Determinants of Telemedicine Satisfaction in Inflammatory Bowel Disease Patients: A Multi-Centre Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Telemedicine has become a vital part of managing chronic Inflammatory Bowel Disease (IBD). However, the factors influencing patient satisfaction with remote consultations remain poorly understood.

The authors conducted a study to evaluate satisfaction with telemedicine services among Italian patients with ulcerative colitis (UC) and Crohn's disease (CD). They aimed to identify sociodemographic, clinical, and organizational factors that could help develop more person-centered telehealth models.

The authors conducted a prospective, multicenter, cross-sectional study at three IBD units in northern, central, and southern Italy from June to October 2024, involving 705 patients. The results showed high satisfaction with telemedicine, and all respondents reported lower indirect costs than with in-person visits. Factors associated with higher satisfaction scores included ease of technology use, more frequent contact with the care team, male gender, older age, and employment status.

Although the authors' model fit was modest (R² up to 0.20), suggesting that additional unmeasured relational and contextual factors may be at play, the authors concluded that telemedicine for IBD is widely accepted in Italy. They emphasized that satisfaction is significantly influenced by digital usability, prior experience with telemedicine, and the complexity of clinical cases.

Manuscript strength: includes a large sample size, clinical heterogeneity among participants, and the use of a validated instrument, I-TSQ, attempting to develop a predictive model integrating clinical and technological features.

Weakness of the manuscript: lack of description of obtaining multivariable models, which methods exist for selecting the significance of variables (forward selection, backward selection, stepwise elimination...), and why the chosen method is used.

Suggested minor corrections:

Since the Telemedicine Satisfaction Questionnaire (I-TSQ) plays a significant role in the manuscript, the introductory section should include general information about how the tests are compiled and the criteria they must meet.

The authors should explain the methodology for obtaining the test scale (Table 2), even though the test is taken from the literature.

Why did the authors not analyze Italy's different geographical regions separately?

Author Response

Dear Peer,

Thank you very much for your effort and time. We hope that in this version, according your precious comments, the manuscript will be suitable for publication.

Thank you again, all Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Review of the Article:
“Determinants of Telemedicine Satisfaction in Inflammatory Bowel Disease Patients: a Multicentre Cross-Sectional Study”

1. ORIGINALITY

The topic of the study is timely and relevant, focusing on patient satisfaction with telemedicine in the context of inflammatory bowel disease (IBD). Telemedicine has become a key component of chronic care, particularly following the COVID-19 pandemic; however, factors influencing patient satisfaction with teleconsultations in IBD have so far been only partially explored. The analyzed article offers a novel perspective through a multicentre study involving a large cohort of IBD patients (705 individuals) in Italy. While individual studies on telecare satisfaction in chronic diseases have previously been published, the present work stands out due to its scale and its focus on identifying determinants of satisfaction. The authors employed a validated questionnaire (I-TSQ) and multivariable analysis, which constitutes a valuable contribution by filling an important knowledge gap regarding which technological, demographic, and clinical factors shape patient satisfaction with telemedicine in IBD.

2. SCIENTIFIC SIGNIFICANCE

The results obtained are of significant importance for both the advancement of knowledge and clinical practice. First and foremost, the study confirms that telemedicine in the care of IBD patients is widely accepted and highly rated, with the mean overall satisfaction score approaching the maximum values of the questionnaire. This represents an important signal for healthcare systems, indicating that remote consultations can effectively complement traditional in-person visits, reducing the burden on both patients and healthcare professionals. Moreover, the study precisely identifies factors that positively or negatively influence patient satisfaction. For example, ease of technology use and more frequent contact with the care team were associated with higher satisfaction, whereas first-ever teleconsultations, the need for technical support, and poorer platform accessibility were linked to lower satisfaction scores. These findings are scientifically relevant as they emphasize the role of digital competencies and telehealth organization in shaping patients’ perceptions of healthcare services. From a clinical perspective, this implies that merely implementing teleconsultations does not guarantee success; attention must be paid to intuitive tools, adequate technical support, and individualized approaches (e.g., enhanced support during the first telemedicine visit). Furthermore, the identification of potential inequalities (e.g., lower satisfaction among individuals less familiar with digital technologies) carries important social implications, highlighting the need for strategies aimed at reducing digital exclusion in healthcare.

3. METHODOLOGY

The selection of methods and the study sample is appropriate. Inclusion and exclusion criteria were clearly defined. Importantly, a validated questionnaire was used. The authors also appropriately addressed the limitations of the study.

4. QUALITY OF PRESENTATION

The article is written clearly and follows the standard structure of a scientific manuscript. One minor comment is that certain concepts requiring interpretation (e.g., “platform access” or the need for technical support) could be described in slightly more detail in the Results section, in order to provide readers with a more complete understanding of the meaning of these variables.

5. MANUSCRIPT STRUCTURE

The structure of the manuscript is logical and coherent.

6. ISSUES REQUIRING REVISION

It would be worthwhile to more explicitly emphasize the limitations resulting from the cross-sectional design of the study. Although the authors mention this issue, it would be advisable to clearly state that the observed associations (e.g., between ease of use and satisfaction) do not imply a direct causal relationship. For instance, it is possible that more satisfied patients are more willing to use technology, rather than technology use alone driving satisfaction.

I recommend further discussion of the observed demographic differences. It was found that men rated teleconsultations slightly more favorably than women. Potential explanations for this finding (e.g., differences in expectations, technology use, or other factors) should be considered, as the role of sex/gender is not extensively discussed in the current version of the manuscript.

I suggest expanding the description of how “platform access” was assessed and how “technical support” was defined in the questionnaire. While it can be inferred that these variables relate to connection difficulties or the need for IT assistance, clarifying these concepts in the Methods or Results sections would further improve the clarity of the manuscript.

Author Response

Dear Peer,

Thank you very much for your effort and time. We hope that in this version, according your precious comments, the manuscript will be suitable for publication.

Thank you again, all Authors

Author Response File: Author Response.pdf