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Abstract

Introduction

Telemedicine has been shown to be an effective approach for people with substance-related disorders. Analyzing patient satisfaction with telemedicine is necessary for improving treatment outcomes. This study aims to assess patient satisfaction with telemedicine for substance-related disorders at the Centro Asistencial Córdoba in Argentina.

Methods

A cross-sectional, descriptive, and correlational design was carried out. A patient satisfaction survey was created, consisting of eight questions and a quality-of-life question, which was administered to N = 115 patients.

Results

The results showed that more than 90% agreed with the ease of use of virtual consultations, 82% felt they received the same level of care as if the consultation had been in person, 86% agreed with the adequacy of time utilized during the virtual session, and over 85% agreed to repeat their telemedicine treatment. Regarding the composite variable “users’ assessment of telemedicine,” we found an average of 17.41 ± 2.80. Concerning satisfaction with virtual care and the previous use of telemedicine, 95.7% were satisfied, and nearly 61.7% reported not having used virtual care previously. In terms of money and time saved, 93.9% saved money with virtual consultations, 66.1% saved more than two hours per week, 23.5% saved more than one hour per week, and 10.4% saved less than one hour per week.

Conclusions

Overall, there is significant approval of telemedicine among users of substance-related disorders services. In particular, they were satisfied with the time employed, the benefits of saving time and money, and the ease of use of telemedicine; furthermore, they were positive about undergoing telemedicine treatment in the future.

Keywords

Telemedicine patient satisfaction substance-related disorders health services accessibility-quality-of-life

Background

Health systems and healthcare services increasingly implement digital health interventions to manage various health issues. According to the World Health Organization (WHO), digital health is defined as the field of knowledge and practice associated with developing and using digital technologies to improve health.¹ Within this field, telemedicine (TM) is the use of information and communication technologies to improve patient outcomes by increasing access to care and medical information.²

Telemedicine has the potential to develop efficient means for delivering quality healthcare services and outcomes, showing equal or, in some cases, better results than in-person treatment.³ An essential benefit of TM is that patients can receive care in their homes or communities, which helps overcome geographical barriers to accessing medical facilities, especially for vulnerable populations living in remote areas.⁴ In addition, it has the potential to save costs, as service users do not have to spend money on transportation and family care and lose less work time.⁵ Furthermore, TM studies have shown an increase in utilization and a decrease in no-show rates.^6,7

Populations affected by substance-related disorders in low- and middle-income countries, such as Argentina, face severe difficulties in receiving adequate treatment, with the estimated treatment gap ranging from 75–95%.⁸ Additionally, over 80–85% of people with substance-related disorders in low- and middle-income countries do not have access to adequate mental healthcare services.⁹ As reported by the National Institute of Statistics and Censuses (INDEC) of Argentina, the prevalence of alcohol consumption was 66.2%, the prevalence of cannabis consumption was 13.8%, and the prevalence of cocaine consumption was 5.1% in people between 16 and 65 years old during 2023.¹⁰ For this reason, a thorough understanding of patients’ satisfaction enables sustainable development and expansion of TM services for substance-related disorders.

During the past years, several factors have contributed to the growth in the use of TM. These factors include significant advances in information and communication technology, the prevalent use of high-speed internet, and the increasing adoption of electronic health records.⁴

Before the COVID-19 pandemic, TM was minimally utilized in low- and middle-income countries, given the technological, legal, and regulatory concerns that health providers had about implementing it as an alternative to physical consultations. Since the beginning of the COVID-19 pandemic, several healthcare services have expanded their TM interventions. In 2020, health services in Argentina started to provide remote assistance, reaching 83,000 teleconsultations in October of that year.¹¹

Nevertheless, there are still various barriers to implementing TM services, such as privacy loss, misdiagnosis, confidentiality issues, and a lack of patient acceptability.¹² Even though low- and middle-income countries have adopted TM during the COVID-19 pandemic, it was a slow process with several obstacles related to infrastructure, lack of connectivity, and inadequacy of digitalization of public health practices.¹³

Patient satisfaction is deemed necessary because it can affect treatment outcomes and a patient's decision on whether to continue treatment.¹⁴ Multiple dimensions influence patient satisfaction, namely communication, reliability, effectiveness, efficiency, ease of use, and usefulness as part of satisfaction measures.¹⁵ Therefore, a thorough understanding of patients’ experiences is imperative to ensure the optimal use of TM and to overcome shortcomings and challenges encountered during virtual visits.¹⁶ If this is not achieved, patients will refuse to use TM, so adoption of the new technology will decline.¹⁷

Telemedicine has been shown to be an effective approach for increasing access to care for people with mental health disorders,¹⁸ reducing stigma and increasing privacy.¹⁹ Multiple studies of patients’ perceptions of TM, particularly regarding the care for substance-related disorders, have shown high satisfaction levels comparable to those for in-person treatment.^20,21 However, the literature about patient satisfaction with TM for substance-related disorders is more limited than that for other behavioral health conditions.¹⁷ In addition, it is crucial to recognize that patients with substance-related disorders face more difficulties accessing healthcare services than other patient populations because of the structural inequalities they have to deal with.²²

Given the above background, the present study aimed to assess patient satisfaction with TM in people who underwent treatment for substance-related disorders at the Centro Asistencial Córdoba.

Methods

Research design

This study used a cross-sectional, descriptive, and correlational design, collecting data about the interest group from November 2021 until June 2022. It is part of a larger research project to assess mental well-being, quality of life, anxiety, depression, and patient satisfaction with the use of TM for treating substance-related disorders.

Study setting

The Centro Asistencial Cordoba is a substance-related disorders and mental health service that provides in-person and virtual multidimensional treatment composed of psychotherapy, group therapy, family therapy and counseling, psychiatry, psychopharmacology, and social and employment inclusion for vulnerable people with substance abuse and other comorbidities who have a polydrug use profile with a higher prevalence of alcohol, cannabis, and cocaine consumption. The initial treatment comprises participation in 12 group therapy sessions during a period of three months (1 per week) and individual psychotherapy, psychiatry, and psychopharmacology consultations according to the specific needs of each person. The treatment program is publicly funded by the Minister of Health of the province of Córdoba in Argentina, which is part of the national public healthcare system. In the course of this research, the Centro Asistencial Córdoba had a staff of 29 multidisciplinary healthcare workers. The Centro is located in the most populated urban area of the city of Córdoba in Argentina. In 2022, it delivered care to 6246 persons, of whom 954 received TM treatment.

Participants

All service users undergoing TM treatment were eligible to participate. An anonymous online Qualtrics survey was sent to them before starting the virtual group therapy sessions between November 2021 and June 2022.

Participation was voluntary. The survey was sent to N = 954 patients, a total of N = 145 responses were collected, and a total of N = 115 responses were valid. At the moment of the survey, none of the participants had health insurance, and the healthcare subsystem of the state ensured their health coverage. Additionally, they were not formally employed. At the time of survey collection, all participants were in treatment for a period between one week and three months. Ethics approval was obtained from the Ethics Committee (Institutional Review Board) of the Hospital Nacional de Clínicas of the National University of Córdoba.

The inclusion criteria were (a) undergoing treatment via TM, (b) being 18 years old or older, (c) having internet access, and (d) having given informed consent to take part in the study. The exclusion criteria were (a) undergoing in-person treatment and (b) presenting any cognitive, psychological, or neurological issues that could pose difficulties for participating in the study.

Research tool

A patient satisfaction survey developed by Garcia-Huidobro et al.²³ was applied. This survey comprises eight items, namely (a) “The virtual consultation was easy to do,” (b) “The time utilized during the virtual session was enough,” (c) “Are you satisfied with the telemedicine service you received?,” (d) “Have you used virtual treatment previously?,” (e) “Would you like to perform your treatment again virtually?,” (f) “Did you receive the same level of care as you would have received if you had attended in person?,” (g) “Do you think you saved money?,” and (h) “How much time do you think telemedicine saved you (including travel time, wait time, visit time)?.” The responses were given on a five-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree).

Besides, one item for measuring the self-perception of quality of life was included. This item is used in several quality-of-life scales such as the WHOQOL²⁴: “How would you rate your quality of life?” with responses ranging from 1 (very bad) to 5 (very good). The dimensions of satisfaction addressed to analyze these items comprised perceived usefulness, ease of use, and costs.¹⁷ This survey was chosen and adapted to obtain the highest number of answers through the ease of response for participants, considering that this population reports several cognitive difficulties in understanding questions with unspecified answers and a higher abstraction level.

Statistical analysis

A descriptive analysis of the categorical variables was performed with their relative and absolute frequencies. Next, a new continuous composite variable named “users’ assessment of TM” was created comprising items (a), (b), (e), and (f) to be used in the multivariate analysis. The four items of the patient satisfaction scale with a five-point category of response (1 = totally agree to 5 = totally disagree) were recoded. Then, we evaluated their reliability, finding it to be good (α = .80). The score of this composite variable ranges between 4 and 20 points, with the higher the score, the greater the perceived adequacy and satisfaction with TM. We performed a logistic regression to see which variables were associated with satisfaction with TM.

Results

Sample characteristics

Sample sociodemographic characteristics showed that 59.1% of the participants were men, 38.3% were female, and 2.6% declared being non-binary. A total of 92.2% of the participants were adults between 25 and 60 years old, 4.3% were young people under 25 years of age, and 3.5% were elderly over 60 years old. The mean age was 41 years. Concerning the educational level, 40% of the participants finished university, 39.1% completed high school, and 20.9% reached primary school.

Adequacy, users’ assessment, satisfaction with the use of TM, and association with the self-perception of quality of life

Descriptive results of the items that evaluate the perceived assessment of TM showed that more than 90% agreed (strongly agree and agree) with the ease of use of virtual consultations, more than 82% felt they received the same level of care as if the consultation had been in person, 86% agreed with the adequacy of time utilized during the virtual session, and over 85% agreed with the desire to use the TM service again (Table 1). Regarding the composite variable “users’ assessment of TM,” we found an average of 17.41 ± 2.80.

Table 1.

Descriptive statistics of satisfaction with TM.

Item/Response category: % (n)	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
The virtual consultation was easy to do	62.3 (71)	28.9 (33)	6.1 (7)	0.9 (1)	1.8 (2)
Same level of care as they would have received if they had attended in person	50.4 (57)	31.9 (36)	10.6 (12)	6.2 (7)	0.9 (1)
The time utilized during the virtual session was enough	53.9 (62)	33.1 (38)	7.8 (9)	5.2 (6)	0 (0)
To perform your treatment again virtually	61.7 (71)	23.5 (27)	11.3 (13)	3.5 (4)	0 (0)

Besides the scale included a dichotomous question about satisfaction with virtual care and previous use of TM. Approximately 96% (95.7%) of the participants answered that they were satisfied, while nearly 62% (61.7%) reported never having used virtual care before.

Regarding the perception of the benefits of TM, in terms of money and time saved, 93.9% of the participants reported they saved money with virtual consultations. Besides 66.1% reported saving more than two hours per week, 23.5% more than one hour per week, and 10.4% less than one hour per week (including transportation, waiting time, and consultation time).

With regard to the question of how you would rate your quality of life, 2.8% answered very bad, 21.1% bad, 46.8% normal, 22% good, and 7.3% very good. The results showed a significant, although small, correlation between positive assessment of the adequacy of the use of TM and self-perception of a good quality of life (Kendall's tau = .16, p = .046).

Predictors of satisfaction with TM

The full logistic regression model was statistically significant, χ² (df = 7, n = 112) = 24.57, p < .001. The model explained the following percentages of variance: R²= 0.20 (Cox & Snell) and 0.64 (Nagelkerke). The results showed that users’ assessment of TM predicted satisfaction with TM. It was also found to be predicted, although marginally, by the amount of time saved with virtual consultations (Table 2). The model correctly classified 97.3% of the cases. No associations were found between the variable satisfaction with TM and the sociodemographic variables of sex, age, and educational level.

Table 2.

Logistic regression analysis of variables related to satisfaction with TM.

Parameter	β	SE β	Wald's χ² (df = 1)	p	e^β (odds ratio) [95% CI]
Constant	15.74	67.98	0.05	0.817	NA
Men (vs. women)	−1.39	2.19	0.40	0.525	0.25 [0.00–18.40]
Age^a	−2.55	33.76	0.01	0.940	0.08 [0.00–4.25]
Level of education^b	1.32	1.36	0.94	0.333	3.74 [0.25–53.98]
Previous use of TM (yes)	−1.89	1.92	0.96	0.327	0.15 [0.00–6.58]
Time saved with TM^c	6.34	3.65	3.00	0.083	564.61 [0.43–72.97]
Money saved with TM (yes)	−7.52	4.66	2.61	0.106	0.00 [0.00–4.99]
Users’ assessment of TM^d	−1.72	0.85	4.13	0.042	0.18 [0.03–0.94]

NA: not applicable.

^aAge category responses: 1 (young), 2 (adult), and 3 (older adult).

^bLevel of education category responses: 1 (no studies), 2 (primary education), 3 (secondary education), and 4 (university studies).

^cTime saved with TM category responses: 1 (less than one hour per week), 2 (more than one hour per week), and 3 (more than two hours per week).

^dScores of users’ assessment of TM ranged from 4 to 20.

Discussion

This study presents results relevant to the development and sustainability of TM services in terms of adequacy, users’ assessment, and patient satisfaction. Also, the study provides insights into the association with the self-perception of quality of life for treating people with substance-related disorders through TM, enabling a better understanding of patient satisfaction from a multidimensional perspective. High levels of satisfaction with TM for substance-related disorders regarding the time utilized during the virtual consultation and the ease of performing TM are outcomes of this study and similar studies.^25–27

Additionally, overall patient satisfaction with TM was very high among the respondents, with a level exceeding 90%. A high level of patient satisfaction was also found in other studies on TM treatment for substance-related disorders.^28,29 Furthermore, as reported by Young in a literature review about TM for substance-use disorders, none of the studies reported patient dissatisfaction, and the majority of the studies (76%) were supportive of TM.³⁰ According to Nguyen et al., two systematic reviews confirmed this trend in patient satisfaction with TM for treating chronic conditions, with the studies analyzed showing over 80% patient satisfaction.^17,31

Regarding patient experience with TM, it is essential to assess whether users have the same or a better level of care than with in-person treatment. If the level of TM care is the same or better, it will be a favorable condition for implementing TM. In the context of this study, the majority of patients reported that they received the same level of care, a finding consistent with other studies assessing TM for substance-related disorders.^32–34 According to other authors, TM showed better levels of care than in-person treatment.^35,36

In the current study, more than 60% of the participants stated that they had not used TM previously. There was no correlation between the previous utilization of TM and higher satisfaction levels. In contrast, other studies highlighted that patients who started TM treatment during the COVID-19 pandemic were more satisfied than those who underwent in-person treatment and then started virtual treatment during the COVID-19 pandemic.^37,38 We can assume that during the pandemic, TM was the only available option for having access to care. Thus, this global health emergency became an advantageous opportunity for integrating TM into substance-related disorders services.

Interestingly, our results demonstrated that more than 80% of the respondents would like to undergo their treatment virtually in the future. This suggests that patients received proper care and were satisfied with their TM consultation, as indicated by Mojdehbakhsh et al.³⁹ in their study of patient satisfaction. Similarly, other studies reported high levels of patient willingness to continue using TM,^40,41 reaching 100% in some cases.²⁵

People with substance-related disorders from low- and middle-income countries are considered a vulnerable population and generally have difficulties maintaining treatment adherence due to a lack of economic resources and time for attending health facilities; instead, they spend time working or performing coping mechanisms to obtain food, household necessities, or other basic needs. The present study shows that saving money and time are features of TM care for substance-related disorders, which are conveniences emphasized in several studies, especially regarding travel, transportation, and lost income from missing work.^42–44 This could be considered one of the main factors that predict the positive association between the variable “users’ assessment of TM” and cost savings.

In this research, no associations were found between educational level, waiting time, and patient satisfaction with TM. However, two studies mentioned that there were associations among these variables.^45,46 It is important to highlight that the majority of studies we found in the literature did not use inferential statistics in their analysis. No articles were found associating patient satisfaction, quality of life, and cost savings.

Conclusion

This study analyses patient satisfaction with TM for the substance-related disorders’ dimensions of adequacy, users’ assessment, satisfaction with the use of TM, and the self-perception of quality of life. The participants reported overall high levels of satisfaction with TM and appraised TM as presenting the same level of care as in-person treatment. Additionally, they were satisfied with the time employed and found that TM was easy to perform. Likewise, they rated positively the benefit of saving time and money and undergoing treatment with TM in the future; in addition, a positive correlation was found between the adequacy of the use of TM and the self-perception of a good quality of life. It is deemed important to incorporate patients’ perceptions to comprehend how they experience their care processes and their relationship with health services for strengthening treatment adherence and success. There is a favorable acceptance of TM among users of substance-related disorders services, highlighting the importance of broadening research in this area.

Further studies should investigate in detail the factors that influence patient satisfaction dimensions utilized in TM, which could differ from those related to in-person interventions.

Limitations

The TM survey implemented in this study is not a validated tool. However, other research studies utilized it to assess patient satisfaction with TM. Additionally, it is important to highlight that the majority of the patients who were surveyed presented cognitive impairment. They found many of the survey questions very difficult to understand, and it took them a lot of time to comprehend the meaning and finally choose a response option. Hence, more factors may influence patient satisfaction and positive assessment, which could not be measured in the present study. There is a scarcity of studies on substance-related disorders and patient satisfaction with TM, and none of them were performed in the Latin American region.

Supplemental Material

sj-docx-1-dhj-10.1177_20552076241240974 - Supplemental material for Patient satisfaction with telemedicine for substance-related disorders

Supplemental material, sj-docx-1-dhj-10.1177_20552076241240974 for Patient satisfaction with telemedicine for substance-related disorders by María Alejandra Farias, Manuel Badino and María Jose Fuster de Apocada in DIGITAL HEALTH

Footnotes

Acknowledgement

The authors would like to thank Darío Gigena Parker from the Secretariat for Prevention and Assistance for Addictions of the Ministry of Health of the Government of the province of Córdoba in Argentina for his support to the fieldwork conducted in this research.

Contributorship

All authors conceived the original idea for this article,and all of them reviewed and approved the final version.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Ethical approval

The Ethics Committee (Institutional Review Board) of the Hospital Nacional de Clínicas of the National University of Córdoba approved this study (REC number: 052-09102023).

Funding

The authors received no financial support for the research,authorship,and/or publication of this article.

Guarantor

MAF

ORCID iD

María Alejandra Farias

Supplemental material

Supplemental material for this article is available online.

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Supplementary Material

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