Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Bethany Rolfe Witham, DNP, FNP-BC
Background and Significance: Migrant and seasonal farmworkers experience many chronic health conditions and are vulnerable to social and structural determinants of health because of their occupations and the rural areas where they work (Corwin et al., 2021). Telemedicine services can expand access to and improve the quality of rural healthcare for this population (Jacobs & Ellis, 2021). However, there is a lack of research on telemedicine's patient satisfaction levels among the agriculture worker population. For this reason, it is imperative to seek new knowledge, a better understanding of patients' experiences, and close the practice gap found between the telemedicine experience and remote/rural onsite clinics.
Problem and Purpose Statement: A telemedicine program was implemented in February 2021 to deliver care to agriculture and food processing workers in Central Washington. The purpose of this project was to assess patient satisfaction and patient experience with telemedicine visits compared to in-person visits.
Methods: The Telemedicine Satisfaction Questionnaire (TSQ) and the Patient Satisfaction Questionnaire (PSQ-18) were distributed in eight clinics in Central Washington between February 1 and April 30, 2022. Project participants included agriculture workers, Temporary Agricultural Employment of Foreign Workers (H-2A) workers, and fruit processing plant workers aged 18 years and older seeking medical care. After the appointment with the healthcare provider, participants who had a telemedicine visit were invited to complete the TSQ and PSQ-18, while participants who had an in-person visit were invited to complete the PSQ-18.
Results/Outcomes: A total of 81 PSQ-18 and 36 TSQ surveys were collected. The results from the PSQ-18 using the Mann-Whitney U test showed an overall statistically significant difference (p-value= 0.003) between patients' satisfaction with in-person compared to telemedicine visits. Patients surveyed were significantly more satisfied with in-person visits in the areas of general satisfaction, accessibility, and convenience. Higher satisfaction with in-person visits was also noted in the categories of technical quality, interpersonal manner, communication, financial aspects, and time spent with the provider, but results were not statistically significant. Results from the TSQ revealed that patients are satisfied to very satisfied with the telemedicine services offered by the organization.
Sustainability: The results of this project are the first step toward providing better telemedicine health services to the agricultural worker population. There are four recommendations for further action by the health organization. First, the health organization should implement the questionnaires at all clinical sites. Second, the implementation phase must be carried out during the busiest agricultural seasons (summer and fall). Third, any future project must originate with the organization's leadership. Fourth, the organization should implement a qualitative and quantitative patient satisfaction survey that is specific to the organization and the population it serves.
Implications for Practice: This project aimed to understand agriculture and food processing workers' satisfaction levels with the telemedicine program. Results of this program evaluation can be used to improve accessibility, communication, quality of care, and overall impressions of the organization. The organization can also use this project as a template or foundation for future studies to measure the patient experience and telemedicine services on a larger scale. This project demonstrates that patient satisfaction surveys are a helpful tool to collect meaningful insight, help identify potential problems, and help springboard future quality improvement projects to overcome the practice gaps among agriculture and food processing workers. Effectively implementing satisfaction surveys and acting on their results will demonstrate the organization’s commitment to patient experience and high-quality care to improve patient outcomes.
Corwin, C., Sinnwell, E., & Culp, K. (2021). A mobile primary care clinic mitigates an early COVID-19 outbreak among migrant farmworkers in Iowa. Journal of Agromedicine, 26(3), 346-351. https://doi.org/10.1080/1059924X.2021.1913272
Jacobs, M., & Ellis, C. (2021). Telemedicine disparities during COVID-19: Provider offering and individual technology availability. Journal of the American Geriatrics Society, 69(9), 2432-2434. https://doi.org/10.1111/jgs.17280
Franco-Lara, Rodrigo, "Comparing Patients’ Satisfaction with Telemedicine Visits to In-person Visits at Central Washington Onsite Clinics: A Program Evaluation" (2023). Doctor of Nursing Practice (DNP) Scholarly Projects. 55.