Closing the Digital Divide: Improving Telemedicine Satisfaction Using Previsit Communication

To evaluate how patient characteristics are associated with telemedicine visit modality (video, phone, or converted from video to phone) and patient satisfaction, to better understand the digital divide in telemedicine.

A retrospective cohort study conducted at a tertiary care center during the early phase of the COVID-19 pandemic (March-October 2020). Adult patients (≥18 years) who completed a telemedicine satisfaction survey following a visit during the study period were included. Visit modality was classified as video, phone, or converted (scheduled as video but completed as phone). Sociodemographic characteristics and broadband access data (by ZIP code and county) were linked to patient records. Multivariable logistic regression was used to identify predictors of visit conversion and satisfaction.

Of 30,578 patients surveyed, 17,859 (58%) responded. The median age was 59 years; 63% were female, and 74% were White. Visit modalities included video (43%), phone (39%), and converted (18%). Conversion from video to phone was significantly associated with older age, Medicare insurance, lower income, and reduced broadband access. Patient satisfaction was highest for video visits, followed by phone, and lowest for converted visits (p < 0.0001). Satisfaction declined with increasing age for phone and converted visits, but not for video visits. A previsit phone call was consistently associated with higher satisfaction across all modalities.

Conversion from video to phone visits is a marker of digital access barriers and is associated with reduced patient satisfaction. Interventions such as previsit support calls should be used to improve patient experiences and help mitigate disparities in telemedicine access and outcomes. Inclusion of phone visits as a form of telemedicine recognized and reimbursed by insurance companies will allow for our most vulnerable patients to have equitable access to the health care system.