BACKGROUND
High quality patient-centered communication (PCC) is the lynchpin of excellent health care, associated with improved patient experience, patient engagement and health related outcomes. The COVID-19 Pandemic necessitated a switch to telehealth and the implementation of in-person safety protocols (e.g., face masks and restrictions on in-person caregiver clinic attendance). It is unclear to what extend PCC in the healthcare setting was impacted.
OBJECTIVE
The objective of the current investigation was to characterize how PCC was impacted by safety measures adopted in response to COVID-19 Pandemic.
METHODS
From September to October 2020, we administered an online 38-item cross-sectional survey to a convenience sample of US adults reporting both in-person and telehealth clinic visits during the pandemic. We assessed PCC using the Communication Assessment Tool and explored differences between in-person and telehealth PCC (repeated measures ANOVA) and factors associated with PCC (multiple linear regression).
RESULTS
The majority of the 522 respondents were female (58.2%), with an average age of 46.1 years (SD 18.9). Most of the visits were for primary care, though specialty care made up a greater proportion of in-person visits. Most respondents reported always wearing masks when visiting in-person (n=432, 82.7%), while 71.1% of patients observed clinicians always wearing masks. Other commonly observed safety protocols included socially distanced waiting rooms (n=424, 81.2%) and screening at the clinic entrance (n=399, 76.4%). Using ANOVA, PCC was higher overall for in-person visits compared to telehealth (45% vs. 42%; P=.003). Specifically, in-person PCC was higher for respondents of Hispanic ethnicity (32% vs. 26%; P=.012), who spoke a language other than English at home (33% vs. 28%; P=.01), aged ≥65 years (55% vs. 50%; P=.051), aged 18 – 34 years (33% vs. 30%; P<.001) and women (48% vs. 43%; P=.002). In regression analysis, respondents aged 18-34 (???? = -0.13; 95% CI = -0.24, -0.01) and caregiver presence (???? = -0.11, 95%CI = -0.19, -0.04) were associated with lower PCC during telehealth visits; while mask use was associated with lower PCC in older adults during in-person visits (???? = -0.46; 95% CI = -0.86, -0.07). Having ≥3 visits was associated with higher PCC both during in-person (???? = 0.1; 95% CI = 0.0, 0.20) and telehealth (???? = 0.11; 95% CI = 0.01, 0.20) visits.
CONCLUSIONS
PCC was reported to be better in a sample of patients who experienced in-person and telehealth visits during the pandemic. Responses to the COVID-19 Pandemic may have had disproportionally negative impacts on PCC that require further investigation as the first step to addressing inequalities in communication and access that affect healthcare outcomes.