Efficacy and Patient Satisfaction of Urological Phone Call Versus WhatsApp Consultation During Covid-19 Lockdown

doi:10.21203/rs.3.rs-4660706/v1

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Efficacy and Patient Satisfaction of Urological Phone Call Versus WhatsApp Consultation During Covid-19 Lockdown

https://doi.org/10.21203/rs.3.rs-4660706/v1

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Background

Telemedicine has evolved as an essential tool for delivering healthcare services, particularly amidst obstacles such as the COVID-19 pandemic. Recent studies have demonstrated good effects and greater patient satisfaction with telemedicine counseling. The purpose of this study is to assess the effectiveness and patient satisfaction of two telemedicine modalities: WhatsApp chat versus phone calls.

Methods

This cross-sectional study was conducted in December 2022 in Madinah, Saudi Arabia, consent forms were obtained, and 10-point scale questionnaires were utilized to determine patient satisfaction. The same measure was also used to assess urologists on their level of confidence in diagnosis. Conventional statistical tests like the t-test and Fisher's exact test were employed in statistical analyses.

Results

77 participants were included in this study, 32 (41.6%) used phone call consultations and 45 (58.4%) chose WhatsApp consultations. Most participants in both groups were male (74.2% and 68.2%; p = 0.616). The mean age was 37.9 ± 17.0 and 32.5 ± 16.2 years for the phone call group and WhatsApp group respectively (p = 0.163). The phone call group expressed significantly higher satisfaction at the time of the consultations compared to WhatsApp users (8.7 vs. 8.0; p = 0.030). However, there was no significant difference between the two groups regarding urologists' confidence in diagnosis (7.7 vs. 7.8; p = 0.935) or satisfaction with follow-up consultations (9.0 vs. 8.7; p = 0.570).

Conclusion

This study revealed no significant differences in patient outcomes or physician confidence in management using phone calls versus WhatsApp chats as a telemedicine modalities, indicating both the patients and healthcare professionals can make good use of both approaches. Notably, patients using phone calls achieved higher satisfaction at the time of consultation and tend to use this modality in urgent situations.

Phone call

telemedicine

covid-19

satisfaction

The concept of telemedicine was first developed in the 1950s, yet during the past 20 years, the digital revolution has completely revolutionized the field.^1,2 According to the WHO, telemedicine is defined as “the delivery of healthcare services, by all healthcare workers using the information and communication technologies for the exchange of dependable data for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and continuing education of healthcare providers, where distance is an important aspect”.³ There are several advantages to telemedicine, such as a lower financial burden on patients' families, better access to healthcare, and more appointment adherence.^3–5 Several measures were taken by governments and nations in response to the COVID-19 pandemic of 2019 to stop the infection from spreading; in Saudi Arabia, lockdown and quarantine were implemented. Following the urology coronavirus recommendations, we applied the concept of telemedicine to our patients, and we prioritized reducing COVID-19 contamination with the best health care possible.

Telemedicine in urology has many advantages, according to recent studies, in terms of results, satisfaction, and cost-effectiveness in comparison to traditional visits.^2,6 Some of the advantages include improved access to care for people in rural areas.

s, reduced travel time and expenses, and improved monitoring of chronic conditions. Telemedicine can also provide a more convenient and comfortable patient experience, leading to higher levels of patient engagement and adherence to treatment plans.⁷ However, there is a lack of evidence comparing telemedicine in urology modalities such as WhatsApp conversations and phone calls, therefore we intend to compare the efficacy and patient satisfaction of these two approaches.

Study Design

After ethical approval. During December 2022, patients who could not visit a private clinic could choose to have a consultation via WhatsApp chat or phone call. The participants gave their informed consent before the consultation and were assured of confidentiality and anonymity. For patients under 18 years old, the researchers collected their history from their parents. The study did not have any age restrictions or exclusion criteria.

Data Collection

The participants who contacted a private urology clinic for a consult were screened by the urologist and informed about the study. Those who agreed to participate had to select either the phone group or the WhatsApp group for consultation. The urologist called the phone group within 24 hours of their request, while the urologist texted the WhatsApp group within 24 hours of their request, asking them to send their medical information via WhatsApp. The urologist recorded the mode of communication, consultation type, demographic characteristics (age, gender, education level), symptoms (chief, secondary, and tertiary complaints), tentative diagnoses (primary and secondary), and treatment recommendations (first and second) after each consultation. The urologist also rated their confidence and satisfaction with the diagnosis on a scale of 1 to 10 after each consultation. The participants rated their satisfaction at the time of consultation on a scale of 1 to 10 after each consultation. They also received a follow-up call or message from the urologist to assess their satisfaction and improvement on a yes or no scale. The data were entered and checked in an Excel spreadsheet.

Outcomes

Patient satisfaction at the time of consultation was the primary outcome measure, measured by a single question on a 10-point scale from very dissatisfied (1) to very satisfied (10). The secondary outcome measures included urologist confidence and satisfaction with the diagnosis, measured by a single question on a 10-point scale from very dissatisfied/low confidence (1) to very satisfied/high confidence (10); patient satisfaction after follow-up, measured by a single question on a 10-point scale from very dissatisfied (1) to very satisfied (10); patient improvement at follow-up, measured by a single question on a yes or no scale; and consultation type, categorized as urgent or elective based on the urologist’s opinion.

Statistical Analysis

The study utilized both descriptive and inferential statistics to analyze the data and evaluate the hypotheses. The demographic and response data of the participants were presented using descriptive statistics, including frequencies, percentages, means, and standard deviations.

. Inferential statistics, namely Fischer’s Exact Test and the Independent Samples t-test, were used to examine the relationships and differences between the variables of interest. Fischer’s Exact Test was used to test the association between categorical variables, such as preference questions. The Independent Samples t-test was used to compare continuous variables, such as satisfaction scores. The normality assumption for the t-test was checked by inspecting the Q-Q Plots. The significance level for all tests was set at p < 0.05, indicating a 95% Confidence Interval. IBM SPSS version 27.0.1 was used for all statistical analyses.

The analysis included 77 participants, 32 (41.6%) in the phone group and 45 (58.4%) in the WhatsApp group for consultation. Most participants in both groups were new patients (90.6% and 82.2%; p = 0.711), male (74.2% and 68.2%; p = 0.616), local residents (81.3% and 71.1%; p = 0.423), and had a bachelor’s degree (60.7% and 59.0%; p = 1.000). The mean age for the phone group was 37.9 ± 17.0 years and for the WhatsApp group was 32.5 ± 16.2 years (p = 0.163). (Table 1)

Table 1

*Sociodemographic characteristics of the participants by consultation group.*
Parameter		Phone	WhatsApp	P value
Parameter		Median (IQR)/Mean ± SD or No. (%)	Median (IQR)/Mean ± SD or No. (%)	P value
Participants		32 (41.6%)	45 (58.4%)
New/Follow-up	New	29 (90.6%)	37 (82.2%)	0.711
	Follow-up	3 (9.4%)	7 (15.6%)
	Opinion	0 (0.0%)	1 (2.2%)
Age		37.9 ± 17	32.5 ± 16.2	0.163
Gender	Male	23 (74.2%)	30 (68.2%)	0.616
Gender	Female	8 (25.8%)	14 (31.8%)	0.616
Location	Local	26 (81.3%)	32 (71.1%)	0.423
Location	Non-local	6 (18.8%)	13 (28.9%)	0.423
Education	Elementary / Intermediate	6 (21.4%)	8 (20.5%)	1.000
	Secondary	4 (14.3%)	7 (17.9%)
	Bachelor	17 (60.7%)	23 (59.0%)
	Doctoral	1 (3.6%)	1 (2.6%)

Phone and WhatsApp users who consulted for LUTS had different main complaints: voiding LUTS (15.6%) and dysuria (15.6%), respectively (p = 0.678). Dysuria was also the most common secondary complaint for both groups (54.5% and 50.0%; p = 0.307). The WhatsApp group reported flank pain as the most frequent tertiary complaint (50.0%). The provisional diagnoses were mostly similar for both groups, with cystitis being the most prevalent (21.9% and 31.1%; p = 0.205). Chronic prostatitis and other diagnoses were also common. The first management recommendations were also comparable for both groups, with antibiotics being the most suggested (43.8% and 38.6%; p = 0.160). Reassurance and advising OPD follow-up were also often provided. The second management recommendation was alpha blockers for both groups (50.0% and 100.0%). However, the statistical test was not applicable due to the low number of cases in some categories. In summary, there were no significant differences in any of the variables between the two groups of consultation. The primary complaints, provisional diagnoses, and first management recommendations were generally similar across the two groups of consultation. (Table 2)

Table 2

*Differences In symptoms, diagnosis, and treatments between the two groups.*
Parameter		Phone	WhatsApp	P value
Parameter		No. (%)	No. (%)	P value
Chief Complaint	SPC Pain	3 (9.4%)	6 (13.3%)	0.678
	Voiding LUTS	5 (15.6%)	4 (8.9%)
	Dysuria	1 (3.1%)	7 (15.6%)
	Storage LUTS	3 (9.4%)	5 (11.1%)
	Flank Pain	4 (12.5%)	3 (6.7%)
	Penile Pain	4 (12.5%)	3 (6.7%)
	Infertility	3 (9.4%)	3 (6.7%)
	Urethral Discharge	3 (9.4%)	2 (4.4%)
	Hematuria	2 (6.3%)	3 (6.7%)
	Erectile Dysfunction (ED)	0 (0.0%)	4 (8.9%)
	Testicular Pain	2 (6.3%)	2 (4.4%)
	Impotence	1 (3.1%)	2 (4.4%)
	Constipation	1 (3.1%)	1 (2.2%)
Secondary Complaint	Dysuria	6 (54.5%)	9 (50.0%)	0.307
	Storage LUTS	2 (18.2%)	7 (38.9%)
	Constipation	1 (9.1%)	0 (0.0%)
	Impotence	0 (0.0%)	1 (5.6%)
	Testicular Pain	1 (9.1%)	0 (0.0%)
	Hematuria	0 (0.0%)	1 (5.6%)
	Voiding LUTS	1 (9.1%)	0 (0.0%)
Tertiary Complaint	Flank Pain	0 (0.0%)	2 (50.0%)	0.657
	Storage LUTS	1 (33.3%)	1 (25.0%)
	Constipation	1 (33.3%)	0 (0.0%)
	Dysuria	1 (33.3%)	0 (0.0%)
	Hematuria	0 (0.0%)	1 (25.0%)
Primary Provisional Diagnosis	Cystitis	7 (21.9%)	14 (31.1%)	0.205
	Chronic Prostatitis	4 (12.5%)	12 (26.7%)
	Other	2 (6.3%)	6 (13.3%)
	Penile Disease	4 (12.5%)	3 (6.7%)
	Infertility	3 (9.4%)	3 (6.7%)
	Urolithiasis	4 (12.5%)	1 (2.2%)
	BPH	3 (9.4%)	1 (2.2%)
	Orchialgia	1 (3.1%)	2 (4.4%)
	Erectile Dysfunction (ED)	1 (3.1%)	2 (4.4%)
	STD	2 (6.3%)	0 (0.0%)
	Torsion	1 (3.1%)	0 (0.0%)
	Constipation	0 (0.0%)	1 (2.2%)
Secondary Provisional Diagnosis	Constipation	2 (66.7%)	0 (0.0%)	0.500
	Infertility	0 (0.0%)	1 (100.0%)
	Urolithiasis	1(33.3%)	0 (0.0%)
First Management Recommendation	Antibiotics	14 (43.8%)	17 (38.6%)	0.160
	Reassurance	4 (12.5%)	12 (27.3%)
	Advise OPD Follow-up Later	3 (9.4%)	10 (22.7%)
	Analgesia	3 (9.4%)	2 (4.5%)
	Alpha Blockers	3 (9.4%)	2 (4.5%)
	Advise ER Visit	3 (9.4%)	1 (2.3%)
	Laxatives	1 (3.1%)	0 (0.0%)
	Anticholinergic	1 (3.1%)	0 (0.0%)
Second Management Recommendation	Alpha Blockers	2 (50.0%)	1 (100.0%)	1.000
	Laxatives	1 (25.0%)	0 (0.0%)
	Analgesia	1 (25.0%)	0 (0.0%)

The mean call time duration for the phone group was 9.3 minutes. Phone users also had higher satisfaction at the time of consultation than WhatsApp users (8.7 vs. 8.0; p = 0.030*)(Fig. 1). Urologist confidence and satisfaction with the diagnosis were similar for both groups (7.7 vs. 7.8; p = 0.935). Satisfaction after follow-up also showed no significant difference between the two groups (9.0 vs. 8.7; p = 0.570). A higher proportion of phone users reported improvement at follow-up than WhatsApp users (70.8% vs. 51.4%), but this difference was not significant (p = 0.181). The consultation type differed significantly between the two groups (p = 0.010*), with phone consultations being more likely to be urgent (59.4%) and WhatsApp consultations being more likely to be elective (71.1%)(Fig. 1). In summary, this report shows that phone users had higher satisfaction at the time of consultation than WhatsApp users, but there were no significant differences in other outcomes between the two groups. However, there was a notable difference in the consultation type, with phone consultations being more urgent and WhatsApp consultations being more elective. (Table 3)

Table 3

*Satisfaction and results of the participants using the two groups of consultation.*
		Phone	WhatsApp	P value
		Median (IQR)/Mean ± SD or No. (%)	Median (IQR)/Mean ± SD or No. (%)	P value
Consult Time Duration (minutes)		9.3 ± 3.8	N/A	-
Patient Satisfaction at Consult Time		8.7 ± 0.9	8.0 ± 2.1	0.030*
Urologist Confidence and Satisfaction with Diagnosis		7.7 ± 1.8	7.8 ± 2.1	0.935
Satisfaction after Follow up		9.0 ± 2.1	8.7 ± 2.5	0.570
Results at Follow-up	Improved	17 (70.8%)	18 (51.4%)	0.181
Results at Follow-up	Same	7 (29.2%)	17 (48.6%)	0.181
Consultation Type	Urgent	19 (59.4%)	13 (28.9%)	0.010*
Consultation Type	Elective	13 (40.6%)	32 (71.1%)	0.010*

Over the last two decades, significant changes occurred in the methods of healthcare delivery, including telehealth methods, firstly it started with video calls and telephone calls followed by chat applications like WhatsApp. Telemedicine is gaining popularity in other fields, such as dermatology, and raising significant interest among both urology patients and physicians. A recent survey of 1,378 urology patients revealed that approximately two-thirds were willing to participate in urological telemedicine.8In terms of patient convenience with telemedicine in urology, a randomized controlled triad found that patients experienced similar levels of face time with providers during video visits (mean 14.5 minutes vs. 14.3 minutes; p = 0.96), patient wait times (18.4 minutes vs. 13.0 minutes; p = 0.20), and total time spent receiving care (17.9 minutes vs. 17.8 minutes; p = 0.97). On the other hand, video visits cut down on the patient's time away from work and save them the expense of travel. Put another way, even though office visits and video visits had comparable clinical outcomes, patients found the video visits to be far more convenient. The video visits were very well received by the study's patients.⁹Convenience, embarrassment, and concerns about low testosterone are among the factors that lead patients, particularly men, to choose telemedicine. As a result, telemedicine has the potential to raise awareness of stigmatized men's health issues, remove physical and psychological barriers to care, and link men to treatments for conditions they might not otherwise seek out.¹⁰ The COVID-19 pandemic is considered a major obstacle to healthcare systems globally, leading in a change to a community-centered strategy rather than patient-centered medical care.

. In the majority of countries, practice has been restricted for many months to urgent operations and non-deferrable cancer surgeries, while other procedures have been largely discouraged, with a propensity to postpone or cancel outpatient appointments.^11,12

In the Kingdom of Saudi Arabia, attitudes regarding telemedicine are generally supportive, particularly in the context of the COVID-19 pandemic. Furthermore, telemedicine use in urology was found to be much greater in the Kingdom of Saudi Arabia (36.15%), the United Arab Emirates (33.3%), and Egypt (10.4%) in a study evaluating the effects of the pandemic on three Arab countries.^13,14

WhatsApp chats proved to be useful during the pandemic, offering an excellent opportunity to assess instances of hematuria from a distance and cutting down on needless expenses for telemedicine-treated hematuria with minor clinical importance. WhatsApp can be especially useful at secondary hospitals where urologists are not always available, as well as in rural places. The main benefits that make WhatsApp effective in clinical practice are both its ease of use and the fact that photo quality is not compromised.¹⁵

Research carried out in the UK examined the following outcomes of phone consultations: evaluation of symptoms, discharge, non-urgent return for examination, follow-up with investigation results, or multidisciplinary team discussion. Overall, 93% of patients gave their consultation an average satisfaction score of 4.7/5, indicating that they were happy with it. Additionally, 83% of patients said they would rather have a phone consultation in the future. Just 10% of respondents said they preferred in-person consultations, while the remaining respondents were unsure.¹⁶

Additionally, a survey-based study measuring the outcomes and experiences of an NHS urological service was conducted on 119 participants. Found that most replies to the adjusted TeSS (Q1–7) were evaluated as ‘Excellent’, ranging from 79 (66%) to 112 (94%). ‘Agree’ responses ranged from 92 (77%) to 117 (98%) for questions (Q8–12), indicating high satisfaction. Patients consulted in post-radical prostatectomy and PSA surveillance clinics offered a significantly increased number of ‘Excellent’ or ‘Agree’ replies. Older age was related to a considerably increased proportion of ‘agree’ responses to one item only. Responses were not affected by gender.¹⁷

Our study shows no significant variations among both groups especially in the gender and educational level as well as type of consultation, implying no significant factors that could affect the preference for WhatsApp chat or phone calls. Moreover, the types of complaints were similar between both groups, interestingly patients with hematuria did not significantly prefer WhatsApp chats to sending pictures. The diagnosis of the patients and the confidence of the urologists in the diagnoses were reported to be statistically similar between both groups, indicating no special preferences adopted by the urologists. Patients with phone calls were more satisfied than patients with WhatsApp chats, this could be due to several factors including verbal barriers and lack of emotional support. Patients with urgent presentations preferred phone calls than WhatsApp chats, which in turn suggests that the verbal communication barriers and lack of emotional support could affect the preferences of the patients.

Our study indicates that there are no significant differences between the two groups, particularly in age, gender, level of education, and kind of consultation, suggesting that there are no significant factors that could influence a preference for phone calls or WhatsApp chats. Furthermore, the complaints between the two groups were similar. It's interesting to note that patients with hematuria did not substantially prefer sending images over WhatsApp talks. There was no discernible difference in the urologists' choices between the two groups based on the statistical analysis of the patient diagnoses and their confidence in those findings. Patients who had phone conversations reported higher levels of satisfaction than those who had WhatsApp chats. This difference in satisfaction could be attributed to several reasons, such as emotional support and verbal obstacles. Patients who had urgent appointments favored phone calls over WhatsApp chats, which implies that emotional support and verbal communication obstacles may have an impact on the patient's preferences. Additionally, patients who required urgent appointments may have felt a greater need for immediate and direct communication with their healthcare provider. This suggests that the mode of communication can significantly influence patient satisfaction and their overall experience with their medical care.

Limitations and recommendations

Our study has several limitations. Firstly, we did not assess the reasons for preferring WhatsApp chats or phone calls. Furthermore, we did not measure the factors that could affect the level of satisfaction with WhatsApp versus phone calls. We recommend further research on the patients’ experience with telemedicine in urology to enhance patient care.

Our experience with telemedicine in urology yielded promising results, with no significant differences in outcomes between WhatsApp chats and phone calls, while phone calls surpassed WhatsApp chats in terms of patient satisfaction during consultations.

Ethics approval and consent to participate:

The data was collected during the covid-19 lock down, as a community contribution by physicians, all institutes were in lock down status at that time, verbal consents were obtained in case of a phone call and text consent in case of whats up consultation.

Consent for publication:

To be submitted upon request.

Availability of Data and materials:

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests:

The authors declare that they have no competing interests

Funding:

The authors declare that they didn’t receive any funding for this study.

Author’s contribution:

MA contribute in study design, data collection, and writing the paper.

SA contribute in writing the paper.

AB contribute in data collection and revision.

MG analyzed the data and contributed in writing the paper

ER AB contribute in data collection and revision.

Acknowledgments:

Not applicable

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No competing interests reported.

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Efficacy and Patient Satisfaction of Urological Phone Call Versus WhatsApp Consultation During Covid-19 Lockdown

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Abstract

Background

Methods

Results

Conclusion

Figures

INTRODUCTION

METHODS

Study Design

Data Collection

Outcomes

Statistical Analysis

RESULTS

DISCUSSION

Limitations and recommendations

CONCLUSION

Declarations

References

Additional Declarations

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