Evaluation of Patients’ Satisfaction with the Transition of Internal Medicine Outpatient Clinics to Teleconsultation During COVID-19 Pandemic
Introduction
Telemedicine is a term that was coined in the 1970s, which translates to “healing at a distance” from Greek “tele” and Latin “medicus.”1 Telemedicine was defined by the World Health Organization (WHO) as the “delivery of health care services, where patients and providers are separated by distance. It utilizes modern information and communication technologies, such as computers, the internet, and cell phones for the exchange of information for the diagnosis and treatment of diseases and injuries.”2 One of the main categories of telemedicine is teleconsultation, which refers to interactive communication between health care providers and patients through electronic means.3 It is valuable, especially for those in remote regions, vulnerable groups, and the elderly.2
Teleconsultations may be preferred in some circumstances by patients and physicians due to the convenience of accessing health care from home or office, which can save time and reduce travel time and missed and rescheduled appointments.4–6
Recent studies have concluded that teleconsultations can provide a rapid alternative to face-to-face clinical visits,7,8 in addition to confirming noninferiority of telemedicine with regard to patient-centered communication and patient satisfaction with physicians’ clinical competence.9
On the other hand, a disadvantage with telemedicine is the potential of being more physician centered, with the physician controlling the dialog and the patient taking a relatively passive role, and the inability of the physician to conduct a full physical examination.10
King Hamad University Hospital (KHUH) is a tertiary university hospital in the Kingdom of Bahrain serving a catchment area of ∼93,000 individuals. The internal medicine outpatient clinic covers, on average, 17,400 patient visits per month among its different subspecialty clinics.
On February 21, 2020, Bahrain announced the first confirmed case of coronavirus disease 2019 [COVID-19]. In March 2020, a global pandemic was declared by the WHO after cases of COVID-19 were confirmed throughout the world.11
In response to the COVID-19 pandemic, the outpatient services at KHUH transitioned to teleconsultation in March 2020. The patients were contacted over the phone and reminded about their teleconsultation appointment a day prior by patient care assistants. In addition, the Information Technology department created a new section in the hospital electronic medical records for teleconsultation appointments, which included a medication pick-up alert, informing patients once medications were ready to be collected.
This transition to teleconsultations at KHUH was necessary to ensure continuity of patient care as many patients might avoid attending the hospital during this time and limiting unnecessary risk of exposure to infections for both patients and health care providers.
The objective of our study was to evaluate patients’ or patient caregivers’ satisfaction with teleconsultation services at the medical outpatient clinics at KHUH during the COVID-19 pandemic and to identify areas for improvement and future applications.
This study evaluates patients’ satisfaction with telemedicine in internal medicine clinics, which is a promising way to improve access to medical care during and potentially after the COVID-19 pandemic.
Methods
DESIGN AND PARTICIPANTS
The study was conducted as a retrospective cross-sectional survey design. The sample size was calculated as 900 participants who are either patients or patient caregivers, with 100 participants from each of the following 9 internal medicine clinics: cardiology, respiratory, endocrinology, gastroenterology, general medicine, nephrology, neurology, rheumatology, and dermatology. The participants were involved in teleconsultation care for a period of 3 months, from April 1, 2020, till June 30, 2020, during the COVD 19 pandemic. They were contacted over the phone by physicians to answer a survey evaluating their satisfaction with previous teleconsultation care, and participants’ verbal consents were obtained at the beginning of filling the survey. Participants were randomly selected (every fifth patient in the teleconsultation clinic list; if the participant was unreachable, then the patient listed prior in the list was selected). Patients younger than 18 years and private clinic appointments were excluded.
The data collection began from September 2020 till the end of February 2021. Participant survey responses were analyzed using SPSS V 25.0. Descriptive statistics were used to compute frequencies, percentages, and mean and standard deviation. Chi-square statistic was utilized to test the relationship between categorical variables. Continuous scores were analyzed using Student’s t-test (Mann–Whitney and Kruskal–Wallis tests were used). A p-value of <0.05 was considered statistically significant. This study was approved by institutional review board (IRB) at KHUH (Reference No. 20-369).
INSTRUMENT DEVELOPMENT
The research team developed a multi-item questionnaire from the department of internal medicine and the department of quality to measure patient satisfaction with teleconsultation in internal medicine outpatient clinics at KHUH during the COVID-19 pandemic (Supplementary Appendix SA1). The survey consisted of 31 questions, which included demographics, type of clinic, method of teleconsultation, dichotomous questions (yes/no), 17 statements using a 5-point Likert scale (strongly agree/very satisfied to strongly disagree/very dissatisfied), and open-ended responses. The questionnaire took ∼10 min to complete.
The questionnaire was pilot tested, using 20 participants who were randomly selected to every fifth patient from the 9 medical specialty clinics. The pilot analysis of survey responses indicated an excellent internal consistency with a Cronbach’s alpha of 0.836.
Results
The researchers contacted 901 participants, which included 741 patients (82.2%) and 160 patients’ caregivers (17.7%). In total, 901 participants completed the satisfaction survey; the overall survey responses indicated a good internal consistency with Cronbach’s alpha of 0.91.
Most of the patients were in the age group 45–64 years (43.7%), 28.7% were 28–44 years, 20.2% were 65 years and older, and 7.3% were between 18 and 25 years. Females represented 61.3% of the sample, and 38.6% were males. Most participants reported this was their first experience with teleconsultation 751 (83.4%). The visit was for follow-up care in 95.8% of participants, and 99.2% were served by telephone call. The demographics of the respondents are listed in (Table 1).
| Participant | |
| Patient | 741 (82.2%) |
| Patient caregiver | 160 (17.7%) |
| Age of the patient, years | |
| 18–25 | 66 (7.3%) |
| 26–44 | 259 (28.7%) |
| 45–64 | 394 (43.7%) |
| >65 | 182 (20.2%) |
| Gender | |
| Male | 348 (38.6%) |
| Female | 552 (61.3%) |
| Is this your first experience with teleconsultation? | |
| Yes | 752 (83.5%) |
| No | 148 (16.4%) |
| Teleconsultation method | |
| Telephone call | 894 (99.2%) |
| Video call | 0 (0%) |
| WhatsApp message | 7 (0.8%) |
| Which outpatient clinic did you use for teleconsultation service? | |
| Cardiology | 100 (11.1%) |
| Dermatology | 100 (11.1%) |
| Endocrinology | 102 (11.2%) |
| Gastroenterology | 101 (11.1%) |
| General medicine | 100 (11.1%) |
| Nephrology | 98 (11.1%) |
| Neurology | 100 (11.1%) |
| Respiratory | 100 (11.1%) |
| Rheumatology | 100 (11.1%) |
| With regard to the above chosen clinic, was this your | |
| Follow-up | 863 (95.8%) |
| First appointment | 37 (4.1%) |
The majority of participants found teleconsultation easy to use (93.1%). Most patients were satisfied with the sound quality during teleconsultation (98.3%). Most participants were satisfied with the timing of consultation (92.6%), especially that they were notified a day prior about the time that they will receive the service by telephone consultation. The majority of the sample showed satisfaction in explaining their medical condition (91.4%), their investigation results (89.1%), and the current and further treatment plan through teleconsultation (89.5%). Similarly, patients’ and caregivers’ satisfaction were also noted for the duration of the encounter with the physician (89.8%). Patients trusted the information and instructions given by their physician (96.6%) as they perceived instructions through the phone or by attending the hospital in person as the same levels at 4.70 ± 0.56 (Table 2).
| STATEMENTS | TOTAL RESPONSES | VERY SATISFIED | SATISFIED | NEUTRAL | DISSATISFIED | VERY DISSATISFIED | MEAN SCORE ± SD |
|---|---|---|---|---|---|---|---|
| How satisfied are you with the sound and image quality of the device used during the teleconsultation? | 900 | 729 (81.0%) | 156 (17.3%) | 13 (1.4%) | 2 (0.2%) | — | 4.79 ± 045 |
| How satisfied are you with timing of the teleconsultation (i.e., were you contacted in an appropriate time)? | 899 | 658 (73.2%) | 174 (19.4%) | 39 (4.3%) | 24 (2.7%) | 4 (0.4%) | 4.62 ± 0.73 |
| How satisfied are you with the physician in terms of introducing himself/herself clearly and their position? | 900 | 664 (73.8%) | 199 (22.1%) | 22 (2.4%) | 15 (1.7%) | — | 4.74 ± 0.52 |
| How satisfied are you with the physician in terms of treating you with care and respect? | 900 | 700 (77.8%) | 179 (19.9%) | 14 (1.6%) | 6 (0.7%) | 1 (0.1%) | 4.51 ± 0.76 |
| How satisfied are you with physician explanation of your medical condition? | 899 | 610 (67.9%) | 211 (23.5%) | 55 (6.1%) | 19 (2.1%) | 4 (0.4%) | 4.50 ± 0.83 |
| How satisfied are you with physician explanation of the investigation results? | 893 | 581 (65.1%) | 214 (24.0%) | 78 (8.7%) | 16 (1.8%) | 4 (0.4%) | 4.50 ± 0.82 |
| How satisfied are you with physician explanation of the treatment plan? | 899 | 600 (66.7%) | 205 (22.8%) | 55 (6.1%) | 29 (3.2%) | 10 (1.1%) | 4.48 ± 0.86 |
| How satisfied are you with duration the physician spent with you during the teleconsultation? | 900 | 589 (65.4%) | 220 (24.4%) | 53 (5.9%) | 29 (3.2%) | 9 (1.0%) | 4.53 ± 0.85 |
| How satisfied are you with the overall quality of teleconsultation | 898 | 482 (53.7%) | 316 (35.2%) | 69 (7.7%) | 24 (2.7%) | 7 (0.8%) | 4.38 ± 0.80 |
| STATEMENTS | STRONGLY AGREE | AGREE | NEUTRAL | DISAGREE | STRONGLY DISAGREE | MEAN SCORE ± SD | |
| I find telemedicine easy to use. | 898 | 652 (72.6%) | 184 (20.5%) | 38 (4.2%) | 19 (2.1%) | 5 (0.6%) | 3.65 ± 1.26 |
| I trust the instructions of my physician provided through teleconsultation | 898 | 708 (78.8%) | 160 (17.8%) | 18 (2.0%) | 10 (1.1%) | 2 (0.2%) | 4.70 ± 0.56 |
| I trust my personal information and privacy will be protected with telemedicine | 898 | 718 (80.0%) | 158 (17.6%) | 12 (1.3%) | 8 (0.9%) | 2 (0.2%) | 4.68 ± 0.60 |
| I felt safer using teleconsultation than attending the hospital during COVID 19 pandemic | 897 | 609 (67.9%) | 166 (18.5%) | 71 (7.9%) | 45 (5.0%) | 6 (0.7%) | 4.76 ± 0.53 |
| I would like to see telemedicine used after COVID-19 pandemic | 898 | 339 (37.8%) | 142 (15.8%) | 236 (26.3%) | 131 (14.6%) | 50 (5.6%) | 4.73 ± 0.57 |
| Were you provided with a call back number in case you had an inquiry? | Total responses | ||||||
| Yes | 142 (15.7%) | ||||||
| No | 756 (83.9%) | 898 | |||||
| Would you recommend teleconsultation at KHUH to others seeking medical care? | Total responses | ||||||
| Yes | 786 (87.2%) | 898 | |||||
| No | 66 (0.7%) | ||||||
| Maybe | 46 (5.1%) | ||||||
Out of the total 901 participants, 798 (88.6%) participants were satisfied with the overall quality of teleconsultation in the internal medicine outpatient department with a satisfaction rate of 4.38 ± 0.80, out of 5 (Table 2). There was no significant difference in overall satisfaction across age groups (p = 0.43) and between genders (p = 0.26).
On subgroup analysis, a larger percentage of male participants viewed teleconsultation as less convenient (p = 0.03) (Table 3). Furthermore, all age groups had similar opinions on finding telemedicine convenient, with rates ranging from 66.8% to 77.8%, p = 0.261.
| TOTAL RESPONSES | I FIND TELECONSULTATION MORE CONVENIENT | p | |||
|---|---|---|---|---|---|
| NO | NEUTRAL | YES | |||
| Age | 898 | 0.261 | |||
| 19–25 | 9 (13.6%) | 5 (7.6%) | 52 (78.8%) | ||
| 26–44 | 54 (21.1%) | 31 (12.1%) | 171 (66.8%) | ||
| 45–64 | 77 (19.5%) | 41 (10.4%) | 276 (70.1%) | ||
| >65 | 24 (13.2%) | 21 (11.5%) | 137 (75.3%) | ||
| Gender | 0.02 | ||||
| Male | 897 | 75 (21.6%) | 29 (8.3%) | 244 (70.1%) | |
| Female | 88 (16.0%) | 69 (12.6%) | 392 (71.4%) | ||
| First experience with teleconsultation | 898 | 0.49 | |||
| Yes | 137 (18.3%) | 86 (11.5%) | 528 (70.3%) | ||
| No | 27 (18.4%) | 12 (8.2%) | 108 (73.5%) | ||
| First appointment | 989 | 9 (24.3%) | 4 (10.8%) | 24 (64.9%) | 0.61 |
| Follow-up appointment | 155 (18.0%) | 94 (10.9%) | 612 (71.0%) | ||
| Total participants | 163 (18.3%) | 98 (10.9%) | 636 (70.08%) | ||
Of 901 participants, 752 (83.5%) were experiencing teleconsultation for the first time, among which 572 patients (70.3%) found teleconsultation to be convenient. Similarly, 73.5% of participants who had previous experience with teleconsultation also reported it as convenient.
Participants’ perception about convenience varied among different clinics, ranged between 75% and 87% in endocrinology, neurology, nephrology, respiratory, cardiology, and gastroenterology. Participants from dermatology, rheumatology, and general medicine clinics found telemedicine less convenient compared to other specialties with percentage ranging between 55% and 61% (p < 0.05) (Fig. 1).
Fig. 1. Distribution of participants’ perception about convenience of teleconsultation among various specialty clinics.
Results revealed that 86.4% of total participants felt safer using teleconsultation compared to attending the hospital during the COVID-19 pandemic, and 56.6% preferred to continue using telemedicine after COVID-19 pandemic, while 20.2% did not (Table 2).
Teleconsultation was viewed as convenient by 636 participants (70.5%) (Table 3). Of these 636 participants, 338 (53.1%) reported that teleconsultation saved their time, 101 (15.8%) reported it saved transportation time, and 91 (14.3%) found teleconsultation saved lost time from their jobs (Table 4).
| STATEMENTS | FREQUENCY | PERCENTAGE |
|---|---|---|
| Saves waiting time in the clinic | 338 | 53.1 |
| Saves lost time from my job | 91 | 14.3 |
| Saves lost time from my family | 27 | 4.2 |
| Saves transportation or difficulty to commute to hospital | 101 | 15.8 |
| Others | 79 | 12.4 |
The mean score was higher for follow-up patients than patients who were attending for the first time in terms of ease of use (mean difference [MD] 0.31 ± 0.55, p = 0.02). The patients who found teleconsultation convenient had a higher mean score in terms of perception of safety using teleconsultation than attending the hospital during COVID 19 pandemic (MD 1.06 ± 0.13, p = 0.000) and in preference to continue with telemedicine after COVID 19 pandemic (MD 1.88 ± 0.12, p < 0.001).
There was no difference in the overall satisfaction of participants with teleconsultation across the various specialty clinics with a mean score rate of 4.38 ± 0.80, out of 5 (p = 0.065) (Fig. 2).
Fig. 2. Overall satisfaction of participants with teleconsultation across specialty clinics.
Discussion
Telemedicine provides a great opportunity to improve delivery of health care services worldwide by enhancing access, efficiency, quality, and cost-effectiveness, especially to underserved communities in remote or rural areas with limited access to health services, as it overcomes distance and time barriers between patients and health care providers.2 The COVID-19 pandemic has opened up an opportunity to introduce teleconsultation as a new method to provide access to medical care in many countries around the world.12–16
Noncommunicable chronic diseases are among the leading causes of death.17 Teleconsultation allows for the management of patients with noncommunicable diseases during this pandemic, which is essential, considering these groups are at higher risk to develop COVID-19 complications with higher risk of mortality.18,19
From a medical point, patients are concerned about avoiding seeking medical care and missing their clinic appointments during the COVID-19 pandemic, especially those with chronic noncommunicable diseases, the elderly, and other vulnerable groups who are at higher risk of COVID-19 complications and mortality.18,19 In a report, it was estimated that 41–42% of U.S. adults reported delaying or avoiding medical care during the pandemic because of concerns about COVID-19.12 A recent study that was conducted by Alromaihi et al. at KHUH, focusing on sustainable diabetes care services during the COVID-19 pandemic, reported the successful transformation from traditional face-to-face encounters to an online telemedicine service.20
Our study aimed to evaluate patients’ and their caregivers’ satisfaction with teleconsultations in internal medicine outpatient clinics during the COVID-19 pandemic. Satisfaction with telemedicine as a service can promote its use for health care delivery after COVID-19 pandemic for certain patients.
The standard method used in our study was telephone calls (99.2%). Other studies identified telephone calls being the primary modality of teleconsultation similar to our study,7,8 while other studies found WhatsApp® (53.8%); Zoom® (33.4%); and videoconference as the predominant methods used.9,16
The demographic data in our study showed that the majority of participants were females, between 45 and 64 years of age. Females considered teleconsultation more convenient compared to males, supporting more for the reason of saving lost time from family (3.3% vs. 1.1%) and transportation time (12.3% vs. 8.9%); this is contrary to other studies that showed gender played no role in patient satisfaction with teleconsultation.7
Older patients, in general, are thought not to embrace change; however, recent studies revealed their acceptance of technology and mobile health.21 Our study showed no statistically significant difference between age and participant satisfaction and convenience of teleconsultation with rates ranging from 66.8% to 77.8%, which was also seen in a study conducted by Magadmi et al.7
This study revealed that majority of the sample showed satisfaction in explaining their medical condition (91.4%), their investigation results (89.1%), and the current and further treatment plan through teleconsultation (89.5%); 34 out of 37 (91.9%) of first appointment patients and 786 out of 863 (91.1%) of follow-up patients were satisfied. In addition, of patients satisfied with explaining their medical condition, 691 (84.2%) had their first experience in teleconsultation and 607 (73.9%) had their first experience in teleconsultation at KHUH. Overall, 88.6% of participants were satisfied with the quality of teleconsultation in the internal medicine outpatient department at KHUH.
The majority of our participants found teleconsultation easy to use (93.1%), with most being satisfied with the quality of the sound (98.3%), and trusted their personal information and privacy would be protected with telemedicine (97.6%) (Table 2). Similarly, in another study, very few patients reported disadvantages of telemedicine requiring technical skills (13.1%), with the concern of losing privacy (2.7%).22
In our study, participants found teleconsultation more convenient as it saved waiting time in the clinic (53.1%), saved transportation or difficulty in commuting to the hospital (15.8%), and saved lost time from their job (14.3%). Of the total participants, 86.4% felt safer using teleconsultation compared to attending the hospital during COVID 19 pandemic, and 56.6% agreed with the use of teleconsultation after COVID 19 pandemic. Previous studies have shown similar high patients’ satisfaction with telemedicine in comparison to traditional “in-person” clinic visits.5,7–9,22
In a study conducted in a diabetes telemedicine clinic, participants reported that telemedicine minimzed the risk of acquiring infection, reduced waiting time to see the healthcare practitioner, eliminated the need to make the trip to the clinic and reduced costs.22
Participants’ perception of convenience varied among different clinics, ranging between 75% and 87% in endocrinology, neurology, nephrology, respiratory, cardiology, and gastroenterology. In contrast, participants from dermatology, rheumatology, and general medicine clinics found telemedicine less convenient, with the percentage ranging between 55% and 61% (p < 0.05) (Fig. 1). However, there was no difference in overall satisfaction with teleconsultation across the various specialty clinics, with the mean score above 4 (Fig. 2). This was contrary to a study that showed most responders were highly satisfied with teledermatology.23 In that model, patients used mobile phones to share pictures of dermatological conditions with the treating physicians; however, 14% of participants refused photography of the skin lesions with the main reasons stated as social or religious.
STRENGTHS AND LIMITATIONS
The strengths of this study include a large sample size of 901 participants from all subspecialty clinics in internal medicine at a busy tertiary care hospital, and the participants were randomly selected from the outpatient clinic list. The study was needed to evaluate a recently developed teleconsultation service, and it reflected the resilience of medical services at our organization in managing care during the pandemic and its commitment to provide high-quality services. The survey was not self-administered, and physicians collected data to standardize the understanding of questions. Furthermore, the analysis evaluated the satisfaction among gender, age groups, and type of visit to highlight several debated issues limiting patients’ satisfaction. The questionnaire was pilot tested, and the analysis of survey responses indicated an excellent internal consistency with a Cronbach’s alpha of 0.836.
Our study has several limitations as this is a single-center study, and it was conducted by interview based on recall of patients about their experiences with teleconsultation, and therefore, it is subject to recall bias, since most participants had multiple follow-up visits with different clinics, which made it hard for some to remember every teleconsultation that was done during the pandemic within the data collection timeframe. A few questions were not answered by some participants. Teleconsultation has inherent limitations, including inability to conduct a full physical examination and the potential for limited interaction and communication with patients. Furthermore, it adds to the challenges of counseling patients or breaking bad news during clinical encounters.
Our study is limited to patients served in internal medicine specialty clinics, and therefore, results cannot be generalizable to other clinics. Most participants were females and from follow-up visits, which could have affected the results. The communication mode was mainly through telephone consultations; hence, satisfaction with video consultations or other telemedicine methods cannot be assessed. Furthermore, the practice of teleconsultation is new in this hospital setting and therefore one of the challenges at the beginning of rollout of the service was explaining to the patient that a phone call by way of discussion with health care provider is a replacement to an office visit, and it took time to gain patients’ trust and acceptance; this, however, was not addressed in the study.
Conclusion
In conclusion, a high level of satisfaction was demonstrated in patients and patients’ caregivers with the recently created teleconsultation services provided at KHUH internal medicine outpatient specialty clinics during the COVID-19 pandemic, with results showing some patients preference to continue such service after the pandemic. As teleconsultation care is a relatively new concept, further studies are required to measure the quality of the service in internal medicine and other departments, measure cost-effectiveness, and broaden the modalities used in telemedicine, including video calls, WhatsApp, Zoom, and other secure modalities of communication.
In addition to conducting studies on health care workers’ perception of teleconsultation and possible challenges faced by them and by patients since the use of phones and technologies, it is not easy for all if there is an issue of patients’ illiteracy or poor network infrastructure, which are areas not addressed in our study, and to help establish guidelines for telemedicine to be integrated in the health care system, to ensure improved patient care.
Authors’ Contributions
D.A.: conceptualization, supervision, project administration, and writing—review and editing. S.A.: project administration, investigation, writing—original draft, and writing—review and editing. M.H.: investigation and writing—original draft. F.F.: investigation and writing—original draft. N.A.: investigation and writing—original draft. S.K.: investigation and writing—original draft. D.J.: investigation and writing—original draft. M.H.: validation. A.A.: writing—review and editing and validation. S.V.: validation.
Acknowledgments
We would like to thank all patients and their primary caregivers who participated in the questionnaire. We would like to thank Dr. Priya Das for conducting the data analysis, and Mr. Sarangh Thomas for creating the template to fill the questionnaires. We would also like to thank Drs. Ghaidaa Sulaiman, Ghaida Odeh, Aya Qassim, Zina Nabil, Sana Al-Rawi, Sharifa Ahmed, and Salman Ali Jan for their contribution in conducting the questionnaires and data collection.
Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.
Supplementary Material
REFERENCES
- 1. . One hundred years of telemedicine: Does this new technology have a place in paediatrics? Arch Dis Child 2006;91:956–959. Crossref, Medline, Google Scholar
- 2.
WHO Library Cataloguing-in-Publication Data Telemedicine : Opportunities and developments in Member States: Report on the second global survey on eHealth. 2009 [Internet]. Who.int. Available at https://www.who.int/goe/publications/goe_telemedicine_2010.pdf (last accessedFebruary 13, 2022 ). Google Scholar - 3. . Virtually perfect? Telemedicine for COVID-19. N Engl J Med 2020;382:1679–1681. Crossref, Medline, Google Scholar
- 4. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care 2019;25:40–44. Medline, Google Scholar
- 5. Patients’ satisfaction with and preference for telehealth visits. J Gen Intern Med 2016;31:269–275. Crossref, Medline, Google Scholar
- 6. Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open 2017;7:e016242. Crossref, Medline, Google Scholar
- 7. . Patients’ Perceptions and Satisfaction Regarding Teleconsultations During the COVID-19 Pandemic in Jeddah, Saudi Arabia. 2020. [Epub ahead of print]; DOI/
10.21203/rs.3.rs-51755/v1 Crossref, Google Scholar - 8. Telephone consultations for general practice: A systematic review. Syst Rev 2017;6:128. Crossref, Medline, Google Scholar
- 9. Patient satisfaction with physician–patient communication during telemedicine. Telemed J E Health 2009;15:830–839. Link, Google Scholar
- 10. . An evaluation of patient-physician communication style during telemedicine consultations. J Med Internet Res 2009;11:e1193. Crossref, Google Scholar
- 11.
WHO Director-General’s opening remarks at the media briefing on COVID-19—March 11, 2020 [Internet] . Who.int. [cited June 5, 2021]. Available at https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19 (last accessedMarch 11, 2020 ). Google Scholar - 12. Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:1595–1599. Crossref, Medline, Google Scholar
- 13. . Telemedicine in the time of coronavirus. J Pain Symptom Manage 2020;60:e13–e14. Crossref, Google Scholar
- 14. . Perspective on COVID-19: Finally, telemedicine at center stage. Telemed J E Health 2020;26:1106–1109. Link, Google Scholar
- 15. Telemedicine in the face of the COVID-19 pandemic. Aten Primaria 2020;52:418–422. Crossref, Medline, Google Scholar
- 16. Telemedicine practice in Saudi Arabia during the COVID-19 pandemic. Cureus 2020;12:e12004. Medline, Google Scholar
- 17.
About global NCDs [Internet] . Cdc.gov. Available at https://www.cdc.gov/globalhealth/healthprotection/ncd/global-ncd-overview.html (last AccessedFebruary 13, 2022 ). Google Scholar - 18. Estimation of effects of nationwide lockdown for containing coronavirus infection on worsening of glycosylated haemoglobin and increase in diabetes-related complications: A simulation model using multivariate regression analysis. Diabetes Metab Syndr 2020;14:319–323. Crossref, Medline, Google Scholar
- 19. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr 2020;14:211–212. Crossref, Medline, Google Scholar
- 20. . Sustainable diabetes care services during COVID-19 pandemic. Diabetes Res Clin Pract 2020;166:108298. Crossref, Medline, Google Scholar
- 21. . Mobile health solutions for the aging population: A systematic narrative analysis. J Telemed Telecare 2016;23:439–451. Crossref, Medline, Google Scholar
- 22. Rapid implementation of a diabetes telemedicine clinic during the coronavirus disease 2019 outbreak: Our protocol, experience, and satisfaction reports in Saudi Arabia. J Diabetes Sci Technol 2021;15:329–338. Crossref, Medline, Google Scholar
- 23. Mobile teledermatology–patient satisfaction, diagnostic and management concordance, and factors affecting patient refusal to participate in Saudi Arabia. J Telemed Telecare 2013;19:315–319. Crossref, Medline, Google Scholar