Factors that Influence Patient Satisfaction with Service Quality of Home-based Teleconsultation in Ontario Stroke Prevention Clinics in COVID-19: A Cross-Sectional Survey Study (Preprint)

Abstract

Ontario stroke prevention clinics held primarily in-person visits prior to COVID-19, then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient satisfaction.

This study sought to understand patients' satisfaction with Ontario stroke prevention clinics' rapid shift to a home-based teleconsultation delivery model used during COVID-19. The research question explored explanatory factors affecting patient satisfaction.

Utilizing a cross-sectional service performance (SERVPERF) model, we surveyed patients who received telephone or video consultations at one of two Ontario stroke prevention clinics in 2021. This survey included closed and open-ended questions. We employed logistic regression and qualitative content analysis to understand factors affecting patients’ satisfaction with the quality of home-based teleconsultation services.

The overall response rate for the online survey was 37.2 % (128/344). The quantitative analysis was based on 110 responses, while the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (P<.001, AOR .034, 95% CI, .006-.188) and empathy (P=.029; AOR .116, 95% CI, .017-.800) were significant factors negatively associated with low satisfaction (scored 1, or 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision-maker (P=.015, AOR 6.592, 95% CI 1.452-29.927). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same dissatisfied service factors (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high satisfaction group offered more positive feedback on assurance, reliability and empathy along with a competent clinician, appropriate patient selection, and excellent communication and empathy skills.

The insights gained from this study can be considered when designing and enhancing home-based teleconsultation services to enhance patient experiences in stroke prevention care.