From satisfaction to referrals: the dual impact of telemedicine on vascular patients

Abstract

Background

While telemedicine is gaining traction for patients managing peripheral vascular disease, more investigation is warranted to truly understand its impact. This study set out to pinpoint the shortcomings of current telemedicine applications for individuals with these conditions.

Methods

We conducted a longitudinal observational study, analyzing data from 1,096 peripheral vascular disease patients who participated in telemedicine between August 2013 and August 2023. Key metrics included consultation duration, diagnosis, physician involvement, post-treatment outcomes, and patient satisfaction.

Results

Telemedicine adoption has risen consistently over the years, alongside an upward trend in two-way referral rates. From 2013 to 2023: the number of patients referred for further diagnostics and treatment at outpatient clinics shot up from 6.38% to 12.50%; those sent to the emergency department doubled from 8.51% to 25.00%; and those admitted to the inpatient department increased from 4.26% to 13.69%. No statistically significant variation was found in outcomes across different vascular conditions. However, patient satisfaction differed notably based on physician seniority. Chief physicians received significantly higher “very satisfied” ratings (89.80%) compared to attending physicians (z= -2.874, p = 0.004), while dissatisfaction ratings also showed meaningful divergence (z= -2.763, p = 0.006). There were 89.80% of patients expressing great satisfaction with the chief physician’s consultation.

Conclusions

As telemedicine gains traction, referral rates continue to climb, underscoring its expanding role in patient care. The involvement of senior specialists proves critical not only for boosting referral efficiency but also for enhancing patient satisfaction. Leadership engagement remains a key driver in optimizing these outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-13680-y.

Introduction

Peripheral vascular disease encompasses disorders affecting the blood vessels in the extremities, primarily involving arterial and venous conditions [1]. As populations age, lifestyles shift, and chronic illnesses become more prevalent, cases of these circulatory disorders have risen steadily [2]. For example, more than 200 million individuals currently live with peripheral artery disease alone, with patient numbers continuing to climb [3]. This concerning trend has elevated vascular health to a critical public health priority [4]. The surge in vascular disease cases, coupled with uneven distribution of medical resources and a rise in complex vascular emergencies, has placed extraordinary strain on frontline healthcare providers [5]. Fortunately, advances in telemedicine have begun to ease some of this burden, offering new ways to manage patient care more effectively.

Telemedicine leverages digital communication and information technology to deliver healthcare services remotely [6]. Studies have demonstrated its effectiveness in reducing hospital readmissions and facilitating remote patient monitoring [7]. For instance, research on varicose vein patients using telemedicine revealed a high level of satisfaction compared to traditional in-person care [4]. Primarily amidst the COVID-19 crisis, telemedicine significantly contributed to diagnosing and managing vascular disorders [8, 9]. Given China’s expansive geography, top-tier medical resources are largely centralized in major urban hubs like Beijing, Shanghai, and Guangzhou. The hospital conducting this study is a large comprehensive hospital in southwestern China, and also a national center for handling complex and critical cases in western China. The hospital began laying the groundwork for telemedicine services in 2001. Since then, we’ve provided telemedicine support for over 50,000 complex cases in community hospitals.

Offering telemedicine services to individuals with peripheral vascular issues is key in ensuring that those at the local level can receive prompt healthcare [10]. Through remote video consultation, doctors can have face-to-face conversations with patients. The doctors can combine methods such as inquiring about medical history, reviewing patient examination reports, and guiding doctors from the patient’s hospital to conduct on-site physical examinations to diagnose and treat patients. Many of these patients are dealing with complicated and severe conditions. Telemedicine allows for swift referrals and, depending on their status, patients can be swiftly rerouted to the necessary emergency, outpatient, or inpatient care within the consulting hospital for continued treatment [11, 12]. More studies and investigations are needed to assess the effectiveness of these treatments and whether they are actually delivering results. Additionally, incorporating nurses into telemedicine can bolster patient involvement and enhance their satisfaction levels [13, 14]. Consequently, this research endeavors to examine the data of telemedicine patients with peripheral vascular diseases from 2013 to 2023, shedding light on the distribution and outcomes of these conditions, and offering guidance for more refined telemedicine approaches to peripheral vascular illnesses.

Methods

Design and setting

This research is a long-term, observational study. We gathered data on patients who received diagnosis and treatment assessments via telemedicine from August 2013 to August 2023. In telemedicine, patients first undergo an initial diagnosis at a local hospital and then receive further treatment through our remote consultation. Patients are evaluated in a digital clinic via secure, two-way video calls. Doctors diagnose and treat their conditions by examining their medical history, test results, and by asking them about their symptoms. Nurses offer patients valuable health advice, including medication instructions, dietary tips, and self-care practices. Should a patient require admission to the inpatient unit for more extensive care, the nurse is responsible for coordinating the hospital transfer and ensuring a smooth admission process. The telemedicine service utilizes high-tech video conferencing that is fully compliant with security standards. It requires an operating system of Windows 10, either 32-bit or 64-bit, a central processing unit (CPU) of at least an Intel i7 quad-core 3.0 GHz, a high-definition Universal Serial Bus (USB) camera, and an omnidirectional microphone.

Patients population

Our study focuses on individuals diagnosed with vascular disorders. Partner hospitals within our research network submit teleconsultation requests, which are promptly initiated upon approval. These affiliated hospitals represent specialized medical institutions that collaborate with community healthcare facilities across various tiers. Through digital health platforms, they deliver remote diagnostic support and expert consultations for complex cases, particularly in challenging medical conditions.

Data collection

With the study’s aims clarified and verbal consent secured from each patient, we proceeded to gather data. This encompassed patient referral sources, consultation duration, diagnoses, involved physicians, and the results observed following the telemedicine intervention. After the consultation, nurses conduct anonymous satisfaction surveys which was developed for this study (supplementary file) on patients or their families. Responses of satisfaction were categorized into one of four tiers: “very satisfied,” “satisfied,” “dissatisfied,” and “very dissatisfied,” allowing patients or their families to select the option that best reflected their overall sentiment.

Data analysis

The research team organized and processed all data in Microsoft Excel 2016 before conducting statistical analysis with IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY). We characterized physician qualifications and consultation results through frequency distributions and proportional breakdowns. To assess variations in treatment outcomes across vascular conditions, we employed chi-square testing. Patient satisfaction levels following consultations with specialists of varying ranks were compared using Wilcoxon-Mann-Whitney nonparametric tests. Throughout our analysis, results achieving p-values below 0.05 were considered statistically significant.

Result

Regional distribution of patients

The research involved 1096 patients who utilized telemedicine services for peripheral vascular disease between 2013 and 2023, predominantly from 14 Chinese provinces, especially the southwest, as depicted in Fig. 1.

Fig. 1.

Regional distribution of telemedicine patients

Trends in consultation frequency and patient outcomes over time

Since its launch in August 2013, telemedicine services have seen a steady annual increase in consultations. By 2019, the program had expanded to include a full team of chief physicians, with greater involvement from senior clinical leaders (Table 1). Chief physicians, typically senior attending physicians, are primarily responsible for managing departments, engaging in scientific research, and teaching. While attending physician refers to a doctor who has obtained a physician professional qualification certificate, usually has completed basic training, possesses the ability to practice independently, and has begun to develop in a specialized field.

Table 1.

Composition of telemedicine medical teams over the years

Year	Total number of telemedicine	The positions of the doctors participating in telemedicine
		Chief Physician n (%)	Attending Physician n (%)
2013.8–12	47	24(51.06%)	23(48.94%)
2014	56	13(23.21%)	43(76.79%)
2015	68	14(20.59%)	54(79.41%)
2016	85	12(14.12)	73(85.88%)
2017	97	7(7.22%)	90(92.78%)
2018	108	60(55.55%)	48(44.45%)
2019	126	126(100.00%)	0(0.00%)
2020	138	138(100.00%)	0(0.00%)
2021	147	147(100.00%)	0(0.00%)
2022	168	168(100.00%)	0(0.00%)
2023.1-8	56	56(100.00%)	0(0.00%)

Concurrently, the effectiveness of these consultations has improved, with more patients being successfully referred for outpatient, emergency, or inpatient care. Notably, the percentage of cases requiring no further treatment after telemedicine has dropped significantly—from 80.85% in 2013 to 44.64% in 2023 (Fig. 2).

Fig. 2.

Distribution of telemedicine outcomes over the years

Telemedicine outcomes across various vascular conditions

Among patients receiving specialized care, those with aortic aneurysms (11.68%) and aortic dissections (10.13%) were most frequently transferred to emergency departments. In contrast, the majority of individuals with Marfan syndrome or Budd-Chiari syndrome (62.50%) were directed to outpatient clinics for follow-up care. Hospital admissions were most common for vasculitis (11.76%) and vascular malformations (11.11%). Despite these variations, statistical analysis revealed no significant differences in telemedicine outcomes across the different vascular conditions (Table 2).

Table 2.

Differences in telemedicine outcomes for different vascular diseases

Disease diagnosis	Number of telemedicine (percentage)	Transfer to the emergency department (percentage)	Transfer to the outpatient department (percentage)	Transfer to the inpatient department (percentage)	No special treatment (percentage)
Arterial and venous thrombosis and embolism	345(31.48%)	22(6.38%)	81(23.48%)	6(1.74%)	236(68.41%)
Varicose veins and phlebitis	67(6.11%)	0(0.00%)	25(37.31%)	1(1.49%)	41(61.19%)
Vascular atherosclerosis and arteriosclerosis	171(15.60%)	11(6.43%)	56(32.75%)	7(4.09%)	97(56.73%)
Aortic dissection	79(7.21%)	8(10.13%)	11(13.92%)	3(3.80%)	57(72.15%)
aortic aneurysm	214(19.53%)	25(11.68%)	85(39.72%)	18(8.41%)	86(40.19%)
Vascular malformation	54(4.93%)	5(9.26%)	12(22.22%)	6(11.11%)	31(57.41%)
Blood vessel compression or stenosis	108(9.85%)	6(5.56%)	39(36.11%)	5(4.63%)	58(53.70%)
valvular disease	33(3.01%)	2(6.06%)	12(36.36%)	2(6.06%)	17(51.52%)
Vasculitis	17(1.55%)	0(0.00%)	5(29.41%)	2(11.76%)	10(58.82%)
Marfan and Budd Chiari syndrome	8(0.73%)	0(0.00%)	5(62.50%)	0(0.00%)	3(37.50%)
χ²	0.000	2.800	1.200	1.200	0.000
P	1.000	0.903	0.991	0.991	1.000

Patient satisfaction evaluation

Following consultations with doctors holding various professional ranks, nurses conducted patient satisfaction surveys. The results revealed a statistically significant difference in satisfaction levels between chief physicians and attending physicians, specifically when comparing the “very satisfied” and “very dissatisfied” responses. A significant majority of patients (89.80%) reported high satisfaction with their consultation with a chief physician (Table 3).

Table 3.

Patient satisfaction evaluation of telemedicine

Satisfaction evaluation of telemedicine	Chief Physician		Attending Physician		Z	P
	N	%	N	%
Very satisfied	687	89.80%	72	21.75%	-2.874	0.004
Satisfied	72	9.41%	201	60.73%	-0.1	0.921
Dissatisfied	6	0.78%	25	7.55%	-1.409	0.159
Very dissatisfied	0	0.00%	33	9.97%	-2.763	0.006

Discussion

This research delved into the impact of telemedicine, leveraging collaborative efforts among medical staff in treating peripheral vascular diseases, by conducting a decade-long longitudinal observation. Out of the 1096 patients who engaged in telemedicine, a significant chunk—exactly 70.35%— hailed from the southwest quadrant of China. This demographic skew might well correlate with the location of the research hub itself, which is situated in Sichuan Province, the west of the nation. Consequently, the network of affiliated hospitals the research encompasses is predominantly rooted in the southwest. As telemedicine technology continues to evolve and gain traction, it’s high time more establishments in the Northeast got on board to offer medical assistance to a wider array of patients dealing with the complexities and critical phases of peripheral vascular diseases.

Over the last ten years, a review of telemedicine stats for vascular ailments has revealed a shift in patient care pathways. More folks are now being directed to seek emergency, outpatient, or inpatient care post-consultation. For instance, the share of patients being referred to outpatient care has surged from 6.38% in 2013 to a staggering 12.50% in 2022. Similarly, those sent to the ER have soared from 8.51% in 2013 to a whopping 25.00% by 2022. The number of those sent to inpatient care has also jumped, from 4.26% in 2013 to 13.69% in 2022. And for patients referred for hospitalization or emergency treatment, the consulting doctor will notify our hospital to prepare for the admission of vascular patients.This growth is largely due to the advancement and widespread adoption of telemedicine, attracting more and more alliance hospitals and including sicker patients in remote care. These complex cases tend to benefit from more intensive care via referral. Despite this trend, previous research has been scarce on the outcomes of telemedicine for vascular disease management. A survey revealed that the main reasons patients opt for telemedicine include seeking treatment advice (37%), getting details on diagnoses or symptoms (27%), and seeking second opinions (15%) [15]. With the proliferation of telemedicine, patients are increasingly accessing superior care through such referrals. These two-way referrals are crucial for organized referrals and info exchange, ensuring patient safety [16]. Telemedicine allows for a more strategic allocation of offline resources to complex, rare, and critically ill patients, thus redistributing medical resources, broadening treatment services, and facilitating the exchange of patient data. This not only enhances access to care but also tackles the queue issues, slashes transportation costs, and fosters a more seamless inter-regional medical resource sharing experience [10].

Meanwhile, having a full-strength faculty in the telemedicine team has bolstered the success rate of referrals post-telemedicine interactions and satisfaction. Studies reveal that effective telemedicine hinges on insights from frontline leaders and a diverse array of specialists, including digital gurus, senior execs, and even home care consultants [17]. The skills of guidance and a people-centric approach are key to shaping the patient’s telemedicine experience [18]. Our study pinpointed a notable discrepancy in satisfaction scores between chief physicians and attending physicians, particularly when it came to being “very satisfied” versus “very dissatisfied.” The chief physicians’ “very satisfied” ratings soared to a staggering 89.80%, whereas the attending physicians’ rate was a mere 21.75%. Early research suggests that support from frontline leaders is vital for delivering quality digital healthcare, and their backing in fostering staff involvement and ensuring resources is also crucial [19, 20]. Frontline leadership and expert involvement are a win-win for telemedicine’s advancement and boosting patient satisfaction. Additionally, nurses engaged in telemedicine play a dual role—offering expert health advice and enhancing the patient’s experience and overall satisfaction.

Regrettably, time and resource limitations, coupled with ethical considerations, prevented us from gathering fundamental patient demographics like age and gender in this study. Consequently, we couldn’t analyze how these factors might have affected consultation outcomes. Future research should prioritize collecting comprehensive patient data to allow for a more thorough analysis and to explore potential correlations.

Conclusion

Over a span of a decade, this longitudinal study delved into the consultative status and results of patients with peripheral vascular disease who utilized telemedicine services. The research revealed that the adoption and proliferation of telehealth for follow-up visits have resulted in a rising number of consultations annually, with the rate of referrals following these consults also climbing each year. The involvement of top-tier healthcare professionals and leaders is pivotal in boosting these referral rates and enhancing patient satisfaction. We propose incorporating telemedicine for diagnosing and treating vascular conditions, which can broaden medical access for those with primary vascular diseases and better cater to the healthcare requirements of a larger population with vascular issues.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

COVID-19

Coronavirus disease-2019

CPU

Central processing unit

USB

Universal Serial Bus

Author contributions

XXF was responsible for the study conception and design. XXF, JX, and JY performed data collection and data analysis. ZPW supervised the study. XXF was responsible for the drafting of the manuscript. ZPW made critical revisions to the paper.

Funding

This was supported by the Key Research and Development (R&D) Project of Department of Science and Technology of Sichuan Provincial (2023NSFSC0589).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study had been approved by the Biomedical Ethics Review Committee of West China Hospital of Sichuan University (2024 Review No. 1083) and reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement for cross-sectional studies. This research had been performed in accordance with the Declaration of Helsinki. All participants provided verbal informed consent before enrollment, and data confidentiality was strictly upheld throughout the study. The survey instruments were validated and administered by trained personnel to ensure accuracy and consistency in data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.