response bias as nearly 50% of the total patients who had sought telepsychiatry consultation were excluded from the study. Although we kept an open-ended question for the study participants, no additional response was received.
| Conclusion|| |
To conclude, the index study adds to the limited research available in this field. The high level of satisfaction from telepsychiatry services delivered through an easy medium (WhatsApp Messenger or audio call) encourages health-care providers to further strengthen these services. The premise that in-person consultation is the preferred choice of consultation in comparison to telepsychiatry services needs further research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM. The empirical evidence for telemedicine interventions in mental disorders. Telemed J E Health 2016;22:87-113.
Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. BMC Public Health 2020;20:1193.
Hicks LL, Boles KE, Hudson S, Kling B, Tracy J, Mitchell J, et al
. Patient satisfaction with teledermatology services. J Telemed Telecare 2003;9:42-5.
Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open 2017;7:e016242.
Li H, Glecia A, Kent-Wilkinson A, Leidl D, Kleib M, Risling T. Transition of mental health service delivery to telepsychiatry in response to COVID-19: A literature review. Psychiatr Q 2022;93:181-97.
Das S, Manjunatha N, Kumar CN, Math SB, Thirthalli J. Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital. Asian J Psychiatr 2020;48:101886.
Somani A, Singh LK. Satisfaction with Psychiatric Teleconsultation Services During COVID-19 Pandemic: Perspective of Service Users. Indian J Psychol Med 2022;44:421-3.
Chakravarty R, Chakrabarti S, Shah R. Home-based telemental health services for Indian patients during the COVID-19 pandemic: A comparison with the pre-COVID phase. J Family Med Prim Care 2022;11:2507-15. [Full text]
Dham P, Gupta N, Alexander J, Black W, Rajji T, Skinner E. Community based telepsychiatry service for older adults residing in a rural and remote region- utilization pattern and satisfaction among stakeholders. BMC Psychiatry 2018;18:316.
Hantke N, Lajoy M, Gould CE, Magwene EM, Sordahl J, Hirst R, et al
. Patient satisfaction with geriatric psychiatry services via video teleconference. Am J Geriatr Psychiatry 2020;28:491-4.
Guinart D, Marcy P, Hauser M, Dwyer M, Kane JM. Patient attitudes toward telepsychiatry during the COVID-19 pandemic: A nationwide, multisite survey. JMIR Ment Health 2020;7:e24761.