294 - Caregiver-reported feasibility and acceptability of direct-to-consumer telemedicine in the ambulatory setting during COVID-19

Poster Number: 294
Publication Number: 294.347

Caren Steinway, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Pearl Subramanian, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Edison, NJ, United States; Jack Chen, Northwell Health, Jamaica, NY, United States; Michelle Katzow, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Sophia Jan, Cohen Children's Medical Center, New Hyde Park, NY, United States

Background: Limited literature suggests that telemedicine is efficient, safe, and can be incorporated into pediatric practices. However, caregiver-reported usability and satisfaction are unknown. Additionally, while telemedicine is seen as a mechanism by which to increase access to care, there is a gap in current literature regarding differential caregiver satisfaction with telemedicine by socioeconomic factors.

Objective: To describe caregiver-reported satisfaction and usability of telemedicine across pediatric primary and subspecialty care in a large clinically integrated health system. The secondary aim was to assess the association of public insurance with telemedicine satisfaction and usability.

Design/Methods: Retrospective electronic health record data of telemedicine encounters that occurred from March 10- April 18, 2020 was collected. To assess the usability of telemedicine we conducted a prospective, cross-sectional study using surveys administered via email. The survey consisted of items adapted from the Telehealth Usability Questionnaire (TUQ), which assessed patients' general comfort level, usability, feasibility, and the benefits and limitations of the telemedicine system.

Results:
In total, 2,869 email invitations to complete the TUQ were sent and 450 (16%) were completed. The median age of patients was 8.3 (IQR=2.6, 14.1) years; 43.1% were White; 61.5% were Non­ Hispanic/Latino; 87.0% were English speaking; 53.5% had commercial insurance; and 93.8% did not require an interpreter (Table 1). A majority of caregivers (58.2%) reported the Northwell Health AW/Touchpoint app was safer to use than other communication apps (e.g. FaceTime, WhatsApp, etc.). Most caregivers were satisfied with the telehealth system (76.2%). They felt the system was simple to use (81.3%), easy to understand (77.5%), and saved time from commuting to and from in-person visits (86.7%). Patients were comfortable communicating with the clinicians using the system (80.5%), and had no trouble expressing themselves effectively (81.1%). Importantly, there were no statistically significant differences regarding the usability of the telemedicine amongst public and commercial insurances (Table 2).
Conclusion(s): Caregivers reported that telemedicine is feasible and acceptable. There were no notable differences between responses of caregivers of children with commercial insurance and Medicaid, indicating equitable access. Future studies should evaluate caregiver perceptions of telemedicine outside of the COVID-19 pandemic, when the risk of seeing a provider in-person may have impacted acceptability.
Table 1 Demographic characteristics and telemedicine platform used among survey respondents for pediatric visit encounters from March 2020 – May 2020 in a large clinically integrated health system
Table 2 Differences among Patient Reported Outcomes Across Six Domains of TUQ by Insurance Type