Hospital Topics

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/vhos20

Healthcare Delivery through Telemedicine during

the COVID-19 Pandemic: Case Study from a
Tertiary Care Center in South India

Brayal D’Souza , Shreyas Suresh Rao , Sayed Hisham , Avinash Shetty ,

Varalakshmi Chandra Sekaran , Mamatha Channappa Pallagatte , Somu G &
Tejas Suresh Rao

To cite this article: Brayal D’Souza , Shreyas Suresh Rao , Sayed Hisham , Avinash Shetty ,
Varalakshmi Chandra Sekaran , Mamatha Channappa Pallagatte , Somu G & Tejas Suresh Rao
(2021): Healthcare Delivery through Telemedicine during the COVID-19 Pandemic: Case Study
from a Tertiary Care Center in South India, Hospital Topics, DOI: 10.1080/00185868.2021.1875277

To link to this article: https://doi.org/10.1080/00185868.2021.1875277

Published online: 02 Feb 2021.

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HOSPITAL TOPICS
https://doi.org/10.1080/00185868.2021.1875277

RESEARCH ARTICLE

Healthcare Delivery through Telemedicine during the COVID-19 Pandemic:

Case Study from a Tertiary Care Center in South India
Brayal D’Souzaa , Shreyas Suresh Raob , Sayed Hishamc , Avinash Shettyd , Varalakshmi Chandra
Sekarane , Mamatha Channappa Pallagattef , Somu Gg , and Tejas Suresh Raoh
a
Prasanna School of Public Health, MAHE, Manipal, India; bDepartment of Computer Science & Engineering, Sahyadri College of
Engineering and Management, Mangalore, India; cBaby Memorial Hospital, Kerala, India; dKasturba Medical College, MAHE, Manipal,
India; eMelaka Manipal Medical College, MAHE, Manipal, India; fDepartment of Management Studies, Indian Institute of Science,
Bangalore, India; gDepartment of Hospital Administration, KMC Manipal, MAHE, Manipal, India; hColumbia Asia, Bangalore, India

ABSTRACT KEYWORDS
The Coronavirus disease 2019 (COVID-19) pandemic has necessitated medical centers across the Telemedicine; telehealth;
world to deliver healthcare through telemedicine. We discuss the adoption, delivery of telemedi- COVID-19; pandemic;
cine services at a tertiary care center and patient satisfaction involving 456 patients in south patient satisfaction
India. Most respondents had sought telemedicine care at the department of Medicine (16.23%).
The maximum satisfaction was reported by patients in OBG (100%). The responses were gener-
ally positive across all the age groups. The paper offers insights on best practices adopted at the
center, lessons learnt, and provides recommendations for health care systems offering telemedi-
cine during COVID-19 times.

Introduction The application of telemedicine was cited by

The World Health Organization declared
COVID-19 as a pandemic on March 11, 2020,
followed by an unprecedented global increase of
the disease in recent times (World Health
Organization 2020). The impact of the pandemic
has been felt across all sectors, especially burden-
ing the already frail health systems in many parts
of the developing world. While recognizing the
need to cater to those affected by the pandemic,
the need for re-imagining health care delivery to
the larger masses loomed large. The need of tele-
health in its broader scope and telemedicine in
particular to cater to the needs of clinical patients
was recognized by several Governments (Board
of Governors 2020; Song, Liu, and Wang 2020)
and is emerging as a key technological innovation
with a view to evolve into a system that is largely
sustainable. The attractiveness of healthcare deliv-
ery through telemedicine lies in its accessibility
and affordability while adhering to social distanc-
ing norms, especially for those who are vulner-
able while at the same time are in need of urgent
care (Venkatesh et al. 2019).
Song, Liu, and Wang (2020) as a useful platform
in extending health services at Shandong, China.
Findings reported by Venkatesh et al. (2019)
among patients from USA, seeking gastroenter-
ology care, found that it reduced “unnecessary
visits and procedures” and more than three-quar-
ters, i.e., 84% of patients were satisfied with the
care provided. The use of telemedicine in the
Indian context is cited sporadically at best in lit-
erature; however, several authors have contrib-
uted to the debate on its application in recent
months (Ateriya et al. 2018; Chellaiyan,
Nirupama, and Taneja 2019). The Board of
Governors (In supersession of the Medical
Council of India) in March 2020 released a report
citing the applications of telemedicine in the
Indian context (Board of Governors 2020).
Given the recent surge in COVID-19 cases
across several nations, telemedicine, it appears, is
not just an optional alternative but may well
become an essential and highly desirable alterna-
tive that is worth serious attention. Per a survey
among 500 respondents in USA by the Sage

CONTACT Varalakshmi Chandra Sekaran varalakshmi.cs@manipal.edu Melaka Manipal Medical College, MAHE, Manipal, India
ß 2021 Taylor & Francis Group, LLC
2 B. D’SOUZA ET AL.
Growth Partner and Black Book Market
Research, 59% reported that they would prefer
telemedicine now than in previous years (Sage
Growth/Blackbook Research 2020) with substan-
tial market value in excess of $175.5B by the year
2026 (Global Market Insights 2020). In light of
these findings, it is imperative that patient needs
are met to their satisfaction. The provision of
telemedicine at our tertiary healthcare center has
been initiated since April 2020 and data on pat-
terns of accessing care as well as satisfaction
toward services obtained are the focus of this
study. The rest of the paper is organized as fol-
lows: Review of literature on practice of telemedi-
cine during the COVID-19 pandemic, the
telemedicine process followed at the tertiary care
center under study, -a case study on the tele-
medicine practice followed at the center through
a patient survey and discussion on -the best prac-
tices and lessons learnt, and lastly, we conclude
the paper and provide limitations of the cur-
rent work.
Healthcare systems have adopted virtual-care
platforms such as telemedicine to deliver health-
care effectively during the COVID-19 pandemic
(Sherwin et al. 2020). Recent studies indicate that
telemedicine is employed in multiple specialities
such as medicine (Nouri, Khoong, and Lyles
2020; Santos-Peyret et al. 2020), urology (Boehm
et al. 2020; Borchert et al. 2020), dermatology
(Marasca et al. 2020), ophthalmology (Saleem
et al. 2020), pediatrics (Garg et al. 2020), neuro-
surgery (Blue et al. 2020) and dentistry (Giudice
et al. 2020) to deliver patient care. The use of
telemedicine, particularly mobile telemedicine,
proved to be a viable patient-care solution in
chronic disease management (Marasca et al.
2020; Nouri, Khoong, and Lyles 2020).
Especially for patients suffering from chronic
inflammatory skin diseases, consultation via tele-
medicine helped increase adherence to treatment
and improved overall quality of life (Marasca
et al. 2020). In order to address the inequity in
using telemedicine for chronic disease manage-
ment, Nouri et al. proposed two actions namely:
(a) explore potential disparities in telemedicine
access; (b) develop solutions to mitigate barriers
to digital literacy and advocate policies and infra-
structure that facilitate equitable telemedicine
access (Nouri, Khoong, and Lyles 2020). The
applications of telemedicine under various
departments with high in-flow of patients includ-
ing Neurology, Urology, Ophthalmology,
Dentistry, and Orthopedics are discussed further.
The neurosurgery department at Penn
Medicine observed that an accurate and compre-
hensive neurological examination can be con-
ducted through the telemedicine platform, despite
minor weaknesses inherent to the absence of
physical presence. Neurosurgical visits such as
postoperative checks, vascular pathology, and
brain tumors inherently lend themselves to easier
evaluation through telehealth visits (Blue et al.
2020). A three pathway method comprising of
“Standard,” “Telemedicine,” or “High-Risk” was
adopted in a urology service department
(Borchert et al. 2020). Standard consultations
were provided for non COVID-19 patients, High-
Risk consultations for COVID-19 positive/sus-
pected patients, and telemedicine consultations
for low-acuity urologic issues in either group of
patients. This novel triage pathway helped man-
age urology consultation and resulted in no
COVID infection spread among medical staff of
the department (Borchert et al. 2020).
A review of e-health tools to overcome the gap
in epilepsy care during COVID-19 revealed that
healthcare systems used several tools such as
online platforms, mobile applications, video con-
ferences, epileptic seizure capture systems, phone
calls, tele-encephalography and text messages to
capture the medical data from patients that aids
in prognosis; however, the study concluded that
there was insufficient literature to arrive at a
definitive conclusion on the effectiveness of these
platforms in epilepsy care (Santos-Peyret et al.
2020). The following factors compel ophthalmol-
ogists to consider virtualizing services viz., patient
and provider interest in telemedicine, the relax-
ation of regulatory restrictions, increased remote
care reimbursement, and ongoing social distanc-
ing practices (Saleem et al. 2020). The same argu-
ment holds good for urologists too, as an
evaluation of the suitability of telemedicine in
urology recommended that a large proportion of
urology patients (84.7%) were willing to be
scheduled for telemedical appointments, due to

contact-free continuity in care (Boehm
et al. 2020).
A pilot study conducted to determine the suit-
ability of teledentistry for patients during the
COVID-19 pandemic concluded that teledentistry
is effective in monitoring the patients’ dentistry
ailments while reducing costs, limiting human
contact, and decreasing the risk of COVID-19
dissemination (Giudice et al. 2020). For the
effective management of “total joint arthroplasty”
in patients through telemedicine, the following
best practices are suggested: (a) patient education;
(b) practice logistics; (c) technological considera-
tions; and (d) regular monitoring of patient
health information, all of which are necessary to
provide care remotely for patients (Giudice et al.
2020; Rao et al. 2020).
This review is in no wise exhaustive as the
applications and utility of telemedicine continues
to evolve and add to our learning. However, the
review attempts to highlight recent work carried
out in telemedicine during the COVID-19 pan-
demic. Furthermore, the study focuses on gaining
understanding over the utility and acceptability
of healthcare delivery through telemedicine in the
context of a pandemic, from a patient
perspective.
Materials and Methods
Telemedicine Process
In the tertiary care center under study, most of
the departments offering clinical services such as
departments of General Medicine, Pediatrics,
Endocrinology, Orthopedics, Obstetrics and
Gynecology etc., offered consultation via tele-
medicine during the ongoing COVID-19 pan-
demic period.
In order to further understand the perception
of patients receiving telemedicine services in this
study, we have grouped the departments into
Basic (Medicine, Pediatrics, Obstetrics &
Gynecology, Dermatology, Orthopedics, and
General Surgery), Secondary (Gastroenterology,
Psychiatry, Ophthalmology, and Infectious
Diseases), and Tertiary (Neurology,
Endocrinology, Nephrology, Nuclear Medicine,
Cardiology, Neuro Surgery, Pulmonary Medicine,
HOSPITAL TOPICS 3
Urology, Cardiothoracic Surgery, Medical
Oncology, OTO Rhino Laryngology, Pediatric
Surgery, Surgical Oncology, Radiotherapy,
Pediatric, Hematology & Oncology, and Surgical
Gastroenterology), based on the categorization
recommended in the paper (Yip et al. 2003). In
contrast to the basic care, secondary and tertiary
care includes more specialized services that vary
in term, recurrence, and complexity.
For this study, we have considered the time
period from first week of April 2020 till last week
of May 2020. The process of telemedicine-based
consultation, followed at the center is as follows:

The patient requests consultation via the hospital
website or telephony.

The practice clerk/manager collects the hospital
identifier from the patient (if it exists) or creates
a new identifier.

A consultation request form is sent to the
patient to collect details such as type of ailment,
department, name of consultant they wish to
seek services from.

The practice clerk/manager schedules an
appointment under the worklist maintained by
the respective department.

Based on the scheduled worklist, the doctor
picks up the case, provides online consultation
using VOIP telephony/Video Call and subse-
quently updates the consultation notes in
the system.

A consultation record is created for the patient,
wherein diagnosis, medications, report details
are entered and sent as a link to the patient via
SMS, Email and WhatsApp media.
Design
This study employed a retrospective study design.
Measurement: A feedback survey was obtained
using the “Telemedicine Satisfaction ques-
tionnaire” as part of the routine hospital data col-
lection, which was subsequently analyzed. The
“Telemedicine Satisfaction questionnaire” has
proven to be reliable and valid (Statistics Canada
2020). The 14-item questionnaire was sent to all
the patients who undertook telemedicine consult-
ation during the months of April and May 2020
at the tertiary care center.
4 B. D’SOUZA ET AL.

Table 1. Case characteristics.

Type of case (n) %
New case 216 47.37
Follow-up / Review 212 46.49
Report Consultation 28 6.14
Total number of cases 456 100

Table 2. Specialization/Department categories.

Specialization categories (n) %
Basic 203 44.7
Dermatology 29 6.4
General surgery 10 2.2
Medicine 74 16.2
Obstetrics and gynecology 32 7
Orthopedics 24 5.3
Figure 1. Age frequency graph. Pediatrics 34 7.5
Secondary 55 12
Gastroenterology 22 4.8
Procedures Ophthalmology 12 2.6
Psychiatry 21 4.6
Approximately 2000 individuals were contacted Tertiary 198 43.3
via Email, Whatsapp, and SMS media, of whom, Cardiology 23 5
Cardiothoracic surgery 6 1.3
456 participants responded with data on their Endocrinology 32 7
Infectious diseases 7 1.5
experiences. For children, primary caregivers Medical oncology 5 1.1
were contacted and data were obtained. Nephrology 26 5.7
Neuro surgery 14 3.1
Neurology 33 7.2
Nuclear medicine 23 5
Statistical Analysis OTO rhino laryngology 5 1.1
Pediatric hematology and oncology 1 0.2
Descriptive statistics in the form of frequencies Pediatric surgery 2 0.4
Pulmonary medicine 9 2
and percentages were drawn and graphically rep- Radiotherapy 2 0.4
resented using Excel and Matplotlib library Surgical gastroenterology 1 0.2
Surgical oncology 2 0.4
in Python. Urology 7 1.5
Grand total 456 100.0
For inferential statistics, regression analysis
using Ordinal logistic regression was carried out
to describe the relationship between the depend- In any hospital, the departments of Medicine,
ent and independent variables considered in Pediatrics, Endocrinology, Obstetrics &
the study. Gynecology, and Orthopedics are considered as
“Speciality” clinics. They get the maximum load
of patients. Hence, it is not surprising that the
Ethical Considerations same is observed in our center during the
The study was conducted following approval COVID-19 period. In order to conduct meaning-
from the Institutional Ethics Committee of a ter- ful analysis, we have classified the Specializations/
tiary care center (IEC 446/2020). departments into Basic, Secondary, Tertiary serv-
ices, as shown in Table 2. It can be seen that the
maximum cases belonged to Basic group with
Results
44.7%, Secondary group at 12% and Tertiary
A total of 456 patients (22.8%) responded to the group with 43.3% of cases. Because of the lock-
feedback survey, having mean age group of down imposed in the country during April 2020,
43.62 years. The age frequency graph, represented the reportage of COVID-19 infections was less,
in Figure 1, indicates that the data is skewed as per the Ministry of Home Affairs’ (circular
toward both tails, with median of 44 and inter- numbers 2, 4, and 10) (Geifman, Cohen, and
quartile range from 27 to 60. Characteristics of Rubin 2013). This could be one of the several
cases and department where consultation was factors that could have impacted the reduced use
provided, are presented in Tables 1 and 2. of telemedicine services through the Infectious

Figure 2. Age distribution of patients.
Figure 3. Overall satisfaction of patients.
Diseases department. Other factors may include
rampant media and internet related education on
COVID-19 symptoms and precautions, and lack
of knowledge of the general public regarding the
existence of a separate department that is dedi-
cated to and handles only infectious diseases.
Perhaps, some of the cases may be represented
within the cases seeking care from the
Medicine department.
The patients were classified based on age groups
such as “Child (0–14 years)”, “Youth (15–24 years)”,
“Adult (25–64 years)” and “Senior (above 65 years)”
based on the classification mentioned in Shi (2012).
As shown in Figure 2, the maximum respondents
were in the age group 26 to 65 years (58.11%), fol-
lowed by Children between 0 and 14 years (12.06%)
and young adults between the ages 15 and 25 years
(10.75%). There was a sizeable representation from
the Above-65 age group (19.08%) as well.
The questionnaire was assessed for patient sat-
isfaction using a Likert scale ranging from
HOSPITAL TOPICS 5
“Strongly disagree” to “Strongly agree” to indicate
their degree of satisfaction with the services
obtained. As depicted in Figure 3, a majority
(95.39%) of patients were satisfied with the con-
sultation rendered through telemedicine during
the COVID-19 pandemic. As shown in Table 3,
the maximum satisfaction of about 42.54% was
reported by patients consulting for Primary/basic
departments of Medicine, OBG, Pediatrics, and
Dermatology, followed by Tertiary services with a
satisfaction level of 39.91% from the departments
of Cardiology, Endocrinology, Nephrology,
Neurology, Nuclear Medicine, etc. Departments
categorized under Secondary services showed
12.94% patient satisfaction level.
Patients in Infectious Diseases (71.42%) and
Neurosurgery (78.57%) expressed least satisfaction
with telemedicine. Since the number of departments
offering consultation via telemedicine was huge, we
filtered only the departments constituting at least 5%
of overall count of responses and the same is
depicted in Figure 4. While most respondents tend
to lean toward positive perception of telemedicine,
the responses “strongly agree” to “agree” seemed to
remain more or less the same between participants
across various departments, except for Nephrology.
The respondents who consulted with “Nephrology”
seemed to be significantly less satisfied than other
departments in comparison, as depicted in the
trend chart.
The responses were generally positive across all
the age groups. Table 4 shows that the age
groups most satisfied (“Agree” and “Strongly
6 B. D’SOUZA ET AL.

Table 3. Specialization/Department categories vs patient satisfaction levels.

Department category Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Grand total
Basic 20.83% 21.71% 1.54% 0.44% 0.00% 44.52%
Secondary 6.58% 6.36% 0.66% 0.00% 0.00% 13.60%
Tertiary 20.18% 19.74% 1.54% 0.44% 0.00% 41.89%
Grand total 47.59% 47.81% 3.73% 0.88% 0.00% 100.00%

Figure 4. Trends in patient satisfaction over the departments consulted.

Table 4. Age vs satisfaction level.

Satisfaction level Over 65 years 26 to 65 years 15 to 25 years 0 to 14 years
Strongly disagree 1% 0% 0% 0%
Disagree 0% 0% 0% 0%
Neither agree nor disagree 1% 2% 0% 0%
Agree 10% 26% 5% 7%
Strongly agree 7% 30% 6% 5%
Total 19.08% 58.11% 10.75% 12.06%

Table 5. Tests of model effects.

Omnibus testa
Likelihood ratio chi-square Df Sig.
11.638 2 .003
Tests of model effects
Source Type III
Likelihood ratio chi-square Df Sig.
Age category 8.440 1 .004
Speciality category number 4.493 1 .034
Dependent Variable: Overall, I am satisfied with the quality of service being provided via telemedicine.
Model: (Threshold), Age Category, Speciality Category Number.
a
Compares the fitted model against the thresholds-only model.

Agree” responses) with telemedicine were Children
(100%), Young Adults (100%) and Adults (100%).
Primary caregivers provided the data for the children
age group. Most of these respondents consulted
Pediatrics and Medicine departments. The age
groups that were fairly happy with telemedicine-
based consultation (“Neither Agree nor Disagree,”
“Disagree” responses) include Adults (97.82%), and
Seniors (93.33%).
Ordinal logistic regression was carried out
between level of patients’ satisfaction (dependent
variable) against “Age Category” and “Specialization
Category” (independent variables), with the hypoth-
esis that: “The different Age groups and
Specializations have no significant impact on the
patient satisfaction level for telemedicine services”.
Table 5 depicts the tests of model effects with
Chi-square likelihood ratio ¼ 11.638 and a p-

Table 6. Parameter estimates for the generalized ordinal logistic regression model.
Parameter estimates
95% Wald
confidence interval
Std.
Parameter B error Lower Upper
Age category 0.308 0.1067 0.517 0.099
Speciality category 0.212 0.1001 0.015 0.408
(Scale) 1a
Dependent Variable: Overall, I am satisfied with the quality of service being provided via telemedicine.
Model: (Threshold), Age Category, Speciality Category Number.
a
Fixed at the displayed value.
value ¼ 0.003 which is less than 0.05, which
further rejects the Null Hypothesis and confirms
that there is significant difference in the
perception of “Satisfaction level” for different age
and specialization categories.
Table 6 provides information on the extent to
which Age groups and specialization categories
influence the Satisfaction level, i.e., Exp(B) of Age
Category ¼ 0.735, suggests that the increase in the
age category value has a decreasing probability on
the overall satisfaction, and, Exp(B) of Specialization
Category ¼ 1.236, suggests an increasing probability
on the overall satisfaction with higher specialization
categories, which are Secondary and Tertiary spe-
cialization categories considered in this study. The
possible reason for this inference could be that, dur-
ing the lockdown period, access to Neurology,
Endocrinology, Cardiology, Psychiatry, Nephrology
departments was more difficult than Basic special-
ization departments such as dermatology, general
surgery, medicine, etc. Hence the availability of
such services through telemedicine services resulted
in higher satisfaction levels.
Discussion
In accordance with the Sage Growth Partner and
Black Book Market Research findings (Sage
Growth/Blackbook Research 2020), a majority
(94.73%) of the respondents expressed satisfac-
tion with telemedicine services provided by the
center and 94.51% responded that they will con-
tinue to use telemedicine facility even after the
pandemic is over. Literature suggests that mobile
telemedicine (particularly WhatsApp) is a viable
option for patient care during COVID-19 pan-
demic (Statista 2018; Nouri, Khoong, and Lyles
2020). In congruence with these observations,
90.35% of the patients felt comfortable using
HOSPITAL TOPICS 7
95% Wald confidence
Hypothesis test interval for Exp(B)
Wald chi-square df Sig. Exp(B) Lower Upper
8.348 1 0.004 0.735 0.596 0.906
4.466 1 0.035 1.236 1.015 1.504
mobile telemedicine and did not need any assist-
ance during consultation.
For the Neurosurgery consultation, 100% of
the respondents were follow-up cases (postopera-
tive checks and reports). A total of 85.71%
respondents expressed satisfaction with telemedi-
cine consultancy, in line with Blue et al.’s (Blue
et al. 2020) findings that telemedicine offers a
supportive platform for neurosurgery consult-
ation despite minor weaknesses inherent to the
absence of physical presence.
In the following, we discuss the responses to
two specific questions (out of 14-set question-
naire) where the respondents were dissatisfied
with the telemedicine service.
1. Question: “I can see my health-care provider
as if we met in person”.
Response: In response to this question, 13.37%
patients showed dissatisfaction that their experi-
ence was not as good as meeting the doctor in
person. Majority of the patients consulted were
from Medicine (30%) and Dermatology (11.67%)
departments. It is interesting that 45% of those
patients consulting medicine department were
aged above 60 years, and numerous research has
shown that they prefer meeting the doctor in per-
son, rather than online. In Dermatology, 86%
were fresh cases (like psoriasis), hence they would
have liked to meet the doctor in person for treat-
ment. This argument is in congruence with the
observation made in Marasca et al. (2020) where
the authors state that patients could be dissatis-
fied while consulting for fresh cases in inflamma-
tory skin conditions; however, the approach is
beneficial for follow-up cases.
2. Question: “I do not need assistance while
using the Telemedicine Service.”
Response: 41% of the patients who responded
they needed assistance during telemedicine
8 B. D’SOUZA ET AL.
service were 60þ years in age. 45.45% of the
patients were for follow-up; 6.8% were for con-
sultation regarding reports; and rest 47.75% were
for fresh consultation. Majority of the consulta-
tions were to the departments of Medicine
(36.36%) and Neurology (11.36%). The center
adhered to all the current guidelines on telemedi-
cine, recommended by the Board of Governors
(In supersession of the Medical Council of India)
(Board of Governors 2020). Furthermore, the
center followed ethical practices in telemedicine,
and obtained due approval from Institutional
Ethics Committee (IEC 446/2020) and registered
the study with the Clinical Trials Registry - India
(CTRI) as required by the IEC. The aforemen-
tioned points can be considered as best practices
followed at the center.
The following suggestions/recommendations
were provided by the patients to improve the
telemedicine facility at the center:

Solicit quick response from the doctors. In some
cases, the doctors did not call for 10 days after
the appointment was scheduled.

While scheduling appointment with doctors, not
only date but also time should be specified.
Conclusion
Healthcare delivery through telemedicine is
emerging as a key technological innovation dur-
ing the COVID-19 pandemic. Telemedicine pro-
vides an affordable alternative to patients, which
can be availed in the comfort of their homes.
The paper discusses a case study on the imple-
mentation of telemedicine in a tertiary care cen-
ter in India. A patient satisfaction survey was
conducted to evaluate the utility of the telemedi-
cine service. Overall, 94.73% of the patients
expressed satisfaction with the services offered via
telemedicine. Among the dissatisfied were
patients above the age of 60 years (they prefer
meeting the doctor in-person and are less techno-
logically savvy) and patients consulting
Dermatology department. The recommendation
is to introduce conferencing facility in telemedi-
cine, where the patients can consult multiple spe-
cialists at the same time.
Some of the limitations of our study are
as follows:

The data was collected through an online survey
following the telemedicine consultation. Low
technological literacy and difficulties with inter-
net services are a reality in the Indian context.
These factors, along with the fact that a sizeable
proportion of the patients who sought care
belonged to the older age group, who may have
been less inclined to provide data, may have
contributed to the lower response rate.

This study was undertaken in a political/
legislative/public health situation where social
distancing is the norm, and public gathering as
well as physical contact is generally discouraged.
This change in health service delivery, that may
or may not be temporary, could have affected
the responses of the participants, as is reflected
in the more positive responses towards
telemedicine, in comparison to other recent
studies referred in the paper.

The inference on overall satisfaction of
telemedicine services is drawn from the cross-
sectional data that was collected during the
lockdown days of COVID-19, first week of
April, 2020 till the end of May, 2020, in India,
when health care services were highly difficult
to obtain due to the challenges considering the
social distancing norms and rapid spread of the
disease among people. Thus, a longitudinal
study considering sample data throughout the
COVID-19 affected duration (March, 2020
till vaccine is made available to general public)
might give us more statistical inferences
with respect to the perception of satisfaction
of telemedicine services by different Age
groups across various specialization categories.
Acknowledgement
The authors would like to acknowledge the support pro-
vided by Mr. Sachin Karanth and team, Marketing
Department, Kasturba Hospital, Manipal.
Disclosure statement
No potential conflict of interest.

ORCID
Brayal D’Souza http://orcid.org/0000-0002-8153-9694
Shreyas Suresh Rao http://orcid.org/0000-0003-
2191-1754
Sayed Hisham http://orcid.org/0000-0002-2806-4159
Avinash Shetty http://orcid.org/0000-0003-3152-6956
Varalakshmi Chandra Sekaran http://orcid.org/0000-
0003-3319-3075
Mamatha Channappa Pallagatte http://orcid.org/0000-
0002-2716-0173
Somu G http://orcid.org/0000-0003-3969-5121
Tejas Suresh Rao http://orcid.org/0000-0002-9457-8852
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