“What are the levels of patient satisfaction with the use of video consultation as a tool for care delivery since Coronavirus (COVID-19) pandemic started?”

1. “What are the levels of patient satisfaction with the use of video consultation as a tool for care
delivery since Coronavirus (COVID-19) pandemic started?”

2. 3.Chapter 3 Systematic literature review
3.1 Findings
3.1.1 Discourse Analysis
In this systematic review both qualitative and quantitative papers were retrieved which
are further discussed and compared extensively throughout the findings chapter. Kludacz-
Alessandri et al. (2012) carried out a research to study patients’ satisfaction from teleconsultation
in primary care and the impact of teleconsultations on GP-patient communication through the
Covid-19 pandemic in Poland. Kludacz-Alessandri et al. (2012) analyses whether the
teleconsultations performed without physical examinations have a positive impact on GP-patient
communication. In Kludacz-Alessandri et al. (2012) research the respondents were
predominantly women (56%) and the mean age of the patients in the study was 55 years. The
highest percentage of responses came from Warsaw and most of the clinics collaborating with
the research team were located in Warsaw. About 5% of respondents are unemployed; In
contrast, before the Covid-19 pandemic, the national unemployment rate was 6.2%. The majority
of respondents are therefore employees (44.5%) and retired or retired (44.5%) (Kludacz-
Alessandri et al. 2021). The majority of respondents are over 65 years of age (39.4%). The
smallest group is younger than 24 years (5.1%). Of the 100 respondents, 45.5% stated that they
rarely visit their family doctor (once every three months) and 27.3% occasionally (once a year).
Only 9.1% of patients consult a doctor frequently, several times a month. However, Gavidia
(2020) research highlighted that regardless of the fact that patient can visit the family doctor
mainly by phone only 5% of people use tip videos. The most common reason for visiting a
family doctor is everyday problems or emergencies. A high proportion of respondents (40.4%)
stated that the main reason for the consultations was administrative matters: orders,

3. recommendations, dismissals or (routine) proceedings (30.3%) (Kludacz-Alessandri et al. 2021).
Fewer participants stated that they seek counselling for preventive reasons (16.2%) and for initial
diagnosis or treatment (12.1%) (Kludacz-Alessandri et al. 2021). This may be because patients
avoid counselling in the following situations during the Covid-19 pandemic. There is no quick
reason. Almost half (46.5%) of respondents stated that the expected waiting time for remote
inquiries is too long (more than 48 hours), which may be a cause for concern and a reduction in
the quality of inquiries.
In contrast, as per Ravnskov (2020) proper communication is essential if the GP does not
see the patient before and during the call and there are no typical visual cues. Overall satisfaction
with long distance communication is very high, averaging 4.5, which is the best measure of
patient satisfaction with distant nurses (Kludacz-Alessandri et al. 2021). Patients rate the
variables related to empathy and respect as the best, so they rate GPs who are kind and
considerate to them, but also patient and supportive. Demand does not increase confidence in the
family doctor.
Nitkunan et al. (2020) conducted a research aiming to help neurologists to conduct
remote consultations, particularly in relation to the current COVID-19 circumstances, and to help
to embed remote consultations as standard practice following the pandemic. Patients benefit
from one-off and remote consultations. In this case, when they think about all the issues, they
feel heard and understood (Nitkunan et al. 2020). It is important to demonstrate active listening
because the patient may not have visual stimuli. In comparison with Imlach et al. (2020) study
Kludacz-Alessandri et al. (2021) confirmed that interviewed patients received good technology
and behavioural counselling, but Kludacz-Alessandri research did not confirm that women were

4. more satisfied with telemedicine - mean value for men = 3.95; mean value for women Value =
3.85.
Almost 80% of participants think that the technical support obtained during the remote
consultation is adequate (Kludacz-Alessandri et al. 2021). However, as only a small number of
patients participated in the video consultation in this study, this conclusion mainly concerns
telephone calls. As the "technical quality" of watching a video can be a more important issue, it
should be considered separately in the next study. Respondents were far from commenting on
connection problems, poor internet access or technical barriers to mobile services. However, it
should be noted that remote consultation is not appropriate for patients with hearing impairment.
Remote counselling is very suitable for patients, even if they have not yet experienced them. The
majority of respondents (62.6%) are willing to discuss their health problems with their GP by
phone or online (Kludacz-Alessandri et al. 2021). The results showed that 55.5% of patients
thought that the medical services obtained during the teleconsultation were as good as the vision
of the face-to-face GP. 33.3% of patients disagreed with this statement and the rest of the
respondents did not express their opinion. Participants noted that distance counseling can save
time (83.8%) and money (65.7%) (Kludacz-Alessandri et al. 2021). On the other hand, many
patients (37.4%) had difficulty accessing electronic medical records. During the study period, the
results showed that distance consultation was an acceptable way to address health issues in
57.6% of patients (Kludacz-Alessandri et al. 2021).
Geenhalgh et al.’s (2020) compiles literature evidences from various studies to support
and justify that the The rapid spread of covid-19, and the fact that healthcare facilities could be
sources of contagion, has focused attention on new models of care that avoid face-to-face contact
between clinician and patient. According to Geenhalgh et al.’s (2020) research the relationship

5. between the quality of remote consultation and the quality of communication is confirmed by
multiple regression analysis, which examines the impact of various representative variables of
the donor population and the impact of the characteristics of remote consultation on the quality
of communication.
Furthermore, Kucharski (2020) conducted a research combining a mathematical model of
severe SARS-CoV-2 transmission with four datasets from within and outside Wuhan, Kucharski
(2020) estimated how transmission in Wuhan varied between December, 2019, and February,
2020. Kucharski (2020) used these estimates to assess the potential for sustained human-to-
human transmission to occur in locations outside Wuhan if cases were introduced. Kucharski
(2020) combined a stochastic transmission model with data on cases of coronavirus disease 2019
(COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how
transmission had varied over time during January, 2020, and February, 2020. Independent
variables include age, level of education, marital status, current employment status, frequency of
consultations, waiting time for consultation, reason for consultation and experience with the
system (Kucharski, 2020). An "inverse" stepwise regression analysis is used for the last selected
variable, which consists in removing individual variables from the model until a satisfactory
version is obtained. Kucharski (2020) mentions that the standard regression coefficient (β) shows
the effect of the predictor variables on the explanatory variables defined by the communication
quality.
Whereas, Kludacz-Alessandri et al.’s (2021) analysis shows that commonly used
independent variables can explain 33.24% of the total variance in the quality of GP
communication (R2 = 0.3324). The results obtained are statistically significant (Fisher's statistic
F = 8.9638; p <0.0005) (Kludacz-Alessandri et al. 2021). Previous results show that four

6. variables are statistically significant predictors of communication: age, level of education,
waiting time for a consultation, reason for consultation, and experience with the system
(Adhikari et al. 2020). Factors that negatively affect the explanatory variables are waiting time
for the visit and reasons for the visit. Adhikari et al. (2020) shows that experience with the
system has the greatest impact on the quality of communication.
3.1.2 Experience and Satisfaction with Telemedicine
Imlach et al. (2020) studied that participants who communicated in more detail with their
family physicians were asked about their experiences with telemedicine and face-to-face
counselling during the quarantine period. Of the respondents, 61% (528) received telephone
calls, 5% via video and 39% face to face (337). The socio-demographic characteristics of the
respondents who conducted the telephone interview were very similar to those interviewed face
to face. Video consultation is not enough to compare patient characteristics (Richard et al. 2020).
Most respondents consult telemedicine themselves, but 14% consult telemedicine for
children or other people (e.g. elderly relatives) (Imlach et al. 2020). Most consultations were
with doctors (84%). Before its closure, only 17% of people had experience with telemedicine.
Counselling fees are generally the same as for regular visits (43% for phone calls and 46% for
video calls) and only 14% lower for phone calls (Imlach et al. 2020). About 22% of telemedicine
consultations are free (for example, government financial accidents or children under 14)
(Imlach et al. 2020). The cost of 18% of telephone calls and 26% of video calls is unknown or
unreported. In terms of qualitative data, this may be because the patient was not informed / asked
about costs, did not remember or did not receive an account before the consultation (Imlach et al.
2020).

7. In Imlach et al. (2020) research, overall satisfaction with telemedicine is relatively high,
91% with video and 86% with telephone counselling, but slightly lower than in person (92%).
The difference in satisfaction between telemedicine and face-to-face meetings is related to the
level of "spending enough time with you" and "listening" reported by professionals (Imlach et al.
2020). In addition, some participants expressed concerns that they would not be seen, with 29%
of those who took part in the telephone consultation and 36% of those who took part in the video
consultation moderately, very or very concerned about not being seen not undergoing the
physical examination (Imlach et al. 2020).
3.1.3 Patients’ Need and Want to Be Seen In-Person
As per Shaker et al. (2020) physical examination and observation are considered
important for certain health problems (such as removal of the IUD or prostate examination) and
can give you peace of mind and confidence. In Davarpanah et al. (2020) research as a result of
telephone and video calls, some participants feared that they would not be seen or properly
projected. Respondents stated that telemedicine is particularly effective in emergency situations
that do not require physical assessment, information or when the patient knows what is wrong.
Acute, new or more complex problems can be more serious, especially when a phone call is
needed.
In the context of the fence, interviewers felt the tension between the need for visibility
and the benefits of maintaining physical distance and protecting others from infection.
Respondents used "recommendations" to meet blocked telemedicine requirements, such as
sending photos, sending blood pressure measurements home via email, phone calls and video
decisions for visual assessment. In this case, video consultation is cheaper than by phone.
Problem solving is sometimes pragmatic, but not ideal (Kang et al. 2020).

8. 3.1.4 Relationships with Patients as a Basis for Telemedicine
Canady (2020) study identifies that successful telemedicine consultation requires mutual
trust between the patient and the clinic, which is easier if the relationship already exists. It is
encouraging to see a clinic that understands patients’ medical history. For many people, the
experience with telemedicine is similar to a regular consultation (Canady, 2020). For those who
value continuity of care, communication with trusted physicians is more trustworthy than a
personal visit. However, if physicians do not pay attention to building relationships in the
telemedicine environment, existing relationships will not be sufficient for a successful
consultation (Canady, 2020). On the other hand, even if the interviewee does not have an up-to-
date relationship with the clinic, the consultation may be successful once the doctor has
established a relationship (Canady, 2020).
As per Canady (2020) some patients find that telemedicine is less stressful, more focused,
more personal, and even offers more room for conversation than usual. Patients like to receive
safe, attentive and always available telemedicine consultations. They feel heard and all their
concerns are resolved. If visual stimuli are not available, it is more important to demonstrate
active listening. For others, telemedicine seems easy, even if the patient knows the other end of
the clinic (Canady, 2020).
3.1.4.1 Technological Barriers
According to Chauhan et al. (2020) research, technological barriers to telemedicine
include limited access to the Internet or mobile services, lack of credit or telephone information,
and connection problems, including for patients or doctors who are unfamiliar with online
devices. Chauhan et al. (2020) mentions that respondents believe that better use of video
technology will reduce the need for face-to-face meetings, but this is not always the case. There

9. are reports of insufficient broadband speeds or unstable internet connections, poor image
resolution, and poor camera angle. Poor sound quality can cause problems for everyone, but
hearing a call can be impossible by telephone (Chauhan et al. 2020).
The introduction of online payments is of concern to some people, especially the elderly,
who are not used to online banking. It is also worrying that some people may be excluded from
telemedicine due to a lack of support, resources or infrastructure. Participants believe that health
services can be provided at some level (such as counselling and video preparation assistance),
but argue that insufficient resources and infrastructure indicate more serious inequalities in
society (such as poverty, technological disparities in rural and urban areas) Chauhan et al. 2020).
Concerns about security and privacy are not uncommon and are mainly due to the fact that many
telemedicine consultations take place at home. The home environment can be very crowded and
some patients may not hear what they are talking about Chauhan et al. 2020). Sometimes people
do not want to talk about health problems at home (lack of privacy, uncertain environment to
discuss problems, etc.) (Chauhan et al. 2020)
3.1.4.2 Patients’ Views on Medical Care Values Regarding Telemedicine
In Imlach et al. (2020) research survey responses did not mention costs as often as
previous topics. The cost of telemedicine varies depending on the GP. Usually, the patient is not
informed about the fees or the method of payment before the consultation, and the doctor cannot
write the fees and the payment order. Patients clearly expressed value for money based on the
time spent with them and the services provided. They are willing to pay the same fee for
telemedicine as for an individual visit, if it seems to correspond to an individual visit and if it
meets their medical needs (Imlach et al. 2020).

10. If for some patients a complete examination is not possible and the problem is not solved,
it is not appropriate for telemedicine to charge the same costs as medical care. There are also
questions about whether telemedicine consultations should be paid for, as well as lengthy
personal consultations, and whether telemedicine consultations should be paid twice for matters
that require personal consultation (Imlach et al. 2020).
3.1.4.3 Preferences of Patient For Using Video Consultation
Gavidia (2020) explains that the patient's choice of telemedicine is also influenced by
personal factors. Patients carefully consider whether they are satisfied with telemedicine and
whether they want to see a doctor in person. One of the reasons is the health problems they face.
Factors such as the severity of the symptoms, the possibility of a physical examination and
whether they could be explained more clearly in person were taken into account (Gavidia, 2020).
The selection of people for certain types of communication can only include content that can be
considered appropriate based on the health problem. Some patients want to see a doctor despite
their fears, because touch, examination and social contact are more important to them than
comfort. Others feel that choosing telemedicine is important because it saves time and money
(Gavidia, 2020). As per Gavidia (2020) patients who choose to make a call or video call are also
very personal and context sensitive. For some people, scheduling a video call is more stressful
and complicated than making a phone call in bed or elsewhere. Others appreciate digital
connections. Therefore, patients want to choose options that are tailored to their needs and
preferences (Gavidia, 2020).
3.1.5 Limitation of the Study
The main limitation of this study is the size of the study sample, which included only four
primary care providers in one country. However, this is a preliminary study, pilot studies and

11. larger studies will be carried out at a later stage. One of the limitation for this systematic review
it insufficient data published in 2020 due to Covid-19 pandemic. In any case, examining patients'
experiences and the quality of communication during distance consultations is crucial for
evaluating and improving services, especially when changes in service provision are new and
unexpected. Research is also limited because UK does not set a standard for distance counselling
in primary care. Follow-up studies should therefore consider specialized outpatient care and
focus on professions that have set such standards and can use many other telemedicine tools
(such as remote patient monitoring). It should be noted that concrete successes in this area have
recently been demonstrated in neurology.
Therefore, there is a need for video conferencing and a specialized outpatient monitoring
system that would further improve the quality of telemedicine and access rights. However, this
includes providing more support to patients who lack technical skills or who use messaging
platforms and options. Further research is needed on inequalities and discrimination in access to
technology. The availability of internet access could be an important factor for the future use of
modern telemedicine. The development of online public interventions therefore requires
widespread, cost-effective and secure internet access.
Literature Analysis
Need for Video Consultations in Present Healthcare
There is little evidence of the effectiveness of video surveillance, but it demonstrates the
effectiveness, safety and satisfaction of patients and healthcare providers (Ravnskov, 2020).
Prepare from a video consultation to a telephone or face-to-face consultation, depending on
technical, patient, or clinical factors. Prior to the COVID-19 pandemic, virtual consultations
(also known as telemedicine consultations) were developed, and many health systems initially

12. supported digital access (Nitkunan et al. 2020). At the beginning of the pandemic, many GPs and
specialists turned to video consultations to reduce the flow of patients in healthcare facilities and
reduce the risk of infectious exposure. Video and telephone calls also allow healthy but isolated
doctors or doctors at risk who need refuge to continue to provide medical services (Nitkunan et
al. 2020). Video consolation covers a wide range of consultations on long-term conditions,
including diabetes, hypertension, asthma, stroke, mental illness, cancer, and chronic pain
treatment (Nitkunan et al. 2020). Video consultation can also be used to present various
emergencies such as emergency eye care. This practical guide summarizes the evidence for using
video advice. Provide practical advice for video counseling in healthcare, primary care and
outpatient care (Nitkunan et al. 2020).
Use of Video Consultation for Health Management of Patients
All digital communication with patients must comply with national and institutional rules
on data protection and telemedicine (Geenhalgh et al. 2020). A medical application or video
surveillance platform reveals compliance with applicable data security and privacy requirements
(such as the “US Health Insurance Portability and Accountability Act or the European Union’s
General Data Protection Regulation guidelines”). Management and personal safety issues are
organizational and operational issues, and more and more countries have developed protocols
and guidelines for the use of video calls. In the UK and US (and other countries), regulators now
allow doctors to use popular non-medical video calling applications (and medical applications
such as (WhatsApp, FaceTime, and Skype) (Geenhalgh et al. 2020).
Evidences Supporting Video Consultations for Improved Patient Health
Evidence of patient outcomes, cost-effectiveness, safety, technical issues, the impact of
video consultations on healthcare, and the quality of consultations are mostly small studies.

13. Some randomized trials focus on the use of video counselling to provide outpatient services for
hospitalized patients with chronic diseases (Kucharski et al. 2020). In general, they state that
video tutorials are very beneficial for patients and physicians; no difference in disease
progression or use of services; Compared to personal consultations, there is no reliable or long-
term evidence of injuries and transaction costs. There are no randomized trial evaluations of
video calls recorded by GPs and outpatient clinics (Adhikari et al. 2020). Report on a non-
randomized study comparing video versus telephone and in-person counselling in primary care
in the UK. There is no difference between a phone call and a call in terms of length, content and
quality. However, both types of remote consultations are considered "less informative" than face-
to-face consultations and technical problems are common. In addition, we did not find any
substantial evidence to advise clinicians whether to use video or telephone consultations
(Adhikari et al. 2020).
Proof of patient love and satisfaction with video advice is very useful, but it often comes
from some people who have chronic diseases but are in a stable state. Car et al. (2020) in their
research explain that in 1837, physicians' attitudes to video consultations were mixed. They
found that compared to a telephone consultation, a video consultation can have the benefits of
visual advice and is more manageable in terms of refunds and privacy. Other unresolved issues
include continuity of personal care and transmission risks. Overall, the evidence for the use of
video conferencing is weak. Car et al (2020) research offers a pragmatic approach (based on the
best available evidence and the author's opinion). Both patients and clinicians need to give due
weight to the relevance and safety of video decision-making, and the threshold for changing
counselling methods is low (Car et al. 2020).
Convenient Use of Video Consultations with Patients and Caregivers during Covid-19

14. Telemedicine has traditionally focused on healthcare in rural areas and / or has been
progressively promoted through institutional initiatives (Ramaswamy et al. 2020). The
widespread adoption of telemedicine in the context of the COVID-19 pandemic is unprecedented
and could have a significant and lasting impact on healthcare. Telemedicine is generally not
tested in catastrophic conditions (Ramaswamy et al. 2020). It is an essential part of the medical
response to COVID-19, reduces the demand for stressful medical infrastructure, including the
demand for home care, and reduces contact between patients and healthcare professionals
(Ramaswamy et al. 2020). The telemedicine needs of patients are greater than those of healthcare
professional. Ramaswamy et al. (2020) explains that early in March, the “Centers for Medicare
and Medicaid Services” linked telemedicine payments to health insurance services for personal
consultations, suspended licenses and accident insurance restrictions, and repealed the “HIPAA
(Health Insurance Portability and Accountability Act”) rules. For video consulting. Prevalence of
telemedicine use, entry barrier restrictions (Ramaswamy et al. 2020).
In order to reduce the number of people receiving personal medical services, healthcare
professionals can communicate with patients via telecommunications so that they can classify,
evaluate and treat each patient individually (Monaghesh and Hajizadeh, 2020). Using real-time
video conferencing or simple mobile telemedicine, healthcare professionals can ask specific
questions and gather the necessary information, classify patients and provide advice, or
determine if a person can monitor symptoms at home during recovery. It can also be used for
routine check-ups such as required breathing, blood pressure and oxygen levels at home.
During the COVID-19 outbreak in China, online mental health surveys enabled
communication programs such as Weibo, TikTok and WeChat to provide health services to
mental health professionals and health officials. Mental health safety online during the COVID-

15. 19 epidemic (Liu et al. 2020). Chinese government officials have launched a network of remote
counselling services that provide online or telephone counselling in a secure environment to
ensure the continued provision of mental health services and reduce the risk of cross-infection
(Jiang et al. 2020). In addition, the Chinese National Health Commission has published a series
of free online guides and e-books on COVID-19, which aim to contribute to China's emergency
and security response and to improve the quality and effectiveness of the crisis (Zhou et al.
2020). In addition, telemedicine can reduce the mental health burden of COVID-19 by providing
online mental health services when patients are in quarantine and by sharing information on the
symptoms of burnout, depression and anxiety (Li et al, 2020).
Shaw et al. (2020) explains that telemedicine is thought to have several advantages in
providing allergy and immunology services, such as reducing healthcare professionals' contact
with potentially infected patients and rapid evaluation of COVID-19 infection. In addition to the
traditional methods used to diagnose COVID-19, the study also identified new detection and
classification strategies during the deadly COVID-19 pandemic in Iran. In response to the
shortage of chest radiologists on site during the COVID-19 pandemic, teleradiology and
teleconferencing services are provided through social media massage provided by the Iranian
Radiological Society (ISR) to spread COVID-19 infection (Yang et al. 2020). In addition to
taking measures to protect the health and safety of patients, staff should also use mobile
healthcare technologies to develop staffing and compensation plans for medical services (Yang
et al. 2020).
Zhai et al. (2020) results show that real-time video consulting has great potential for easy
setup to manage COVID-19. Real-time videoconferencing can prevent direct physical contact,
reducing the risk of exposure to respiratory secretions and preventing the spread of possible

16. infections to physicians and other healthcare providers (Zhai et al. 2020). In addition, the live
video is very useful for patients seeking advice about COVID-19, people with high concerns, and
personal discussions about revisions of chronic diseases (such as diabetes and cancer), drug tests,
specifications, and classifications (Richard et al. 2020). Video consultations and telephone
monitoring can be performed to monitor the spread of the COVID-19 epidemic in various
cancers, including lung cancer, endometrial cancer, colorectal cancer, and prostate cancer
(Richard et al. 2020).
According to research from the United States, telephone and “Electronic Health Records
(EHR)” can make it easier to find or treat patients who do not need a personal visit to a doctor
and improve the admissions process (Reeves et al. 2020). Decisions of outpatient care teams in
general and ambulances (Reeves et al. 2020). During the COVID-19 pandemic, telemedicine has
a significant impact on disease prevention and public access to high-risk areas such as hospitals.
In addition, older people can use electronic devices to access health services (Nicol et al. 2020).
Today, fine-tuning the local system through rate changes and service coordination is a major
obstacle to the widespread use of telemedicine in the fight against COVID-19 (Murillo-Cabezas
et al. 2020). Finally, Reeves et al. (2020) hope to make significant progress in preventing and
managing the COVID-19 pandemic by educating healthcare providers and patients in the full use
of telemedicine equipment, re-examining the traditional definition of clinical practice, and using
the platform. Website closed. .
Negative Perceptions of Telehealth
In Imlach et al. (2020) study most patients in this study responded positively to the
sudden switch to telemedicine in general practice during the block from March 2020 to May
2020. Cases were not common in the past (only 17% of people had experience with telemedicine

17. in the past) (Imlach et al. 2020). Many patients appreciate the practicality and effectiveness of
telemedicine and its ability to be "visible" without affecting the infection. However, telemedicine
is not for everyone or for everyone. Compared to the convenience of telemedicine, some people
pay more attention to direct contact with doctors (offering physical examination options if
needed), which is especially important in areas such as palliative care (Chwistek, 2020). The
health of others requires physical examination. The haste or indifference to telemedicine
consultations, along with the fear that others will not see them, makes some aspects of the quality
of telemedicine as high as personal consultations. Despite these differences, most respondents,
regardless of age or other characteristics, are prepared to try telemedicine in the future
(Chwistek, 2020).
Previous telemedicine studies have confirmed that the use of telephone and general
medical care can reduce the number of individual visits (Chwistek, 2020). Telemedicine has
improved access to care and the ability of patients to manage chronic diseases on their own and
has significantly reduced the number of outpatient visits (Richard et al. 2020). Other studies have
shown that patients choose telemedicine for convenience and prefer to see a doctor in person due
to personal preferences or technical barrier (Shaker et al. 2020; Davarpanah et al. 2020). A study
examining the perception of telemedicine by US patients during the COVID-19 pandemic has
shown that both new and old telemedicine users are very satisfied, but new users are more
motivated to avoid waiting rooms and potential infections (Chauhan et al. 2020).
Prior to the COVID-19 pandemic, telemedicine research focused primarily on the
treatment or prevention of chronic diseases and was often conducted on an outpatient basis
(Kang et al. 2020). In this case, telemedicine (mainly video consultation) provides great patient
satisfaction and appropriate health outcomes, but cannot in all cases replace face-to-face care

18. (Kang et al. 2020). Current research supports these findings in the general practice of blocked
telemedicine.
Patients in this study were carefully evaluated to see if telemedicine was appropriate or
inappropriate. Additionally, Chauhan et al. (2020) research is consistent with the clinical view
that remote consultation may not be safe under rare, unknown or unstable conditions or during a
physical examination and will most likely be performed when the patient is situational informed
and communicates effectively with the physician. Patients also approve telemedicine for more
common problems based on recent recommendations. Further studies have also shown that good
telemedicine practice requires supportive clinical relationships and access to the Internet and
related technologies relevant to research experience (Chauhan et al. 2020; Canady, 2020). In the
United Kingdom, the quality of telephone consultations was also very poor due to the short
consultation time and poor communication (Imlach et al. 2020).
Previous research has shown that telemedicine (telephone and video) counselling can
improve access to healthcare and offer services as well as face-to-face visits, but telemedicine is
not yet fully integrated into general medical practice (Imlach et al. 2020). During the initial
period of detention, patients feel heard during consultations with telemedicine, have a good
understanding of what they consider valuable and have the confidence to decide when
telemedicine is needed and when to see themselves in person. A particularly important feature of
successful telemedicine is the establishment of trustworthy relationships between doctors and
patients (Imlach et al. 2020).
For many patients, telemedicine can be as good as or even better than personal care,
especially for patients facing geographical and time constraints. For others, telemedicine is not as
effective as face-to-face meetings, but for respondents, it is essential that participants choose

19. medical services flexibly and optimally (Murillo-Cabezas et al. 2020). Intervention under this
deadlock is an unexpected tool for innovation and change, which has a certain positive impact on
the provision of health care to those who receive health care at this time. The challenge now is to
integrate positive change and integrate it into the overall implementation system (Triana et al.
2020). Telemedicine has always been an important part of managing COVID-19, enabling
remote assessment of people in need of care, and protecting patients and healthcare providers
from unnecessary exposure to the virus. In the future, traditional telemedicine services can
reduce indirect costs for patients, such as travel, unemployment and wasting time and money in
the waiting room (Richards and Scowcroft, 2020). In particular, when telemedicine can be used
to manage a patient's normal or stable health problems on its own, it can improve access to
medical care, which increases the need for personal counselling. As Dawson et al. (2020) study
shows, time will tell whether telemedicine seeds planted during childbirth will thrive in medical
care.
Future Implication
Practical skills for improving the patient's telemedicine experience include, above all,
open and thoughtful communication. For example, in this study, some participants indicated the
expected waiting time for telemedicine consultations; this was a problem and a problem for
employees who booked video calls or other conference calls that day (Kludacz-Alessandri et al.
2021). In practice, therefore, patients must be aware of long delays, realizing that they do not
know when they will "see" when they will keep their distance. Other studies have highlighted the
need to clarify contact details, procedures and expectations, in particular as to the date and
purpose of the meeting, who is present and what to do in case of a technical error or speech
(Richards and Scowcroft, 2020). Other procedural aspects that need to be clarified are the cost of

20. telemedicine and the payment process, whether the patient wants to make an appointment to visit
their regular clinic or accept another available appointment. During a telemedicine consultation,
doctors and patients can set privacy settings and exchange information about where they are
(private or public at home or at the clinic) and who is still there. Information is especially
important when the doctor cannot see the patient before and during phone calls without the usual
visual stimuli.
Patient-centred general practice clinics may also regularly request and record individual
patient preferences for telephone or video consultations and provide telemedicine as needed.
Guidelines for patients and practitioners on how to engage in telemedicine, how to consider the
risks and benefits, and how to ensure the protection of telemedicine (Triana et al. 2020).
Providing active support to patients without technical or cultural skills can increase the skills and
usability of telemedicine (Triana et al. 2020), but specialized resources are needed to support and
ensure the disappearance of patients. Further research is needed to see if telemedicine can reduce
inequalities depending on how differences in technology availability are addressed.
People expect telemedicine to be faster, easier and cheaper for patients. However, this is in
contrast to traditional business models based on downloadable applications, which can promote
more expensive services (face-to-face rather than telemedicine). Greater attention should be paid
to the sources of funding for telemedicine, including the cost of setting up video consultations,
additional payments and the cost of communicating with patients (such as telephone credit and
internet data).

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26. Appendix A: PRISMA Flowchart
PRISMA 2009 Flow Diagram
Records identified through
database searching.
(n = 100)
Screening
Included
Eligibility
Identification
Additional records identified
through other sources (i.e.
snowballing).
(n = 10)
Records after duplicates removed
(n = 90)
Records screened
(n = 50)
Records excluded
(n = 40)
Full-text articles assessed
for eligibility
(n = 4)
Full-textarticlesexcluded,
with reasons
(n = 36)
Studies included in
qualitative and
quantitative synthesis
(n = 4)

27. Appendix B: Data Collection Chart
Retrived Articles
S.No Pro Forma Article 1 Article 2 Article 3 Article 4
1 Reference(s)
Kludacz-Alessandri,
M., Hawrysz, L.,
Korneta, P.,
Gierszewska, G.,
Pomaranik, W. and
Walczak, R., 2021.
The impact of medical
teleconsultations on
general practitioner-
patient
communication during
COVID-19: A case
study from Poland.
Plos one, 16(7),
p.e0254960.
Imlach, F., McKinlay,
E., Middleton, L.,
Kennedy, J., Pledger,
M., Russell, L.,
Churchward, M.,
Cumming, J. and
McBride-Henry, K.,
2020. Telehealth
consultations in
general practice
during a pandemic
lockdown: survey and
interviews on patient
experiences and
preferences. BMC
family practice,
21(1), pp.1-14.
Ramaswamy, A.,
Yu, M., Drangsholt,
S., Ng, E., Culligan,
P.J., Schlegel, P.N.
and Hu, J.C., 2020.
Patient satisfaction
with telemedicine
during the COVID-
19 pandemic:
retrospective cohort
study. Journal of
medical Internet
research, 22(9),
p.e20786.
Shaw, S.E., Seuren,
L.M., Wherton, J.,
Cameron, D.,
Vijayaraghavan, S.,
Morris, J.,
Bhattacharya, S.
and Greenhalgh, T.,
2020. Video
consultations
between patients
and clinicians in
diabetes, cancer,
and heart failure
services: linguistic
ethnographic study
of video-mediated
interaction. Journal
of medical Internet
research, 22(5),
p.e18378.

28. 2 Title
The impact of medical
teleconsultations on
general practitioner-
patient
communication during
COVID-19: A case
study from Poland.
Telehealth
consultations in
general practice
during a pandemic
lockdown: survey and
interviews on patient
experiences and
preferences.
Patient satisfaction
with telemedicine
during the COVID-
19 pandemic:
retrospective cohort
study.
Video consultations
between patients
and clinicians in
diabetes, cancer,
and heart failure
services: linguistic
ethnographic study
of video-mediated
interaction.
3 Author (s)
Kludacz-Alessandri,
M., Hawrysz, L.,
Korneta, P.,
Gierszewska, G.,
Pomaranik, W. and
Walczak, R.,
Imlach, F., McKinlay,
E., Middleton, L.,
Kennedy, J., Pledger,
M., Russell, L.,
Churchward, M.,
Cumming, J. and
McBride-Henry, K.,
Ramaswamy, A.,
Yu, M., Drangsholt,
S., Ng, E., Culligan,
P.J., Schlegel, P.N.
and Hu, J.C.,
Shaw, S.E., Seuren,
L.M., Wherton, J.,
Cameron, D.,
Vijayaraghavan, S.,
Morris, J.,
Bhattacharya, S.
and Greenhalgh, T.
4 Year of Publication 2021 2020 2020 2020
5 Country of Focus Poland None NewYork
6 Source Google Scholar Google Scholar Google Scholar Google Scholar
7 Relevent/Used Chapters 1,2,3 and 4 1, 2, and 4 1, 2, and 4 1, 2, and 4

29. 8 Aim/Research Question
The objective of this
paper is to study
patients’ satisfaction
from teleconsultation
in primary care and
the impact of
teleconsultations on
GP-patient
communication
through the Covid-19
pandemic in Poland.
This research aimed
to explore how
patients accessed
general practice
during lockdown and
evaluate their
experiences with
telehealth, to inform
how telehealth could
be most effectively
used in the future.
This study aimed to
determine if patient
satisfaction differs
between video and
in-person visits.
Using conversation
analysis, this study
aimed to identify
and analyze the
communication
strategies through
which video-
mediated
consultations are
accomplished and
to produce
recommendations
for patients and
clinicians to
improve the
communicative
quality of such
consultations.

30. 10 Research Method (s)
The quality of
teleconsultation and
GP-patient
communication have
been measured using a
questionnaire
regarding the quality
of medical care in a
remote care
conditions. Among 36
items, nine questions
have been related to
the dimension of GP-
patient
communication and
ten to system
experience.
Using a mixed-
method approach, we
undertook an online
survey and in-depth
interviews with adults
(> 18 years) who had
contact with practices
during lockdown,
recruited through
social media and
email lists. We
present descriptive
statistics from the
survey data
(n = 1010) and
qualitative analysis of
interview data
(n = 38) and open-
ended survey
questions, using a
framework of access
to health care, from
the patient’s
perspective.
In this retrospective
observational
cohort study, we
analyzed 38,609
Press Ganey patient
satisfaction survey
outcomes from
clinic encounters
(620 video visits vs
37,989 in-person
visits) at a single-
institution, urban,
quaternary
academic medical
center in New York
City for patients
aged 18 years, from
April 1, 2019, to
March 31, 2020.
Time was
categorized as pre–
COVID-19 and
COVID-19 (before
vs after March 4,
2020). Wilcoxon-
Mann-Whitney tests
and multivariable
linear regression
were used for
hypothesis testing
and statistical
modeling,
respectively.
Conducted an in-
depth analysis of
the clinician-patient
interaction in a
sample of video-
mediated
consultations and a
comparison sample
of face-to-face
consultations drawn
from 4 clinical
settings across 2
trusts (1 community
and 1 acute care) in
the UK National
Health Service. The
video dataset
consisted of 37
recordings of video-
mediated
consultations (with
diabetes, antenatal
diabetes, cancer,
and heart failure
patients), 28
matched audio
recordings of face-
to-face
consultations, and
fieldnotes from
before and after
each consultation.
We also conducted

31. 37 interviews with
staff and 26
interviews with
patients. Using
linguistic
ethnography
(combining analysis
of communication
with an appreciation
of the context in
which it takes
place), we
examined in detail
how video
interaction was
mediated by 2
software platforms
(Skype and
FaceTime).

32. 11 Sample Size 36
survey data
(n = 1010) interview
data (n = 38)
38,609 Press Ganey
patient satisfaction
survey
37 interviews with
staff and 26
interviews with
patients.