A Comparison of the Convenience, Quality of Interaction, and Satisfaction of Virtual and In-Person Healthcare Consultations: A Nationwide Study
1
Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), P.O. Box 7544, Riyadh 13317, Saudi Arabia
2
Seha Virtual Hospital, Ministry of Health, Riyadh 12382, Saudi Arabia
3
King Saud University Medical City, King Saud University, P.O. Box 7805, Riyadh 11472, Saudi Arabia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(17), 5203; https://doi.org/10.3390/jcm13175203
Submission received: 31 July 2024
/
Revised: 22 August 2024
/
Accepted: 31 August 2024
/
Published: 2 September 2024
(This article belongs to the Section Epidemiology & Public Health)
Abstract
Background: There are few direct comparisons of service utilization and patient-reported outcomes in patients attending medical consultations in person or virtually. This was a prospective, cross-sectional study of adults engaging with a healthcare practitioner via virtual or in-person consultations. Methods: Participants were recruited in person by convenience sampling between November 2023 and January 2024 across Saudi Arabia, and data were gathered on (i) basic demographic and consultation information and (ii) convenience, quality of interaction, and satisfaction with their consultations. Results: Of 3196 individuals who completed the survey, 28.7% had attended their most recent healthcare interaction virtually and 71.3% had attended in person. Participants attending virtual consultations were more likely to live rurally (69.0% vs. 21.9% for in-person consultations; p < 0.001). Virtual appointments were more common for primary care and diabetes/endocrinology but not surgical specialties (p < 0.001), and private apps and hospitals more frequently provided virtual appointments. Conclusions: Overall, patients found virtual consultations to be significantly more convenient, prompt, private, and well communicated than in-person appointments, translating into extremely high satisfaction (97.4% overall vs. 84.0% for in-person consultations; p < 0.001). This study provides population-level data on the current prevalence of telehealth use in Saudi Arabia. Further prospective research demonstrating the clinical noninferiority of telemedicine could help promote further uptake in specialties such as surgery.
1. Introduction
Telehealth uptake in the Middle East has lagged behind many other countries [1]. However, Saudi Arabia, through the delivery of telemedicine via outpatient telemedicine clinics (virtual clinics), 937 call centers, and the Sehhaty smartphone application according to global best practices [2], has consistently advocated, implemented, and developed telemedicine in the country since 1990 [3]. This is important, as about 20% of the population lives in rural areas [4]. Given that smartphone and internet access are nearly universal (>90%) [5,6], the effective implementation of telemedicine can facilitate best healthcare practices in underserved and rural communities [1].
Patients are generally very satisfied with telemedicine [7,8,9,10,11], including in Saudi Arabia [9,10,12,13,14,15,16,17]. Although a recent study showed that over a million virtual consultations were delivered in Saudi Arabia over eighteen months [18], the overall prevalence of telemedicine use is unknown, and there are little direct data on differences in service utilization and patient-reported outcomes of convenience, quality of interaction, and satisfaction between those attending medical consultations in person or virtually. Understanding which populations utilize which services and their preferences is essential to plan quality improvement initiatives and target specific areas for service development.
We therefore conducted a prospective, nationwide cross-sectional survey to compare the demographics, service utilization, and patient-reported outcomes of individuals accessing medial consultations virtually and in person. The null hypothesis was that there would be no differences in demographics, service utilization, and patient-reported outcomes between individuals attending consultations virtually and in person, recognizing that any detected differences could provide evidence for focused quality improvement.
2. Materials and Methods
This study is reported according to the STROBE statement for cross-sectional studies [19]. This was a prospective, cross-sectional study of adults aged 18 years or older who could complete a questionnaire. The Institutional Review Board of Imam Mohammad Ibn Saud Islamic University approved the study protocol on 1 September 2023 (reference number 588/2023). All participants provided written, signed informed consent.
Recruitment was carried out between November 2023 and January 2024 across all regions of Saudi Arabia. Participants were convenience sampled in public areas by 16 medical students trained in the study objectives and the questionnaire, who read each question to participants and recorded the answers to ensure complete data collection. Individual responses were deidentified (from consent forms) for data analysis, and participants were coded using sequential unique identifiers within the analysis spreadsheet. As convenience sampling is inherently biased and relevant only to the study population, we randomly sampled a large population with a similar demographic profile to the wider population.
The questionnaire is presented in Appendix A. The first 16 questions collected data on basic demographics (e.g., age, sex, area of residence, access to healthcare), the most recent appointment (e.g., who it was for, how long ago, what the consultation was for), and whether the consultation was virtual or on-site. A further nine questions were conceptually based on the Telehealth Usability Questionnaire (TUQ), designed to assess technology implementation and services across the domains of usefulness and convenience, ease of use, effectiveness, reliability, quality of the interaction, and satisfaction [20]. These nine questions were selected for relevance to both in-person and virtual consultations and captured information about the convenience (one question), quality of interaction (three questions), and satisfaction (five questions) of their most recent healthcare consultation using a seven-point Likert scale, where 1 = strongly disagree, 2 = disagree, 3 = somewhat disagree, 4 = neither agree nor disagree, 5 = somewhat agree, 6 = agree, and 7 = strongly agree.
Statistical analyses were performed in SPSS v29 (IBM Statistics, Armonk, NY, USA). Categorical variables are presented as counts and percentages, and age is presented as mean (SD). Responses to questions about opinions on the respondent’s most recent virtual appointment were dichotomized into “agree” (somewhat agree, agree, and strongly agree) or “neutral or disagree” (strongly disagree, disagree, somewhat disagree, and neither agree nor disagree). Associations between variables and these categorizations were assessed with the chi-squared test or Fisher’s exact test for 2 × 2 contingency tables with small expected frequencies (Student’s t-test for age). A p-value of <0.05 was considered significant.
3. Results
Overall, 3196 individuals completed the survey, with an average age of 46.1 (13.7) years; 1627/3196 (50.9%) were female, and 1569/3196 (49.1%) were male. In total, 916/3196 (28.7%) had attended a virtual consultation as their most recent healthcare interaction, while 2280/3196 (71.3%) had attended in person.
A comparison of participant demographics according to the most recent type of consultation is shown in Table 1. Participants attending virtual consultations were more likely to be female (53.7% vs. 50.9% for in-person consultations; p = 0.046), live in rural areas (69.0% vs. 21.9% for in-person consultations; p < 0.001), and consequently live further away from their nearest hospital (only 29.7% living within 50 km of their nearest hospital vs. 79.3% living within 50 km for those attending in-person; p < 0.001).
There were also differences in the general appointment characteristics of individuals attending virtual or in-person appointments (Table 2). Virtual appointments were more common than in-person appointments for respondents who were attending for themselves rather than a family member (87.8% vs. 61.9%, p < 0.001); attending primary care and diabetes/endocrinology appointments (in-person appointments were especially common for emergency medicine and surgical specialties; p < 0.001); and those attending with heart disease and diabetes (33.2% vs. 15.1%; p < 0.001), with general check-ups most common for in-person appointments.
Virtual appointments were more likely to have been provided by private apps and hospitals rather than publicly funded services, and although the spectrum of healthcare professionals seen was largely similar between groups, those attending virtual appointments were more likely to see a psychologist than those visiting in-person (2.6 vs. 1.1%; p < 0.001). More in-person appointments than virtual appointments were scheduled for follow-ups for results. Those attending virtual appointments expressed a strong preference for that type of appointment (92.8%), while for those attending in-person, the preference for virtual or in-person appointments was roughly equally split (44.4% vs. 53.5%, respectively).
Finally, we assessed differences in convenience, quality of interaction, and satisfaction of in-person vs. virtual consultations (Table 3). Overall, patients found virtual consultations to be significantly more convenient (95.6% and 87.4%, respectively), prompt, private, and well communicated than in-person appointments (all p < 0.001). These perceptions of the service translated into extremely high satisfaction levels for virtual appointments (97.4% overall), compared with 84.0% for in-person consultations.
4. Discussion
This large-scale, population-wide comparison of virtual and in-person appointments reveals that, in Saudi Arabia, virtual healthcare consultations are common (~30% of consultations) and mainly serve a rural community living far from their nearest hospitals. Our analysis suggests that private healthcare services are more likely to offer virtual consultations than public health services and that virtual services are currently not favored in certain disciplines such as emergency medicine and surgery. Although in-person consultations still enjoyed relatively high perceived convenience, interaction, and satisfaction from users (>80% in most cases), participants attending virtual consultations were consistently—and nearly universally—satisfied with the convenience and interactions of their consultations, which translated into extremely high (>95%) satisfaction.
Like in many countries, Saudi Arabia has had a long-term policy on telemedicine use, expansion, and enhancement that predated the COVID-19 pandemic [3]. Although there are little data from Saudi Arabia, before the pandemic, one study on the prevalence of telehealth use in Gulf Cooperation Council (GCC) countries reported that only about 11% of respondents were exposed to telehealth before the COVID-19 pandemic [21], which increased over 250% during the pandemic to about 40% of all users. Assuming parity within the GCC, our prevalence data (28.7% attending a virtual consultation) suggest that at least some of the effects of the pandemic on telemedicine use may have persisted in Saudi Arabia. Indeed, in their 2023 study, Almalki et al. [22] reported that about a quarter of participants attending primary health centers in Riyadh utilized telemedicine. Mirroring these findings, Al-Rayes et al. [23] reported that both awareness and utilization of the 937-Telephone Health Services—a free, 24/7 confidential telephone service that provides medical and administrative health care services, increased from 46% and 42% before the pandemic to 66% and 78% during the pandemic, respectively. Although still much lower than telehealth utilization in Western countries (e.g., ~40% in the United States in the post-COVID-19 era) [24,25,26], our data suggest that Saudi Arabia has progressed in terms of meeting its vision of improving healthcare service accessibility through telehealth across the Kingdom following Saudi Vision 2030 [27]. This progress may have at least in part been driven by the need to control infection during the pandemic.
One of the largest potential advantages of telehealth use is its suggested benefits in increasing access to care and reducing health disparities in specific populations, such as rural and underserved communities. However, to date, there has been little evidence that telehealth preferentially serves these communities. For example, previous reports from Canada [28], the United States [24,29], and Saudi Arabia [18,22] have reported either no difference or increased utilization of virtual health services in urban, rather than rural, locations. Although it has been suggested that access to technology may be lower in rural areas, coupled with cultural factors and a preference for in-person consultations, which may be barriers to telehealth in rural settings [30], our data show a promising uptake of virtual consultations in individuals living in rural locations without close access to hospitals. This discrepancy with previous findings hopefully reflects a genuine shift in healthcare utilization towards telehealth use in individuals in rural settings living distant from secondary and tertiary services and the realization of the promise of telehealth to overcome the barrier of the inconvenience and cost of traveling to healthcare appointments in these settings [14].
Our finding that virtual appointments were more common than in-person appointments for respondents attending primary care and diabetes/endocrinology appointments is consistent with previous data showing variable telehealth utilization across specialties but very low utilization for surgical visits and high utilization for endocrinology clinic visits [29,31], as well as high utilization within primary care in Saudi Arabia [18]. Similarly, relatively higher virtual consultation use by those seeing a psychologist than those visiting in person is consistent with previous data showing high telemedicine use by mental health professionals [31]. While virtual medicine may be truly inappropriate for emergencies requiring urgent intervention, there is plenty of evidence that telemedicine could play an active role in surgical care and surgical specialties, especially in the specific scenario of regular telemedicine for postoperative follow-up [32]. It is important to highlight opportunities for surgeons to utilize telemedicine to optimize their practice. Where telemedicine services do not exist or there is resistance to their implementation, there is a need for high-quality, prospective implementation science research to prove the clinical noninferiority of telehealth for outcomes of interest while maintaining, or even improving, patient satisfaction. For instance, Mariani et al. [33] performed a head-to-head prospective comparison of the feasibility and effectiveness of virtual visits compared with in-person visits for patients requiring clinical electrophysiology evaluation and found no significant differences between the two consultation types in terms of symptoms, remote monitoring alerts, and urgent hospitalizations between groups. This was coupled with an increase in satisfaction for patients receiving virtual appointments [33]. In our opinion, providing a sound, objective evidence base through the implementation science framework—which also takes contextual barriers and health economics into account [34]—provides the best route to changing standards of care.
It was interesting to note that virtual appointments were more likely to have been provided by private apps and hospitals rather than publicly funded services, perhaps reflecting different attitudes to healthcare expenditure within the private and public healthcare systems. Nevertheless, although telehealth is often assumed to be a cost-effective means to deliver healthcare [35], it is worth remembering that the implementation of telehealth and encouraging service use must be driven by clinical needs and benefits. In fact, when added to traditional services, telehealth may increase costs [35]. Nevertheless, a recent meta-analysis showed that telemedicine is associated with very high patient satisfaction [8]. The very high convenience and satisfaction levels reported by our participants are similar to previous findings from Saudi Arabia, where >80% of survey respondents were either very satisfied or satisfied with the overall quality of care and telemedicine experience in both general [9,10,12,13,14] and specialist [15,16,17] settings. Our direct head-to-head comparison now adds further weight to the evidence that telemedicine not only delivers comparable quality and outcomes to traditional in-person visits [36] and more efficient appointments but also extremely high levels of satisfaction.
This study has some limitations. We used a convenience sampling methodology, which of course may not be representative of the population as a whole. Nevertheless, to mitigate against unintended bias, we sampled a large cohort of individuals with a similar demographic profile as the wider population. Confirming this, the demographic profile reflected the relatively young population of Saudi Arabia and approximately four-fifths living in urban areas [4,37], increasing confidence that the survey is representative of the wider population and is therefore generalizable. Although there can be recall bias in survey studies, the majority of appointments were within the preceding few months.
Despite the growing body of evidence that virtual medicine is associated with high levels of patient satisfaction, it remains unclear overall whether it offers good value for money [35] or whether it has other impacts on the healthcare team. Encouragingly, a recent meta-analysis suggested that, overall, physicians are satisfied with telehealth for both patient care and consultations with other physicians [38]. It is also unclear whether it marginalizes certain groups or widens disparities. Any prospective studies to prove the clinical equivalence of virtual and in-person consultations must be supported by health economic analyses and account for social determinants of health. Management must also have a visionary policy to ensure equitable service delivery.
5. Conclusions
This is one of the largest studies conducted to date comparing virtual and in-person healthcare interactions, and our findings provide population-level data on the current prevalence of telehealth use in Saudi Arabia (~30% of consultations). Although telehealth is often touted as a solution for bridging inequality, not least in serving rural areas, data supporting uptake in rural areas have been lacking. Our data now suggest that Saudi Arabia has progressed in terms of meeting its vision of improving healthcare service accessibility. Virtual consultations are associated with extremely high levels of perceived convenience, quality of interaction, and satisfaction. Although not currently used by specific specialties, further education and awareness of the benefits of telemedicine—supported by high-quality implementation studies to provide objective evidence of clinical noninferiority—could help promote further uptake in specialties such as surgery.
Author Contributions
Conceptualization, S.M.A.; methodology, S.M.A. and A.A.A.; software, S.M.A.; validation, S.M.A.; formal analysis, S.M.A.; investigation, S.M.A.; resources, S.M.A. and A.A.A.; data curation, S.M.A. and A.A.A.; writing—original draft preparation, S.M.A.; writing—review and editing, S.M.A. and A.A.A.; supervision, S.M.A.; project administration, S.M.A.; funding acquisition, S.M.A. All authors have read and agreed to the published version of the manuscript.
Funding
This work was supported and funded by the Deanship of Scientific Research at Imam Mohammad Ibn Saud Islamic University (IMSIU) (grant number IMSIU-RG23051).
Institutional Review Board Statement
The Institutional Review Board of Imam Mohammad Ibn Saud Islamic University approved the study protocol on 1 September 2023 (reference number 588/2023).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
All raw data are available from the corresponding author upon reasonable request.
Conflicts of Interest
The authors declare no conflicts of interest.
Appendix A
Questionnaire on the use, convenience, effectiveness, reliability, and satisfaction of healthcare consultations in Saudi Arabia
1. Are you male or female?
Options: male, female
2. How old are you?
Option: free text, number
3. Are you married/widowed, separated/divorced, never married?
Options: married/widowed, separated/divorced, never married
4. Which part of the country do you live in?
Options: central/eastern/western/northern/southern
5. Do you live in a city or in the countryside?
Options: city, countryside
6. How far are you from your nearest hospital?
(<50 km, 50–100 km, 100–300 km, > 300 km, I don’t know)
7. Approximately how long ago was the appointment (in months)?
Option: less than three months, from 3–6 months, from 7–9 months, from 10–12 months, more than a year and after a period of COVID-19 restrictions, during a period of COVID-19 restrictions.
8. Was the appointment for you or with someone else (i.e., a child, family member)
Options: for myself, for someone else
9. Which department was your appointment with?
Options: primary care (family/general medicine), medicine (cardiology, respiratory medicine, nephrology, diabetes and endocrinology, allergy and immunology, neurology, rheumatology, infectious disease, hematology, oncology, gastroenterology, psychiatry, psychology and psychotherapy, smoking cession, dermatology, sleep medicine), surgery (general surgery, ENT, ophthalmology, urology, orthopedics), pediatrics, obstetrics and gynecology, emergency
10. Why did you see the healthcare professional?
Options: hypertension, hyperlipidemia, arthritis & joint disorders, diabetes, depression or anxiety, obesity, asthma, allergic rhinitis and or allergic sinusitis, cancer, COPD, osteoporosis, skin disorders, back problems, upper respiratory infections, prenatal or post-natal care, chronic neurologic disorders, headaches and migraines, GERD, irritable bowel syndrome, obstructive sleep apnea, insomnia, other sleep disorder, psychotherapy, smoking cessation, periodic health examination, other (free text)
11. Was this your first consultation for this complaint? Options: yes/no
12. Who provided the appointment?
Options: Call 973, Sehhaty app, Seha virtual hospital, other government hospital, private hospital, Other private healthcare apps like Cura, Vezeeta, labayh. etc., I can’t remember.
13. What type of healthcare professional did you see?
Options: doctor, nurse, pharmacist, physiotherapist, psychologist, occupational therapist, can’t remember/don’t know
14. Was your appointment a new consultation or for a pre-existing health problem?
Options: new consultation, routine follow-up for ongoing health problem, follow-up for results, follow-up for medication re-fill
15. For healthcare consultations, which type you prefer?
Virtual consultation, onsite consultation
16. Thinking back on the last consultation, was it virtual of onsite consultation?
ALL THE FOLLOWING ARE ON A 7-POINT LIKERT SCALE WHERE 1—STRONGLY DISAGREE, 2—DISAGREE, 3—SOMEWHAT DISAGREE, 4—NEITHER AGREE NOR DISAGREE, 5—SOMEWHAT AGREE, 6—AGREE, 7—STRONGLY AGREE, N/A
17. Overall, I found my last consultation very convenient (usefulness/convenience)
18. My last consultation visit started on time (interaction)
19. My privacy was respected (interaction)
20. My healthcare provider explained things in a way that was easy to understand (interaction)
21. I felt comfortable communicating with the healthcare professional (satisfaction)
22. This type of consultation was an acceptable way to receive healthcare services (satisfaction)
23. I would use this type of consultation services again (satisfaction)
24. I would recommend this type of consultation to family and friends (satisfaction)
25. Overall, I was satisfied with this consultation (satisfaction)
References
- Al-Samarraie, H.; Ghazal, S.; Alzahrani, A.I.; Moody, L. Telemedicine in Middle Eastern countries: Progress, barriers, and policy recommendations. Int. J. Med. Inform. 2020, 141, 104232. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health-Saudi Arabia. Telemedicine. Available online: https://www.moh.gov.sa/en/Ministry/Information-and-services/Pages/Telemedicine.aspx (accessed on 1 April 2024).
- Ministry of Health-Saudi Arabia. Legal Regulations for Telehealth Services. Available online: https://www.moh.gov.sa/en/Ministry/Rules/Documents/Legal-Regulations-for-Telehealth-Services.pdf (accessed on 1 April 2024).
- Salam, A.A.; Mini, T. The Changing Demography of Saudi Arabia; Cambridge Scholars Publishing: Cambridge, UK, 2024. [Google Scholar]
- Taylor, K.; Silver, L. Smartphone Ownership Is Growing Rapidly around the World, but Not Always Equally. Pew Research Center. 2019. Available online: https://coilink.org/20.500.12592/ffd2v5 (accessed on 1 April 2024).
- Saquib, J. Internet addiction among Saudi Arabian youth. Int. J. Health Sci. 2020, 14, 1. [Google Scholar]
- Mair, F.; Whitten, P. Systematic review of studies of patient satisfaction with telemedicine. BMJ 2000, 320, 1517–1520. [Google Scholar] [CrossRef] [PubMed]
- Vinade Chagas, M.E.; Cristina Jacovas, V.; de Campos Moreira, T.; Rodrigues Moleda Constant, H.M.; Fernanda Rohden, S.; Stiehl Alves, S.; Santini, F.; Dall’Agnol, S.; Konig Klever, E.; Cezar Cabral, F.; et al. Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis. Telemed. J. e-Health 2024, 30, 1522–1538. [Google Scholar] [CrossRef] [PubMed]
- Abdel Nasser, A.; Mohammed Alzahrani, R.; Aziz Fellah, C.; Muwafak Jreash, D.; Talea, A.A.N.; Salem, A.B.D.; Abdel Ra’oof Abed, R. Measuring the Patients’ Satisfaction About Telemedicine Used in Saudi Arabia During COVID-19 Pandemic. Cureus 2021, 13, e13382. [Google Scholar] [CrossRef]
- Alotaibi, H.F.; Ghazi, S.S.; Asraf, N.O.; Al Asmari, Z.S. Patients’ perceptions of telehealth video visits experience in primary healthcare setting, Saudi Arabia. J. Fam. Med. Prim. Care 2023, 12, 2676–2684. [Google Scholar] [CrossRef]
- Kruse, C.S.; 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. [Google Scholar] [CrossRef]
- Alharbi, K.G.; Aldosari, M.N.; Alhassan, A.M.; Alshallal, K.A.; Altamimi, A.M.; Altulaihi, B.A. Patient satisfaction with virtual clinic during Coronavirus disease (COVID-19) pandemic in primary healthcare, Riyadh, Saudi Arabia. J. Fam. Community Med. 2021, 28, 48–54. [Google Scholar] [CrossRef]
- Abdulwahab, S.A.; Zedan, H.S. Factors Affecting Patient Perceptions and Satisfaction with Telemedicine in Outpatient Clinics. J. Patient Exp. 2021, 8, 23743735211063780. [Google Scholar] [CrossRef]
- Albaghdadi, A.T.; Al Daajani, M.M. Perceptions, Satisfaction, and Barriers to Telemedicine Use: A Community-Based Study From Jeddah, Saudi Arabia. Cureus 2023, 15, e40738. [Google Scholar] [CrossRef]
- Alshareef, M.; Alsaleh, S.; Albaharna, H.; Alghulikah, A.; Aloulah, M.; Alroqi, A.; Alromaih, S.; Alanazy, F.H.; Al-Dousary, S. Utilization of telemedicine in rhinologic practice during COVID-19 pandemic. Am. J. Otolaryngol. 2021, 42, 102929. [Google Scholar] [CrossRef] [PubMed]
- Alhumud, A.; Al Adel, F.; Alwazae, M.; Althaqib, G.; Almutairi, A. Patient Satisfaction Toward a Tele-Retinal Screening Program in Endocrinology Clinics at a Tertiary Hospital in Riyadh, Saudi Arabia. Cureus 2020, 12, e7986. [Google Scholar] [CrossRef]
- Wafia, G.; Bahadur, O.; Thabet, S.; Alsalem, M.; Khan, M.A.; Alharbi, M.A.; Alsaleh, A. The quality of telepsychiatry in terms of accessibility, appropriateness, effectiveness, and safety among psychiatric patients in King Abdulaziz Medical City: An observational cross-sectional analytical study. Medicine 2022, 101, e30499. [Google Scholar] [CrossRef]
- AlOmar, R.S.; AlHarbi, M.; Alotaibi, N.S.; AlShamlan, N.A.; Al-Shammari, M.A.; AlThumairi, A.A.; AlSubaie, M.; Alshahrani, M.A.; AlAbdulaali, M.K. Pattern of Virtual Consultations in the Kingdom of Saudi Arabia: An Epidemiological Nationwide Study. J. Epidemiol. Glob. Health 2024. [Google Scholar] [CrossRef] [PubMed]
- von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gotzsche, P.C.; Vandenbroucke, J.P.; Initiative, S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 2007, 370, 1453–1457. [Google Scholar] [CrossRef] [PubMed]
- Parmanto, B.; Lewis, A.N., Jr.; Graham, K.M.; Bertolet, M.H. Development of the Telehealth Usability Questionnaire (TUQ). Int. J. Telerehabil 2016, 8, 3–10. [Google Scholar] [CrossRef] [PubMed]
- Shamiyah, K.A.; Whitebridge, S.; Kumar, N.; Aljenaee, K.; Atkin, S.L.; Ali, K.F. The Impact of COVID-19 on the Prevalence and Perception of Telehealth Use in the Middle East and North Africa Region: Survey Study. JMIR Form. Res. 2023, 7, e34074. [Google Scholar] [CrossRef]
- Almalki, Z.S.; Imam, M.T.; Abou Chahin, N.F.; NS, A.L.; Entabli, S.M.; Alhammad, S.K.; Alanazi, G.F.; Kharsa, R.A.; Alonazi, L.A.; Mandil, R.A.; et al. Access and Disparities in the Use of Telemedicine Among Patients with Chronic Conditions in Saudi Arabia: A Cross-Sectional Study. J. Multidiscip. Healthc. 2023, 16, 3789–3798. [Google Scholar] [CrossRef]
- Al-Rayes, S.A.; Alumran, A.; Aljabri, D.; Aljaffary, A.; Aldoukhi, E.; Alahmedalyousif, Z.; Al Madani, R. Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study. J. Med. Internet Res. 2021, 23, e27618. [Google Scholar] [CrossRef]
- Fischer, S.H.; Ray, K.N.; Mehrotra, A.; Bloom, E.L.; Uscher-Pines, L. Prevalence and Characteristics of Telehealth Utilization in the United States. JAMA Netw. Open 2020, 3, e2022302. [Google Scholar] [CrossRef]
- Wong, M.Y.Z.; Gunasekeran, D.V.; Nusinovici, S.; Sabanayagam, C.; Yeo, K.K.; Cheng, C.Y.; Tham, Y.C. Telehealth Demand Trends During the COVID-19 Pandemic in the Top 50 Most Affected Countries: Infodemiological Evaluation. JMIR Public. Health Surveill. 2021, 7, e24445. [Google Scholar] [CrossRef] [PubMed]
- Spaulding, E.M.; Fang, M.; Commodore-Mensah, Y.; Himmelfarb, C.R.; Martin, S.S.; Coresh, J. Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey. J. Med. Internet Res. 2024, 26, e52124. [Google Scholar] [CrossRef]
- Alghamdi, S.M.; Alqahtani, J.S.; Aldhahir, A.M. Current status of telehealth in Saudi Arabia during COVID-19. J. Fam. Community Med. 2020, 27, 208–211. [Google Scholar] [CrossRef]
- Bhatia, R.S.; Chu, C.; Pang, A.; Tadrous, M.; Stamenova, V.; Cram, P. Virtual care use before and during the COVID-19 pandemic: A repeated cross-sectional study. CMAJ Open 2021, 9, E107–E114. [Google Scholar] [CrossRef]
- Harju, A.; Niu, Z.; Neufeld, J. State-Specific Variation in Medicare Telehealth Utilization During the COVID-19 Pandemic. Telemed. J. E Health 2023, 29, 1332–1341. [Google Scholar] [CrossRef] [PubMed]
- Alharbi, A.; Alzuwaed, J.; Qasem, H. Evaluation of e-health (Seha) application: A cross-sectional study in Saudi Arabia. BMC Med. Inform. Decis. Mak. 2021, 21, 103. [Google Scholar] [CrossRef] [PubMed]
- Drake, C.; Lian, T.; Cameron, B.; Medynskaya, K.; Bosworth, H.B.; Shah, K. Understanding Telemedicine’s “New Normal”: Variations in Telemedicine Use by Specialty Line and Patient Demographics. Telemed. J. E Health 2022, 28, 51–59. [Google Scholar] [CrossRef] [PubMed]
- Huang, E.Y.; Knight, S.; Guetter, C.R.; Davis, C.H.; Moller, M.; Slama, E.; Crandall, M. Telemedicine and telementoring in the surgical specialties: A narrative review. Am. J. Surg. 2019, 218, 760–766. [Google Scholar] [CrossRef]
- Mariani, M.V.; Pierucci, N.; Forleo, G.B.; Schiavone, M.; Bernardini, A.; Gasperetti, A.; Mitacchione, G.; Mei, M.; Giunta, G.; Piro, A.; et al. The Feasibility, Effectiveness and Acceptance of Virtual Visits as Compared to In-Person Visits among Clinical Electrophysiology Patients during the COVID-19 Pandemic. J. Clin. Med. 2023, 12, 620. [Google Scholar] [CrossRef]
- Bauer, M.S.; Kirchner, J. Implementation science: What is it and why should I care? Psychiatry Res. 2020, 283, 112376. [Google Scholar] [CrossRef]
- Snoswell, C.L.; Taylor, M.L.; Caffery, L.J. Why telehealth does not always save money for the health system. J. Health Organ. Manag. 2021, 35, 763–775. [Google Scholar] [CrossRef]
- Snoswell, C.L.; Chelberg, G.; De Guzman, K.R.; Haydon, H.H.; Thomas, E.E.; Caffery, L.J.; Smith, A.C. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2023, 29, 669–684. [Google Scholar] [CrossRef] [PubMed]
- Mundi, I. Saudi Arabia Demographics Profile 2018. 2019. Available online: https://www.indexmundi.com/saudi_arabia/demographics_profile.html (accessed on 1 April 2024).
- Hoff, T.; Lee, D.R. Physician Satisfaction With Telehealth: A Systematic Review and Agenda for Future Research. Qual. Manag. Health Care 2022, 31, 160–169. [Google Scholar] [CrossRef] [PubMed]
Table 1.
A comparison of participant demographics between patients attending virtual or in-person consultations.
Table 1.
A comparison of participant demographics between patients attending virtual or in-person consultations.
| Virtual | In-Person | |||||
|---|---|---|---|---|---|---|
| Characteristic | Number | % | Number | % | p-Value | |
| Sex | Male | 424 | 46.3 | 1145 | 50.2 | 0.046 |
| Female | 492 | 53.7 | 1135 | 50.9 | ||
| Age (mean, SD) | 47.2, 14.1 | 45.7, 13.6 | 0.003 | |||
| Relationship status | Married | 667 | 72.8 | 1640 | 72.2 | 0.631 |
| Not married | 249 | 27.3 | 640 | 28.1 | ||
| Area of residence | Central | 356 | 38.9 | 1092 | 47.9 | <0.001 |
| Eastern | 148 | 16.2 | 256 | 11.2 | ||
| Northern | 116 | 12.7 | 208 | 9.1 | ||
| Southern | 104 | 11.4 | 172 | 7.5 | ||
| Western | 192 | 21.0 | 552 | 24.2 | ||
| Urban or rural | Urban | 284 | 31.0 | 1780 | 78.1 | <0.001 |
| Rural | 632 | 69.0 | 500 | 21.9 | ||
| Distance from nearest hospital | <50 km | 272 | 29.7 | 1808 | 79.3 | <0.001 |
| 50–100 km | 108 | 11.8 | 140 | 6.1 | ||
| 100–300 km | 268 | 29.3 | 148 | 6.5 | ||
| >300 km | 248 | 27.1 | 96 | 4.2 | ||
| Unsure | 20 | 2.2 | 88 | 3.9 | ||
Table 2.
A comparison of general appointment characteristics between patients attending virtual or in-person consultations.
Table 2.
A comparison of general appointment characteristics between patients attending virtual or in-person consultations.
| Virtual | In-Person | |||||
|---|---|---|---|---|---|---|
| Characteristic | Number | % | Number | % | p-Value | |
| Time since most recent appointment | <3 months | 436 | 47.6 | 1412 | 61.9 | <0.001 |
| 3–6 months | 332 | 36.2 | 440 | 19.3 | ||
| 7–9 months | 76 | 8.3 | 136 | 6.0 | ||
| 10–12 months | 48 | 5.2 | 64 | 2.8 | ||
| >12 months | 24 | 2.6 | 228 | 10.0 | ||
| Appointment patient | Participant | 804 | 87.8 | 1848 | 81.1 | <0.001 |
| Someone else (e.g., child, family member) | 112 | 12.2 | 432 | 18.9 | ||
| Department | Allergy and immunology | 0 | 0.0 | 24 | 1.1 | <0.001 |
| Cardiology | 44 | 4.8 | 163 | 7.1 | ||
| Dermatology | 8 | 0.9 | 92 | 4.0 | ||
| Diabetes and endocrinology | 116 | 12.7 | 165 | 7.2 | ||
| Emergency | 0 | 0.0 | 72 | 3.2 | ||
| ENT | 40 | 4.4 | 156 | 6.8 | ||
| Gastroenterology | 20 | 2.2 | 84 | 3.7 | ||
| General surgery | 0 | 0 | 72 | 3.2 | ||
| Hematology | 0 | 0.0 | 12 | 0.5 | ||
| Infectious diseases | 0 | 0.0 | 4 | 0.2 | ||
| Nephrology | 24 | 2.6 | 52 | 2.3 | ||
| Neurology | 60 | 6.6 | 102 | 4.5 | ||
| Obstetrics and gynecology | 12 | 1.3 | 76 | 3.3 | ||
| Oncology | 0 | 0.0 | 16 | 0.7 | ||
| Ophthalmology | 4 | 0.4 | 48 | 2.1 | ||
| Pediatrics | 36 | 3.9 | 72 | 3.2 | ||
| Primary care | 412 | 45.0 | 894 | 39.2 | ||
| Psychiatry | 68 | 7.4 | 36 | 1.6 | ||
| Respiratory medicine | 40 | 4.4 | 36 | 1.6 | ||
| Rheumatology | 8 | 0.9 | 32 | 1.4 | ||
| Sleep medicine | 8 | 0.8 | 8 | 0.4 | ||
| Smoking cessation | 12 | 1.3 | 12 | 0.5 | ||
| Urology | 4 | 0.4 | 48 | 2.1 | ||
| Reason for attendance | Allergy (including asthma) | 56 | 6.1 | 101 | 4.4 | <0.001 |
| Arthritis, joint and back pain | 16 | 1.7 | 164 | 7.2 | ||
| Neurology, including headaches | 28 | 3.1 | 44 | 1.9 | ||
| Respiratory problems (excluding asthma) | 80 | 8.7 | 192 | 8.4 | ||
| Psychological or psychiatric conditions | 52 | 5.7 | 52 | 2.3 | ||
| Cardiovascular disease, including diabetes | 304 | 33.2 | 344 | 15.1 | ||
| Dermatological conditions | 16 | 1.7 | 62 | 2.7 | ||
| Pediatrics | 8 | 0.9 | 4 | 0.2 | ||
| Gastrointestinal conditions | 16 | 1.7 | 16 | 0.7 | ||
| Sleep problems, including OSA | 56 | 6.1 | 45 | 101 | ||
| Obesity | 8 | 0.9 | 13 | 0.6 | ||
| Other, including general health check-up or smoking cessation | 260 | 28.4 | 1218 | 53.4 | ||
| Peri- or postnatal care | 8 | 0.9 | 24 | 1.1 | ||
| Renal | 8 | 0.9 | 0 | 0.0 | ||
| Who provided the appointment? | Call 973 | 28 | 3.1 | 32 | 1.4 | <0.001 |
| Other government hospital | 344 | 37.6 | 1056 | 46.3 | ||
| Other private healthcare app | 72 | 7.9 | 12 | 0.5 | ||
| Private hospital | 324 | 35.4 | 692 | 30.4 | ||
| Seha virtual hospital | 32 | 3.5 | 28 | 1.2 | ||
| Sehhaty app | 116 | 12.7 | 460 | 20.2 | ||
| Healthcare professional seen | Doctor | 876 | 95.6 | 2160 | 94.7 | <0.001 |
| Nurse | 8 | 0.9 | 32 | 1.4 | ||
| Psychologist | 24 | 2.6 | 24 | 1.1 | ||
| Don’t know | 8 | 0.9 | 64 | 2.8 | ||
| New appointment or for pre-existing condition | New consultation | 376 | 41.0 | 788 | 34.6 | <0.001 |
| Routine follow-up | 360 | 39.3 | 796 | 34.9 | ||
| Follow-up for results | 56 | 6.1 | 448 | 19.6 | ||
| Follow-up for medication refill | 120 | 13.1 | 236 | 10.4 | ||
| Missing | 4 | 0.4 | 12 | 0.5 | ||
| Preferred type of appointment | In-person | 40 | 4.4 | 1220 | 53.5 | <0.001 |
| Virtual | 848 | 92.8 | 1012 | 44.4 | ||
| Missing | 28 | 3.1 | 48 | 2.1 | ||
Table 3.
Convenience, interaction, and satisfaction of in-person vs. virtual consultations.
| Question | Virtual | In-Person | p-Value | |||
|---|---|---|---|---|---|---|
| Number | % | Number | % | |||
| Overall, I found my last consultation very convenient | Neutral or disagree | 28 | 3.1 | 288 | 12.6 | <0.001 |
| Agree | 888 | 95.6 | 1992 | 87.4 | ||
| My consultation started on time | Neutral or disagree | 44 | 4.8 | 460 | 20.2 | <0.001 |
| Agree | 872 | 95.2 | 1820 | 79.8 | ||
| My privacy was respected | Neutral or disagree | 32 | 3.5 | 200 | 8.8 | <0.001 |
| Agree | 884 | 96.5 | 2080 | 91.2 | ||
| My healthcare provider explained things in a way that was easy to understand | Neutral or disagree | 32 | 3.5 | 240 | 10.5 | <0.001 |
| Agree | 884 | 96.5 | 2040 | 89.5 | ||
| I felt comfortable communicating with the clinician during my consultation | Neutral or disagree | 32 | 3.5 | 276 | 12.1 | <0.001 |
| Agree | 884 | 96.5 | 2004 | 87.9 | ||
| This type of consultation is an acceptable way to receive healthcare services | Neutral or disagree | 32 | 3.5 | 172 | 7.5 | <0.001 |
| Agree | 884 | 96.5 | 2108 | 92.5 | ||
| I would use this type of consultation service again | Neutral or disagree | 28 | 3.1 | 420 | 18.4 | <0.001 |
| Agree | 888 | 96.9 | 1860 | 81.6 | ||
| I would recommend this type of consultation to family and friends | Neutral or disagree | 32 | 3.5 | 452 | 19.8 | <0.001 |
| Agree | 884 | 96.5 | 1828 | 80.2 | ||
| Overall, I was satisfied with this type of consultation | Neutral or disagree | 24 | 2.6 | 364 | 16.0 | <0.001 |
| Agree | 892 | 97.4 | 1916 | 84.0 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
MDPI and ACS Style
AlShareef, S.M.; AlWabel, A.A. A Comparison of the Convenience, Quality of Interaction, and Satisfaction of Virtual and In-Person Healthcare Consultations: A Nationwide Study. J. Clin. Med. 2024, 13, 5203. https://doi.org/10.3390/jcm13175203
AMA Style
AlShareef SM, AlWabel AA. A Comparison of the Convenience, Quality of Interaction, and Satisfaction of Virtual and In-Person Healthcare Consultations: A Nationwide Study. Journal of Clinical Medicine. 2024; 13(17):5203. https://doi.org/10.3390/jcm13175203
Chicago/Turabian StyleAlShareef, Saad Mohammed, and Abdullah Abdulaziz AlWabel. 2024. "A Comparison of the Convenience, Quality of Interaction, and Satisfaction of Virtual and In-Person Healthcare Consultations: A Nationwide Study" Journal of Clinical Medicine 13, no. 17: 5203. https://doi.org/10.3390/jcm13175203
APA StyleAlShareef, S. M., & AlWabel, A. A. (2024). A Comparison of the Convenience, Quality of Interaction, and Satisfaction of Virtual and In-Person Healthcare Consultations: A Nationwide Study. Journal of Clinical Medicine, 13(17), 5203. https://doi.org/10.3390/jcm13175203
Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.
