Patient Opinions on Telemedicine Visits in Cleft/Craniofacial Multidisciplinary Team Clinic

BACKGROUND & PURPOSE: In the COVID-era, telemedicine has played an increasing role in patient care and many centers have begun to adopt hybrid telemedicine/in-person models for multidisciplinary cleft and craniofacial clinic. It remains unclear how telemedicine may be used to decrease attrition rates in cleft and craniofacial care, where continued follow-up through skeletal maturity is especially important. We surveyed families attending cleft and craniofacial multidisciplinary team clinic to understand barriers to attendance, perceived helpfulness of providers, and desire for telemedicine visits. METHODS/DESCRIPTION: Families attending team clinic between July 2022 - January 2023 were surveyed. We asked about the helpfulness of the overall visit and of individual providers, whether telemedicine would be as informative as an in-person visit, assessed barriers to attendance, distance traveled, and the likelihood of returning if telemedicine were available. We separately analyzed provider-specific responses among families seeking cleft vs. craniosynostosis care. RESULTS: The survey received 179 responses. Respondents hailed from 6 states and median transit length was 1-2 hours. 56% of families believed the team clinic visit would or might be equally informative via telemedicine. 94% of families stated that they were somewhat or extremely likely to attend their next visit in-person. Child’s age was associated with likelihood of attending next visit, with 21% of families of children 12 or older saying they were unlikely or unsure whether they would attend their next visit (p=0.05). 52% of families would be more likely to attend their next visit if telemedicine were available. The most frequently identified specialties which families thought would be equally or more informative via telemedicine were psychology, which 83% of families thought would be at least equally informative, and speech pathology, which 67% thought would be at least equally informative via telemedicine. Barriers to attendance included trouble taking time off work (14%) and transportation difficulty (14%), with cost named as a barrier only in 4% of responses. Patients who named transportation as a barrier to attendance were more likely to attend their next visit if a telemedicine option were available (p=0.02). Having attended a prior telemedicine visit was not associated with either perceived helpfulness of telemedicine, or likelihood of attending subsequent visits if telemedicine were offered (p≥0.65). The majority of families seeking cleft care chose plastic surgery (36%) or speech pathology (29%) as their most helpful provider. Those seeking craniosynostosis care most commonly chose plastic surgery (44%) or psychology (21%) as their most helpful provider. Responses about most-helpful provider were significantly associated with likelihood of return if telemedicine visits were available in the cleft subgroup (p=0.01). Those who named plastic surgery most helpful were more likely to be interested in a telemedicine option than those who chose speech pathology (p=0.04). CONCLUSION: Perceived informative value of telemedicine visits is mixed, however offering telemedicine options may encourage better attendance at multidisciplinary team clinic, especially for families with transportation barriers. Preferences for telemedicine may in part be driven by which providers will be seen during each visit.