A survey of patient experience in New Zealand during the first COVID-19 lockdown

COVID-19 patient experience survey results

Background

The Health Quality & Safety Commission ran a COVID-19-specific patient experience survey in partnership with interested primary health organisations (PHOs) in June 2020.

The goal of the survey was to understand the impact of COVID-19 on people’s experience of accessing health care during and after the first COVID-19 lockdown (levels 3 and 4[1]) and how health services could understand, learn and respond. For example, who delayed or deferred care during lockdown, why and what they did instead? If people had a video or phone appointment, what was their experience of this and did they prefer this approach? What barriers did people experience and who experienced the most barriers?

Key findings

  • During the level 3 COVID-19 lockdown, most people had an in-person (49 percent) or phone (47 percent) appointment, with 4 percent held via videoconference. Since leaving lockdown, appointments are returning to pre-COVID levels, with around 90 percent being in person.
  • Of services that respondents would like available in the future, ninety percent of respondents said they would like to have prescriptions directly sent to their pharmacy for pick up and for test results to be available through an online portal. Results from the August 2020 primary care survey found that 51 percent of respondents had heard of and used a general practice online service or patient portal; 26 percent had heard of but not used a portal; and 24 percent had not heard of portals.
  • Nearly everyone who responded said they would like same-day appointments to be available for urgent issues. This echoes findings from a review of the 2019 primary care survey which found that on average 37 percent reported they were able to see their usual GP on the same or next day.

Findings:

  • Around one-third of respondents reported that alert levels 3 and 4 kept them from visiting their GP. Around half of these had a telehealth (phone or videoconference) appointment instead.
  • There were four clear reasons why people were not able to access care during the level 3 and 4 lockdown:
    • alert level restrictions meant they weren’t able to have a usual face-to-face appointment
    • people did not perceive the health issue as being urgent enough
    • concern around making health providers too busy
    • concern about catching COVID-19.
  • Nearly half of all respondents (46 percent) who did not access health care as they normally would have due to COVID-19 had a video or phone appointment instead. It is not known what proportion of in-person appointments related to COVID-19 testing, although only 28 percent were the first appointment for a health matter.
  • Māori and Pacific peoples were significantly less likely to report having a phone or video appointment compared with non-Māori, non-Pacific (nMnP) when they were not able to access health care as they normally would.

Chart showing patients who had a phone of video appointment during lockdown.

  • During the level 3 lockdown, most people had an in-person (49 percent) or phone (47 percent) appointment, with 4 percent via videoconference. Since leaving lockdown, in-person appointments are returning to pre-COVID levels with around 90 percent of appointments reported as being in-person in the August 2020 primary care patient experience survey.
  • Respondents said they liked remote appointments because they:
    • meant people were not around others who were unwell
    • saved time due to faster appointments, less wait time, less time off work and no travel time
    • found having an appointment at home more relaxed and they didn’t have to find childcare.
  • Thirty-six percent of respondents didn’t dislike anything about telehealth appointments. For those who did experiences difficulties with telehealth appointments, this was said to be due to:
    • difficulties showing physical symptoms
    • it being harder to explain issues
    • it being hard to hear/understand
    • privacy
    • technical issues (phone, video or internet).
  • Respondents were asked what services they would like their general practice/health clinic to offer in the future. 
    • Nearly all people responded they would like same-day appointments to be available for urgent issues. This echoes findings from a review of the 2019 primary care survey which found that on average 37 percent of people reported they were able to see their usual GP on the same or next day. This varied between district health boards from 14 percent to 57 percent of respondents.
    • Ninety percent of respondents said they would like to have prescriptions directly sent to their pharmacy for pick up and for test results to be available through an online portal. Results from the August 2020 primary care survey found that 50.5 percent of respondents had heard of and used a general practice online service or patient portal; 25.6 percent had heard of but not used a portal; and 23.9 percent had not heard of portals.
  • A high percentage of people responded positively to experience questions, such as being listened to, being informed, having things explained and being treated with respect. It is not clear whether this is a result of changes to the survey method or whether COVID-19 has impacted positively on experience.
Question Percentage responding most positively
COVID survey 2019 data
Total Māori Total
Did your GP or nurse listen to what you have to say? 93 91 88
Did your GP or nurse inform you as much as you wanted about your health condition, treatment or care? 87 83 -
Did your GP or nurse explain things in a way that is easy to understand? 92 90 88
Did your GP or nurse treat you with kindness and understanding? 95 93 93
Did your GP or nurse treat you with respect? 96 95 95
Did your GP or nurse spend enough time with you? 89 87 80
Did your GP involve you as much as you wanted to be in decisions about your treatment and care? 87 86 82

Methodology

The national enrolment service (NES) was used as the source of patient contact details to identify two cohorts:

  1. enrolled patients who had general practice contact during level 3 lockdown (includes repeat scripts, telehealth and appointments)
  2. enrolled patients who did not have general practice contact (sample matched to the patient survey sample). The goal was to identify those who had a health need and who didn’t make contact.

Survey sample period

The survey sample period invited patients who had contact with a general practice during the first two weeks of level 3 lockdown (27 April–10 May 2020). This period was selected to ensure that we covered a period of time where initial teething issues with telehealth appointments had been resolved.

Fieldwork

The patient sample were invited to respond to the survey late June and early July. The survey was kept open for three weeks and a reminder was sent after seven days.

PHOs had two options for running the survey. They could choose to either have the invitation sent only to those enrolled in a participating practice or they could invite patients across the PHO-enrolled population. The survey invitation was tailored to the chosen approach and worded so patients understood how their privacy was being managed. Some PHOs took a mixed approach, sampling from both participating practices and from the PHO.

Equity

To improve participation by Māori and Pacific patients we:

  • tested the content and style of the survey invitation with Māori and Pacific patients as part of the national survey review and applied those learnings to the COVID-19 survey
  • tested different invitation modes to see which most increased response rates (eg, pair email invite with SMS reminder, offer SMS to those with no email contact)
  • amended the sample to over-sample Māori and Pacific patients deliberately.

The impact of amending the sample frame meant that, while in November 2019, Māori received 10 percent of the survey invitations, in the COVID-19 survey, 27 percent of invitations were sent to Māori.

We also collected the following demographic details for comparative analysis: ethnicity, age, disability, long-term conditions and COVID-19 vulnerability. National analyses will help us understand whether certain groups had better or worse experiences than others.


References

  1. Level 4 lockdown: 25 Mar–26 April, level 3 lockdown 27 April–12 May 2020.

Last updated 23/12/2020