A pilot project conducted at the Mayo Clinic by Fibbs and colleagues examining the feasibility of social work telehealth services was recently reported in Frontiers in Psychiatry. Expanding Access to Social Support in Primary Care via Telemedicine showed increased telehealth patient satisfaction when patients used a tablet to digitally connect with social workers in two busy primary care clinics. The telehealth intervention was tested at Mayo Clinic-affiliated primary care facilities in Rochester, Minnesota.
Measuring Patient Satisfaction with Social Work Telehealth Services
The sample study looked at 22 telehealth social work visits over 37 days and served 18 patients. Sixty-eight percent of the patients were adults, and 55% were male. Visits lasted an average of 44 minutes. Positive outcomes measured were anxiety reduction, improved well-being, and staff satisfaction.
Naturalistic information was gathered during the regular day-to-day operation of two clinics during actual patient visits. The social work telehealth intervention was designed to be minimally disruptive to patients, providers, social workers, and clinic staff. Data were gathered from the primary care providers who ordered the social work consultations, participating patients, and social workers. Data collection methods were designed to capture brief real-time feedback about implementing virtual social work visits. During the initial trial at the first site, healthcare providers conducted virtual social work visits with tablets during the medical encounter.
Social Work Telehealth Service Pilot Study Conclusions
This in-practice pilot study demonstrated that telehealth social work triage was possible and valued by patients and providers in two busy primary care practices. Patients of all ages seemed to accept virtual social work without great difficulty. The primary care physicians were easily able to include this telehealth service into their busy workflow. The main challenges described in the feedback were centered around encounters where the tool was not working well (not the concept of using a virtual tool for evaluation). Healthcare providers gave feedback after using this tablet. Their feedback included convenience, timely access to care, and time savings. Telehealth patient satisfaction scores collected were measured using a Likert scale from 1 to 5. Results showed an average score of 4.7 out of five, indicating high patient satisfaction with telehealth. All patients who participated in the survey indicated that they would recommend this service to other patients. Comments were generally positive and indicated that patients and clients were satisfied using the tablets for the convenience they provided. Feedback from social workers was also primarily positive, including the benefit of timely access to patient care and the ability to see the faces of patients and staff.
Feedback from primary care physicians included:
- I truly do not think the patient would have come in to see a social worker otherwise.
- As a provider, I cannot tell you how much better I felt knowing he had a visit and a plan was made when the patient needed it most.
- I kept moving, doing other stuff—kept working while the patient and social worker talked. Time-wise, that was very useful.
Feedback from patients included:
- It’s right there—no waiting for an appointment, a great way to take advantage of technology.
- There was a slight lag in the video and the sound.
- I’m not an IT guy, so when the session has ended, make sure it logs off.
- The nurse setting it up had trouble getting the picture right and trouble with the cord too.
- I would recommend it; I think it’s a good idea.
- Absolutely I do [recommend it]).
Feedback from social workers included:
I was doing a suicide assessment on an adult individual, and there was a delay and an audio breakup during an important question. I almost missed a facial expression that was not congruent with the response. I was able to go back and repeat the question, noting the facial response, for a more accurate account. Had I missed that, which I probably would not have in person, there could have been a very different outcome.
I was doing a trauma assessment on a young person, and there were several breakups in the audio, as well as difficulty hearing them speak. They were crying and speaking softly because what they were talking about was difficult for them. It is hard to be attentive to the patient’s needs when the audio is breaking up during a serious and difficult discussion.
There was one instance where the family member of a patient had an angry look, and I asked if I had missed something, and they said the visual and verbal delays made her frustrated. Despite this, almost every patient and family member I spoke with appreciated the immediate response and ability to access services quickly and efficiently.
The study also examined factors that could enhance the experience, such as the location of the tablet within the clinic, the speed at which it was delivered to the exam room where the patient was located, how to disinfect and deliver the tablet to the next patient quickly, how to optimally notify the social worker when the next patient was ready, and how to handle emergencies. Once having developed this workflow, the social worker collected data on the nature of requests, her ability to respond, and estimates of additional resources needed. The study initially started in one primary care physician clinic but spread to a second clinic due to demand. Requests for social work point-of-care input (described as triage visits), missed opportunities, and patient and provider satisfaction with virtual triage telehealth services were tracked throughout the study. Data were captured on-site.
Noted limitations of the study included a lack of randomization in assigning patients and clients, limited survey questions and responses, and no comparison group.
More research is needed to determine the future of social work telehealth and telehealth patient satisfaction. Still, the study results show that such telehealth services may be an excellent alternative to in-person visits. See TBHI’s previous article Telehealth Patient Satisfaction Boosts Telehealth Provider Marketing for related information.
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