Enhancing Healthcare Access Through Telehealth: Patient-Centered Insights from Pakistan’s Primary Care Sector

Enhancing Healthcare Access Through Telehealth: Patient-Centered Insights from Pakistan’s Primary Care Sector | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Healthcare Access Through Telehealth: Patient-Centered Insights from Pakistan’s Primary Care Sector Tooba Malik, Siew Chin Ong, Muhammad Daoud Butt This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6902014/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Dec, 2025 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Pakistan’s healthcare system faces critical challenges, including limited infrastructure and disparities in access between urban and rural regions. Telehealth has emerged as a promising solution to improve accessibility, but patient-centered evidence on its effectiveness and cost-efficiency remains limited. Methods: A cross-sectional quantitative study was conducted from May to December 2023 using a validated, modified patient satisfaction tool. Data were collected from 532 patients via EZShifa’s telehealth platform across Pakistan. Key indicators included satisfaction, trust, comfort, accessibility, and cost. Statistical analyses included chi-square tests, ordinal regression, and independent samples t-tests. Results: High satisfaction was reported with internet connectivity (94.9%), provider behavior (96.6%), consultation fees (93.9%), and diagnostic trust (80.8%). While 67.7% were satisfied with prescribed medications, 30.7% expressed dissatisfaction. Comfort was highest for follow-ups and lab reviews but lower for initial visits with new providers and sensitive discussions. Regression analysis identified comfort score (OR: 20.27, p < 0.0001) and perceived quality of care (OR: 2.585, p = 0.004) as significant predictors of telehealth acceptance. The average cost of a teleconsultation was PKR 2,000, compared to PKR 4,800 for in-person care. The incremental cost-effectiveness ratio (ICER) was PKR − 3,111.11, indicating telehealth was both more effective and less costly. Conclusions: Telehealth offers a cost-effective, accessible, and patient-satisfactory alternative to traditional care in Pakistan’s primary healthcare system. These findings support broader telehealth adoption and the development of patient-centered digital health policies. Cost-effectiveness Digital health Patient satisfaction Telehealth Virtual care Introduction Healthcare innovation has consistently aimed to enhance human well-being, increase life expectancy, and improve access to quality medical services. From ancient practices to contemporary advancements, the evolution of healthcare has been shaped by the need to reach populations efficiently and equitably.(Kvedaravičienė and Pukelienė 2021 ) Among the most transformative innovations is telehealth —a system that uses digital technologies to connect patients and providers across physical distances, thus redefining the delivery of healthcare.(Adeghe, Okolo et al. 2024 ) Telehealth, derived from the Greek “tele” (meaning “at a distance”), goes beyond clinical consultations to encompass preventive care, health education, remote monitoring, and chronic disease management.(Pallotta 2021 ) This holistic approach to healthcare has gained global traction, especially in low- and middle-income countries where healthcare disparities are pronounced. The COVID-19 pandemic further accelerated its adoption, validating its role in sustaining care delivery amid widespread health system disruptions.(Zhang, Mosier et al. 2021 ) Countries across the world—from Denmark to India—have leveraged telehealth to address physician shortages, improve chronic disease outcomes, and bridge access gaps.(Naik and Sarkar) Africa, for instance, bears a quarter of the global disease burden with only a fraction of health workers and funding. In response, telemedicine initiatives have become vital in regions where traditional care systems fall short.(Omboni, Padwal et al. 2022 ) Similarly, countries like Canada, Germany, and Brazil have developed national telehealth platforms to enhance service delivery and patient engagement.(Hashiguchi 2020 ) In Pakistan, where healthcare challenges are compounded by underfunding, infrastructure gaps, and an unequal urban-rural distribution of providers, telehealth presents a promising solution.(Choudhry, Iqbal et al. 2024 ) With public health expenditure below 1% of GDP and millions lacking adequate access to care, digital health services can significantly reduce access barriers.(Wilson, Sheikh et al. 2021 ) Platforms like EZShifa—deploying video-linked health kiosks in underserved regions—demonstrate the potential of technology to connect patients with physicians, diagnostics, and education without the cost and complexity of travel.(Osipov and Skryl 2021 ) However, despite these advances, telehealth adoption in Pakistan remains uneven. Infrastructure limitations, technological illiteracy, and socio-cultural concerns such as privacy, trust, and communication preferences pose significant barriers.(Maqsood, Gul et al. 2024 ) While telehealth has shown effectiveness in maternal health, chronic disease management, and health worker training, much of the existing research focuses on system-level outcomes or provider perspectives, leaving a critical gap in patient-centered evaluations.(Bailey, Gurgol et al. 2021 ) Globally, studies confirm that telehealth can improve outcomes in diabetes, cardiovascular disease, COPD, and mental health. Yet acceptance varies by age, condition, and digital literacy.(Anisha, Sen et al. 2025 ) Children and adolescents may embrace app-based care, whereas older adults often prefer face-to-face interactions. These nuances underscore the importance of designing telehealth services that reflect patient preferences, context, and comfort—especially in culturally complex environments like Pakistan.(Cugini 2024 ) In the context of primary healthcare—often the first and most essential point of contact—telehealth can transform service delivery by reducing geographical, financial, and social barriers.(Sutarsa, Kasim et al. 2022 ) But its long-term success depends on patient trust, satisfaction, and willingness to engage with digital platforms. As such, patient-centered research is vital to understanding how telehealth is experienced, accepted, and valued within diverse communities.(Bailey, Gurgol et al. 2021 ) This study seeks to address this gap by exploring telehealth use in Pakistan’s primary healthcare sector from the patient’s perspective. It aims to evaluate patient satisfaction, trust, perceived barriers, cost effectiveness and the effectiveness of telehealth services in improving access and care quality. The findings will offer actionable insights for policymakers, providers, and technology developers seeking to strengthen telehealth implementation in low-resource settings. Methodology Study Design and Setting This study adopted a quantitative, cross-sectional research design to evaluate the effectiveness and cost-efficiency of telehealth services in delivering primary healthcare from the patient’s perspective. The central objective was to assess both the quality of care and the potential financial benefits associated with remote healthcare delivery. Data were collected from May to December 2023 across various districts in Pakistan, with the capital city, Islamabad, serving as the primary coordination center. EZShifa, a telehealth provider with nationwide coverage, was selected as the focal platform due to its wide accessibility and diverse user base. This setting enabled the capture of data from patients in urban, semi-urban, and rural areas, thereby providing a comprehensive view of telehealth implementation across varying healthcare contexts. Study Population and Sampling The study population consisted of EZShifa patients who had completed teleconsultations and were accessible through the provider’s customer support database. Participants were eligible for inclusion if they were 18 years or older, had utilized telehealth services for chronic conditions not requiring hospitalization, could communicate effectively in the consultation languages, and had provided informed consent to participate in the study. Patients requiring hospital admission or emergency care, those unable to communicate effectively, or those working as healthcare professionals within EZShifa were excluded. From a total of 3,458 teleconsultation sessions conducted during the study period, 1,581 patients met the inclusion criteria. Using Raosoft sample size calculation software with a 95% confidence level and 5% margin of error, the minimum required sample size was determined to be 310. A random convenience sampling approach was used to distribute the survey to eligible patients, and a total of 532 valid responses were obtained for analysis. Instrumentation and Data Collection To assess patient satisfaction and related outcomes, the questionnaire was adapted and modified from the internal patient satisfaction form used by EZShifa, with validation input from experts at the Health Services Academy. A pilot study involving 20 participants was conducted to evaluate the tool's reliability and clarity. Feedback from the pilot phase informed final adjustments to the questionnaire, ensuring its contextual accuracy and content validity. The final version used in this study is available as a Supplementary File. The survey captured information across multiple domains, including access to care, quality of services, connectivity and consultation response time, diagnostic accuracy, behavior and professionalism of healthcare providers, and transparency in consultation fees. In addition to clinical and satisfaction indicators, the survey included a dedicated section focusing on the economic dimension of telehealth, enabling a pharmacoeconomic evaluation of the service. Pharmacoeconomic Assessment of Telehealth To assess the cost-effectiveness of telehealth from the patient’s perspective, a structured economic section was included in the survey. Patients were divided into two groups both had used telehealth but one group was asked to report the actual consultation fee they paid, along with related expenses such as the cost of prescribed medications. They were then prompted to estimate how much they would typically spend for an equivalent in-person visit, including transport costs (e.g., fuel, ride-hailing fares), time taken off work, childcare, and any additional incidental expenses. To enhance accuracy, response options were categorized into cost ranges (e.g., "< PKR 500," "PKR 500–1,000") and respondents were guided with examples. For indirect costs, participants indicated the number of work hours or days missed and their average income to approximate productivity loss. This data enabled a comparative cost analysis between telehealth and physical visits, with mean consultation costs calculated for each mode. Effectiveness was assessed using patient acceptance (Likert scale: 1–5) and comfort (scale: 8–40), and independent samples t-tests compared outcomes across both groups. These inputs were then used to compute an Incremental Cost-Effectiveness Ratio (ICER). Data Analysis Quantitative data collected from patient responses were analyzed using IBM® SPSS Statistics version 25. Descriptive statistics were used to summarize socio-demographic characteristics and economic data. Continuous variables, such as age and cost figures, were reported as means with standard deviations, while categorical variables were expressed as frequencies and percentages. The relationship between patient demographics and satisfaction scores was assessed using the Chi-square test, while binary logistic regression was applied to identify significant predictors of patient satisfaction. To evaluate the economic implications of telehealth, patient-reported costs were aggregated and compared to conventional care benchmarks, allowing for a quantifiable measure of cost savings. Hypotheses were tested at a significance level of α ≤ 0.05, with 95% confidence intervals used to interpret the strength and precision of the findings. Ethical Considerations Ethical approval for the study was obtained from the Institutional Review Board (IRB) at the Health Services Academy. All participants received an informed consent form detailing the purpose of the study, the voluntary nature of their participation, and the measures in place to ensure the confidentiality and anonymity of their responses. Only de-identified data were used for analysis, and all research procedures adhered to the ethical standards set forth in the Declaration of Helsinki. Result The sociodemographic parameters as shown in Table 1 provide a rich foundation for understanding the context in which this study unfolds, with characteristics that reveal intricate patterns shaping health-seeking behaviors, healthcare accessibility, and health outcomes. Age distribution is a significant factor, as it influences health dynamics within the population. For instance, participants aged 18–25 may be more susceptible to lifestyle-related health issues, while those in the 51–79 age range could experience chronic diseases and age-related health challenges. The majority of participants are aged 26–50, accounting for roughly 75% of the sample, with 26.12% in the 51–79 age group, underscoring the importance of addressing age-specific health needs. Analyzing the intersection between age and healthcare preferences is essential for a comprehensive understanding. Gender composition further enriches the study, as gender dynamics play a crucial role in healthcare utilization. While the sample is nearly gender-balanced, with slightly more males (51.1%) than females (48.9%), it is crucial to recognize gender as a spectrum. This distribution highlights the need for gender-sensitive healthcare approaches, exploring gender-specific health behaviors and the impact of societal norms on healthcare decisions. Geographical distribution across provinces adds a regional dimension, reflecting health disparities driven by infrastructure, socioeconomic conditions, and cultural factors. Punjab has the highest representation (43.2%), followed by Sindh (19.73%) and Islamabad Capital Territory (9.83%), suggesting a diverse geographic spread. This enables an analysis of health outcomes within regional contexts to identify disparities and inform targeted interventions. Occupational diversity further enhances the study, linking lifestyle, income, and healthcare access. Private sector employees constitute the largest occupational group (32.92%), followed by government employees (24.24%) and business owners (18.79%). Each occupational category brings unique health challenges; for instance, the health needs of private sector employees might differ from those of government employees or retirees, underscoring the value of workplace-specific health programs. Educational attainment is also pivotal, as it affects health literacy, shaping how individuals understand health information and interact with healthcare systems. Participants with university education represent the largest group (46.05%), followed by postgraduates (33.27%), indicating relatively high educational levels. This demographic could benefit from tailored health communication strategies that align with different literacy levels. Transportation habits reveal accessibility factors that impact healthcare access. Most participants (72.36%) own a vehicle, while 21.61% rely on hired services, such as taxis or Uber, indicating good overall accessibility. For those dependent on others for transportation, barriers like potential delays could hinder timely healthcare access, which could otherwise go unnoticed. Physical state status offers further insight into participants' health, with 61.5% reporting full activity without restrictions, indicative of generally good physical health. However, around 13% of participants report health-related limitations, pointing to specific challenges that may necessitate targeted interventions to improve health outcomes. The presence of chronic diseases among participants emphasizes the need for a focused approach, as 63.1% report at least one chronic condition, with diabetes (35.90%) and hypertension (26.69%) being most prevalent. By examining chronic disease distribution across sociodemographic factors, the study can inform preventive strategies and healthcare planning. Lastly, different chronic conditions present unique challenges, impacting both disease management and quality of life. An in-depth analysis of the prevalence and sociodemographic associations of these chronic conditions will provide a comprehensive understanding of the health landscape. This exploration into sociodemographic parameters contributes to a nuanced perspective on healthcare needs, utilization, and outcomes, forming a basis for targeted, data-driven healthcare strategies. Table 1 Socio demographic characteristics of study population. Sociodemographic Parameters (N) (%) Age 18–25 115 21.61 26–35 120 22.55 36–50 158 29.72 51–79 139 26.12 Gender Female 260 48.9 Male 272 51.1 Residence province Punjab 230 43.2 Sindh 105 19.73 Khyber Pakhtunkhwa 32 6.01 Balochistan 46 8.64 Islamabad Capital Territory 52 9.83 Gilgit-Baltistan 38 7.14 Azad Jammu and Kashmir 29 5.45 Occupation Private sector employee 175 32.92 Government employee 129 24.24 Business owner 100 18.79 Retired 20 3.75 Unemployed 23 4.32 Student 85 15.98 Highest level of education Middle school or less 4 0.77 High school 70 13.15 Diploma 36 6.76 University 245 46.05 Postgraduate 177 33.27 Transportation I have my own transportation method 385 72.36 I hire a transportation method (Taxi, Uber) 115 21.61 I get driven by Family/Friend 20 3.78 Other 12 2.25 Which best describes your physical state status? My health makes it impossible for me to engage in most activities 10 1.9 My health makes it impossible for me to engage in some activities 22 4.1 My health makes it difficult for me to engage in some activities 38 7.1 I am able to go about my daily activities with minimal difficulty 135 25.4 Fully active without restrictions 327 61.5 Presence of chronic disease Yes 336 63.1 No 196 36.9 Type of chronic disease Diabetes 191 35.90 HTN 142 26.69 Heart disease 58 10.92 Asthma 76 14.28 Hypothyroidism 18 3.38 Other 47 8.83 The findings of the study reveal a generally positive response to telehealth services among patients, particularly concerning aspects such as internet connectivity, trust in treatment, the behavior of healthcare providers and support staff, consultation fees, and connectivity during consultations. Internet connectivity was rated positively, with most respondents marking it as good (337) or excellent (168), highlighting its importance in maintaining effective communication during telehealth consultations. However, a minority (26 respondents) rated connectivity as poor, suggesting a potential area for enhancement. Patient trust in the treatment and findings of telehealth doctors was substantial, with 303 respondents expressing satisfaction and 127 indicating high satisfaction. This reflects positively on the perceived credibility of healthcare professionals involved in the service, although a small number (13 respondents) expressed dissatisfaction, warranting further investigation into their specific concerns. The behavior of telehealth doctors also garnered overwhelmingly positive feedback, with 514 respondents happy with their interactions, underscoring the value of effective communication and empathy in virtual healthcare settings. Support staff and operators received similar commendation, with 522 respondents reporting satisfaction with their service, while only 4 expressed dissatisfactions, highlighting the role of support staff in facilitating a smooth telehealth experience. The satisfaction with consultation fees was high, with 522 respondents expressing approval, suggesting a well-received and accessible pricing structure. Connectivity time during consultations was also positively rated; 263 respondents expressed satisfaction and 250 were very satisfied, with relatively low dissatisfaction (19), indicating an effective handling of connectivity issues that is aligned with patient expectations. Moreover, recommendations to friends and family are high indicators of overall satisfaction, with 320 respondents expressing willingness to recommend Telehealth Services, which reflects strong word-of-mouth potential for the service. Regarding prescribed medicine usage, patient satisfaction levels were significant (67.7%), with 42.9% very satisfied and 24.8% satisfied. However, 30.7% of respondents expressed dissatisfaction, pointing to potential improvements in prescription and medication management processes within telehealth. The study underscores the success of Telehealth Services in providing quality virtual healthcare, with high levels of satisfaction observed across most dimensions. Areas requiring further improvement, especially in prescribed medicine usage, emphasize the importance of continuous assessment and refinement to enhance patient experience. Detailed feedback sessions, targeted improvement initiatives, and addressing specific patient concerns are recommended to strengthen the quality and reliability of telehealth services, reinforcing Telehealth Services as a patient-centric healthcare provider. The comfort of patients in discussing symptoms, undergoing assessments, and managing follow-up care remotely reflects telehealth's potential in offering accessible healthcare, with this study providing valuable insights into patient perspectives and experiences The analysis of patient comfort levels in telehealth interactions as mentioned in Table 2 reveals a diverse range of responses across various scenarios, highlighting key areas for enhancing patient-centered virtual care. When discussing new symptoms and concerns, 2.63% of participants reported extreme discomfort, while 24.97% felt somewhat uncomfortable. Conversely, 35.3% were somewhat comfortable, and 23.4% were extremely comfortable, underscoring the need for deeper insights into factors that influence patient comfort in sharing health-related issues remotely. Comfort in discussing sensitive or personal information also varied, with 12.40% feeling extremely uncomfortable and 27.26% somewhat uncomfortable. Meanwhile, 21.26% were extremely comfortable, suggesting that while some patients are at ease, a significant portion may benefit from enhanced security assurances to improve comfort in sharing personal health information. Regarding discussions of diagnosis, treatment, and follow-up recommendations, 5.08% of respondents reported extreme discomfort, and 10.90% were somewhat uncomfortable. However, a considerable 42.42% felt somewhat comfortable, and 32.64% were extremely comfortable, suggesting that patients generally find structured medical discussions more manageable in telehealth settings. When reviewing imaging and lab tests, comfort levels were again varied; 4.51% expressed extreme discomfort, while 10.52% were somewhat uncomfortable. Notably, 30.26% felt extremely comfortable, and 35.35% were somewhat comfortable, indicating that telehealth may effectively support the review of complex medical information for many patients. Initial clinic visits, especially with new providers, revealed a mixed comfort level. Around 18.42% were extremely uncomfortable and 19.73% somewhat uncomfortable, while only 14.30% were extremely comfortable. These findings suggest that the familiarity with a provider may play a significant role in telehealth comfort. Post-operative follow-up visits had more favorable responses, with 4.70% expressing extreme discomfort and 19.73% somewhat uncomfortable, while 27.77% were extremely comfortable and 33.3% somewhat comfortable. This suggests a relatively high level of comfort with post-operative telehealth follow-ups, which could reduce the need for in-person visits. Confidence in the privacy and security of telehealth video communications was generally positive, with only 7.33% feeling extremely uncomfortable, while 19.37% felt extremely comfortable, indicating a widespread belief in telehealth’s security measures, which is crucial for patient acceptance. These findings underscore the importance of tailoring telehealth services to enhance patient comfort. Key factors, including interaction type, familiarity with providers, and perceptions of privacy, should be carefully addressed to improve patient satisfaction. Further refinement of privacy measures, increased patient education, and ongoing research into patient feedback can help align telehealth services more closely with patient needs, promoting a patient-centered approach in the evolving virtual healthcare landscape. Table 2 Patient Comfort with Telehealth Services Across Various Healthcare Scenarios Statements Extremely uncomfortable Somewhat uncomfortable Neither comfortable nor uncomfortable Somewhat comfortable Extremely comfortable 1. Discussing new symptoms and concerns 14 (2.63%) 130 (24.97%) 73 (13.7%) 194 (35.3%) 121 (23.4%) 2. Discussing sensitive and personal information 66 (12.40%) 145 (27.26%) 65 (12.21%) 143 (26.87%) 113 (21.26%) 3. Discussing diagnosis, treatment and follow-up recommendations 29 (5.08%) 58 (10.90%) 53 (8.96%) 213 (42.42) 179 (32.64%) 4. Review imaging and laboratory tests 24 (4.51%) 56 (10.52%) 103 (19.36%) 188 (35.35%) 161 (30.26%) 5. Undergoing an initial clinic visit with a new provider 98 (18.42%) 105 (19.73%) 106 (19.92%) 147 (27.63%) 76 (14.30%) 6. Undergoing an initial clinic visit with a provider in the 8 (1.50%) 97 (18.23%) 70 (13.16%) 207 (39%) 150 (28.11%) presence of my established physician 7. Completing post-operative follow-up 25 (4.70%) 105 (19.73%) 77 (14.5%) 178 (33.3%) 147 (27.77%) 8. I am confident that communications using video calls are private and secure 39 (7.33%) 146 (27.44%) 92 (17.29%) 152 (28.57%) 103 (19.37%) The ordinal regression analysis shown in Table 3 was conducted to explore the factors influencing the population's willingness to accept virtual video calls from their healthcare providers (HCPs). The dependent variable, "Acceptance," is categorized into ordinal levels, representing the degree of willingness. The following factors were considered in the analysis: Age, Education, Transportation, Comfort score, Gender, Physical state of health, Comfort with technology, and Quality of care perception. The analysis provides insights into factors affecting the acceptance of virtual video calls for healthcare among different demographic groups. Age appears to have a limited impact on acceptance, with age groups 18–25, 26–35, and 36–50 all showing non-significant differences in odds ratios (OR) compared to the reference group of 51–79 years (e.g., OR for 18–25 is 0.916, p = 0.84). This suggests that age alone may not strongly predict acceptance of virtual healthcare services. Similarly, educational attainment does not significantly affect acceptance. Although individuals with higher education show a lower odds ratio of 0.822 compared to those with a high school education or less, this finding is not statistically significant (p = 0.563). Transportation status, analyzed based on car ownership, also does not significantly impact acceptance. Those without a car have a slightly higher odds ratio (1.132) than car owners, yet this difference is not statistically significant (p = 0.576). Gender, too, does not significantly influence acceptance, with males showing an odds ratio of 0.72 compared to females (p = 0.37). Physical health status similarly lacks statistical significance, with odds ratios ranging from 0.357 to 1.732, indicating no strong relationship between self-reported health status and virtual care acceptance. On the other hand, the comfort score—a composite measure reflecting ease and confidence in using telehealth—emerges as a significant predictor. Compared to a Low comfort score (8–18), individuals with Moderate (19–29) and High (30–40) scores show significantly higher odds of acceptance, with odds ratios of 4.148 (p = 0.008) and 20.27 (p < 0.0001), respectively. Comfort with technology, while positive, does not achieve statistical significance (OR = 1.405, p = 0.452). Perception of care quality in virtual settings is also a strong predictor. Those who perceive virtual consultations as providing comparable quality to in-person visits show significantly higher odds of acceptance (OR = 2.585, p = 0.004). Thus, while sociodemographic factors like age, education, transportation, and gender do not significantly influence virtual care acceptance, subjective factors such as comfort score and perceived care quality substantially contribute to acceptance levels. These insights highlight the importance of enhancing patient comfort and maintaining high care standards in telehealth to foster wider acceptance of virtual healthcare services. Table 3 Ordinal Regression Analysis of Factors Influencing Population's Acceptance of Virtual Video Calls from Healthcare Providers (HCPs) Factor OR 95% CI Significance Age 18–25 0.916 0.393–2.13 0.84 26–35 0.819 0.323–2.074 0.674 36–50 0.616 0.227–1.670 0.342 51–79 Ref Education High school or less Ref Diploma or higher 0.822 0.829–3.255 0.563 Transportation Does not own a car 1.132 0.424–1.593 0.576 Owns a car Ref Comfort score Low (8–18) Ref Moderate (19–29) 4.148 1.444–11.91 0.008∗ High (30–40) 20.27 6.415–64.05 < 0.0001∗ Gender Male 0.72 0.351–1.475 0.37 Female Ref Which best describes your physical state of health 1. My health makes it impossible for me to engage in most activities 1.732 0.324–9.249 0.52 2. My health makes it impossible for me to engage in some activities 0.357 0.089–1.425 0.149 3. My health makes it difficult for me to engage in some activities 0.704 0.277–1.786 0.461 4. I am able to go about my daily activities with minimal difficulty 0.907 0.447–1.546 0.56 5. Fully active without restriction Comfort with technology: ease of use Strongly agree or agree Ref Comfort with technology: ease of use Strongly agree or agree 1.405 0.579–3.409 0.452 Strongly disagree or disagree Ref Quality of care: I believe I can get the same quality of care from a video call as from an in-person visit Strongly agree or agree 2.585 1.364–4.896 0.004∗ Strongly disagree or disagree Ref The cost-effectiveness analysis in Table 4 compared the economic and patient-centered outcomes of telehealth consultations versus traditional in-person visits from the patient's perspective. The cost per telehealth consultation was estimated based on reported consultation fees and savings on transportation and time. The average cost for a telehealth visit was PKR 2,000, while the average cost of an in-person visit—including consultation fee, transport, and incidental costs—was estimated at PKR 4,800. Effectiveness was assessed using two validated proxies: patient acceptance of video consultations (scored on a 1–5 Likert scale) and comfort score (scale: 8–40). Patients using telehealth services reported significantly higher levels of acceptance and comfort compared to those attending physical clinics. Independent samples t-tests revealed statistically significant differences in both outcomes between the two groups. The mean acceptance score for telehealth users was 3.8 (± 0.8) compared to 2.9 (± 1.1) for in-person visits ( p < 0.001). Similarly, the mean comfort score for telehealth users was 30.2 (± 6.1), significantly higher than 22.5 (± 5.4) in the in-person group ( p < 0.001). Using these outcomes, the Incremental Cost-Effectiveness Ratio (ICER) was calculated. The ICER for acceptance score improvement was: The negative ICER indicates that telehealth is a dominant strategy, offering better outcomes at lower cost compared to in-person consultations. These findings support the cost-effectiveness and sustainability of virtual care models in the Pakistani healthcare context. Table 4 Summary of Cost-Effectiveness Analysis and Statistical Results Outcome Telehealth (n = 315) In-Person (n = 240) Difference 95% CI p-value Mean Cost per Consultation (PKR) 2,000 4,800 -2,800 -3,024 to -2,576 < 0.001 Mean Acceptance Score (1–5 scale) 3.8 (± 0.8) 2.9 (± 1.1) + 0.9 0.67 to 1.14 < 0.001 Mean Comfort Score (8–40 scale) 30.2 (± 6.1) 22.5 (± 5.4) + 7.7 6.45 to 8.92 < 0.001 Incremental Cost-Effectiveness Ratio — — PKR -3,111.11 — — Discussion This study examined patient perspectives on the effectiveness, satisfaction, and cost-effectiveness of telehealth services within Pakistan’s primary healthcare system. The findings highlight both the strengths and areas for improvement in virtual healthcare delivery. The demographic characteristics of the study population offer important context for interpreting patient responses. A substantial proportion of participants were younger adults aged 18–35, suggesting a generational openness to digital healthcare solutions.(Clarke, Fruhling et al. 2020 ) This observation aligns with global patterns where younger, more technologically adept individuals exhibit higher telehealth acceptance.(Tandon, Ertz et al. 2024 ) Female participants slightly outnumbered males, reflecting established healthcare-seeking trends that show women’s higher likelihood to engage in health services. Regionally, most respondents were from Punjab and Sindh, indicating strong telehealth uptake in urban and semi-urban areas. These trends underscore the potential of telehealth to meet the growing healthcare demands in densely populated regions.(Adeghe, Okolo et al. 2024 ) The high prevalence of chronic diseases among participants—including diabetes, hypertension, and asthma—further emphasizes telehealth’s utility in chronic disease management.(Omboni, Campolo et al. 2020 ) Teleconsultations offer a practical means for long-term monitoring, especially where in-person access to specialist care is limited.(Mann, Turner et al. 2021 ) This is particularly relevant in Pakistan, where healthcare resources are unevenly distributed and rural populations often face significant barriers to accessing regular care.(Habib, Jamal et al. 2021 ) Patients' responses revealed high overall satisfaction with various aspects of telehealth services, including consultation quality, healthcare provider behavior, and affordability. Most participants rated internet connectivity positively; however, a small subset reported poor connectivity, signaling an infrastructure gap that may hinder the broader scalability of telehealth.(Aashima, Nanda et al. 2021 ) Enhancing network reliability, particularly in underserved areas, will be essential for consistent and high-quality virtual care delivery.(Fujioka, Budhwani et al. 2020 ) Comfort levels in virtual consultations varied across clinical scenarios. Patients reported being relatively comfortable discussing new symptoms and follow-up care but showed less comfort when addressing sensitive or personal health issues.(Campbell, Greenfield et al. 2023 ) These findings suggest that concerns over privacy and data security continue to influence patient openness during virtual consultations. Increasing awareness of security protocols and reinforcing privacy safeguards may help improve patient confidence in discussing personal matters remotely.(Almathami, Win et al. 2020 ) The high level of trust in telehealth providers and diagnoses, coupled with the willingness to recommend telehealth services to others, reflects strong patient endorsement of virtual healthcare.(Barr 2021 ) This positive perception has the potential to influence health-seeking behaviors through word-of-mouth advocacy. Nonetheless, issues related to prescribed medication use were more nuanced.(Torres Stone, Cardemil et al. 2020 ) While a majority of patients expressed satisfaction, nearly one-third were dissatisfied, suggesting a need for more detailed guidance during teleconsultations regarding medication use, adherence, and potential side effects.(Hashiguchi 2020 ) A key strength of the study lies in its exploration of patient comfort and technology use as predictors of telehealth acceptance.(An, You et al. 2021 ) The ordinal regression analysis identified comfort score and perceived quality of virtual care as statistically significant predictors, underscoring the role of subjective experience in shaping telehealth utilization.(Mardenborough 2022 ) These findings support the notion that technical functionality alone is insufficient; patient-centered approaches that prioritize comfort, trust, and communication quality are equally vital.(Shafik 2025 ) Importantly, the cost-effectiveness analysis revealed that telehealth services were significantly less expensive than traditional in-person consultations. (Snoswell, Taylor et al. 2020 ) With an average consultation cost of PKR 2,000 compared to PKR 4,800 for face-to-face visits, and a favorable incremental cost-effectiveness ratio (ICER) of PKR − 3,111.11, telehealth emerged as a dominant option—offering both economic and experiential advantages.(Dooley, Simpson et al. 2022 ) These findings align with global evidence positioning telehealth as a cost-saving, accessible, and scalable model for healthcare delivery, particularly in resource-constrained settings.(Singh, Chand et al. 2025 ) Despite these strengths, certain limitations should be noted. The study employed convenience sampling, which may limit generalizability. In addition, cost data were estimated based on patient-reported information rather than direct billing records, which may introduce recall bias. However, the large sample size, geographical representation, and validated survey tool enhance the reliability of the findings.(Aithal and Aithal 2020 ) Overall, this study underscores the potential of telehealth to improve primary healthcare accessibility, particularly in managing chronic conditions, reducing healthcare costs, and enhancing patient satisfaction. For telehealth to realize its full potential in Pakistan, targeted efforts are needed to address technological gaps, improve privacy assurances, and strengthen patient-provider communication.(Al-Worafi 2023 ) These findings contribute to the growing body of evidence supporting telehealth integration into mainstream healthcare systems and provide actionable insights for policymakers and healthcare providers aiming to design patient-centered virtual care models. Conclusion Promoting health and wellness is critical to improving quality of life, and efficient healthcare delivery is a key societal goal, especially in light of resource limitations and advancements in technology. Collaboration between technology experts, health scientists, and healthcare professionals is essential to address the barriers in achieving these goals. As a developing nation, Pakistan faces significant challenges in providing comprehensive healthcare services, particularly due to inadequate infrastructure, limited transportation, poverty, and low health literacy. This has led to substantial disparities in healthcare access between rural and urban areas. Telemedicine has emerged as a potential solution to bridge these gaps, providing timely diagnostic and treatment options to individuals in remote regions. This study, potentially the first of its kind in Pakistan, investigates public willingness to engage in virtual healthcare, providing a foundation for the development of a telehealth framework that can be integrated into routine medical practice. A core element of this research is the assessment of patient perceptions of telehealth across dimensions of quality, comfort, and ease of use, which will be crucial in guiding system design to prioritize confidentiality, privacy, accessibility, and high-quality care. By addressing this gap in the literature, the study aims to provide insights into the public's perception of telehealth in Pakistan, with an emphasis on factors like acceptance, comfort, ease of use, perceived quality of care and cost effectiveness. The findings are intended to support healthcare stakeholders in making informed decisions on telehealth implementation, expanding access to healthcare information, expediting diagnoses, and improving overall accessibility for patients. Despite limitations related to time, budget, and the exclusion of "grey literature," this research emphasizes the importance of telehealth applications for decision-makers in developing nations. The study’s recommendations include the need for targeted telehealth interventions across different age groups, user-friendly platform design, investments in digital infrastructure, gender-inclusive strategies, and awareness campaigns to engage communities and address cultural concerns. Additional recommendations stress the importance of enhancing connectivity, addressing dissatisfaction related to medication usage, and providing healthcare professionals with telehealth training. Policy implications for the government include implementing education and awareness campaigns to foster telehealth acceptance, establishing regulatory frameworks to safeguard privacy, and integrating telehealth into national health policies to improve healthcare access in underserved regions. These strategies will guide stakeholders in developing a robust telehealth system that supports high-quality, cost-effective healthcare delivery. The study’s limitations include possible response bias from self-reported data, limited causal insights due to the quantitative approach, and a lack of direct telehealth observation. Additionally, the sample may not fully represent Pakistan’s healthcare landscape, as it skews younger. Future research could benefit from incorporating the perspectives of healthcare providers to enhance telehealth’s effectiveness by considering both patient and provider experiences. Declarations Ethics approval and consent to participate The study received ethical approval from the Institutional Review Board (IRB) of the Health Services Academy, Islamabad. Written informed consent was obtained from all participants before data collection. I confirm that all methods were performed following the relevant guidelines and regulations, and that the study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and its later amendments. Consent for publication Not applicable. Data availability All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding This study received no external funding. Author contributions Tooba Malik conceptualized the study, designed the methodology, coordinated data collection, performed the statistical analysis, and drafted the manuscript. Muhammad Daoud Butt contributed to study design and supervised the data collection process. Siew Chin Ong reviewed and approved the final manuscript. Acknowledgements Not applicable. References Aashima, M. Nanda and R. Sharma (2021). "A review of patient satisfaction and experience with telemedicine: a virtual solution during and beyond COVID-19 pandemic." Telemedicine and e-Health 27 (12): 1325-1331. Adeghe, E. P., C. A. Okolo and O. T. Ojeyinka (2024). "A review of emerging trends in telemedicine: Healthcare delivery transformations." International Journal of Life Science Research Archive 6 (1): 137-147. Aithal, A. and P. Aithal (2020). "Development and validation of survey questionnaire & experimental data–a systematical review-based statistical approach." International Journal of Management, Technology, and Social Sciences (IJMTS) 5 (2): 233-251. Al-Worafi, Y. M. (2023). Telehealth and Telemedicine in Developing Countries. Handbook of Medical and Health Sciences in Developing Countries: Education, Practice, and Research , Springer : 1-26. Almathami, H. K. Y., K. T. Win and E. Vlahu-Gjorgievska (2020). "Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients’ homes: systematic literature review." Journal of medical Internet research 22 (2): e16407. An, M. H., S. C. You, R. W. Park and S. Lee (2021). "Using an extended technology acceptance model to understand the factors influencing telehealth utilization after flattening the COVID-19 curve in South Korea: cross-sectional survey study." JMIR medical informatics 9 (1): e25435. Anisha, S. A., A. Sen, B. Ahmad and C. Bain (2025). "Exploring Acceptance of Digital Health Technologies for Managing Non-Communicable Diseases Among Older Adults: A Systematic Scoping Review." Journal of Medical Systems 49 (1): 35. Bailey, J. E., C. Gurgol, E. Pan, S. Njie, S. Emmett, J. Gatwood, L. Gauthier, L. G. Rosas, S. M. Kearney and S. K. Robler (2021). "Early patient-centered outcomes research experience with the use of telehealth to address disparities: scoping review." Journal of medical Internet research 23 (12): e28503. Barr, E. A. (2021). Trust, Telehealth, and Transition: Factors Affecting Patient-Provider Trust, Trust in Telehealth, and Engagement in Care During Health Care Transition of Young Adults with HIV During the COVID-19 Pandemic , University of Colorado Denver, Anschutz Medical Campus. Campbell, K., G. Greenfield, E. Li, N. O'Brien, B. Hayhoe, T. Beaney, A. Majeed and A. L. Neves (2023). "The impact of virtual consultations on the quality of primary care: systematic review." Journal of Medical Internet Research 25 : e48920. Choudhry, M. T., S. Iqbal and R. Anwar (2024). "Telemedicine in Regional Prospects Towards Globalization: An Overview of the Telehealth Utility in Region Around Pakistan, Challenges and Opportunities from Neighbourhood." 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"Challenges and strategies for promoting health equity in virtual care: protocol for a scoping review of reviews." JMIR research protocols 9 (12): e22847. Habib, S. S., W. Z. Jamal, S. M. A. Zaidi, J.-U.-R. Siddiqui, H. M. Khan, J. Creswell, S. Batra and A. Versfeld (2021). "Barriers to access of healthcare services for rural women—applying gender lens on TB in a rural district of Sindh, Pakistan." International journal of environmental research and public health 18 (19): 10102. Hashiguchi, T. C. O. (2020). "Bringing health care to the patient: An overview of the use of telemedicine in OECD countries." OECD Health Working Papers (116): 0_1-101. Kvedaravičienė, G. and V. Pukelienė (2021). "Technological Innovations in Healthcare as Fostering Factor for Life Expectancy." Applied Economics: Systematic Research 15 (1). Mann, C., A. Turner and C. Salisbury (2021). "The impact of remote consultations on personalised care." Personalised Care Institute . Maqsood, A., S. Gul, T. Zahra, N. Noureen and A. Khattak (2024). "From face-to-face to screen-to-screen: exploring the multifaceted dimensions of digital mental health care." Frontiers in Psychiatry 15 : 1413127. Mardenborough, L. A. (2022). Demographic, Experience, and Satisfaction Factors Associated with Future Use of Virtual Healthcare to treat Acute Illnesses in Oklahoma , Trident University International. Naik, A. and B. Sarkar "Health and Policy Innovations in India: Exploring the Potential of Telehealth." Omboni, S., L. Campolo and E. Panzeri (2020). "Telehealth in chronic disease management and the role of the Internet-of-Medical-Things: the Tholomeus® experience." Expert Review of Medical Devices 17 (7): 659-670. Omboni, S., R. S. Padwal, T. Alessa, B. Benczúr, B. B. Green, I. Hubbard, K. Kario, N. A. Khan, A. Konradi and A. G. Logan (2022). "The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future." Connected health 1 : 7. Osipov, V. S. and T. V. Skryl (2021). Impact of digital technologies on the efficiency of healthcare delivery. IoT in healthcare and ambient assisted living , Springer : 243-261. Pallotta, G. (2021). "Development of Telehealth systems and technologies for remote patients’ healthcare." Shafik, W. (2025). Patient-Centered Healthcare: Trust and Transparency Through Technology. AI and Blockchain Applications for Privacy and Security in Smart Medical Systems , IGI Global Scientific Publishing : 309-338. Singh, M., K. Chand and M. Singh (2025). Navigating Challenges and Innovations in Global Healthcare. Driving Global Health and Sustainable Development Goals With Smart Technology , IGI Global Scientific Publishing : 303-338. Snoswell, C. L., M. L. Taylor, T. A. Comans, A. C. Smith, L. C. Gray and L. J. Caffery (2020). "Determining if telehealth can reduce health system costs: scoping review." Journal of medical Internet research 22 (10): e17298. Sutarsa, I. N., R. Kasim, B. Steward, S. Bain-Donohue, C. Slimings, S. H. Dykgraaf and A. Barnard (2022). "Implications of telehealth services for healthcare delivery and access in rural and remote communities: perceptions of patients and general practitioners." Australian Journal of Primary Health 28 (6): 522-528. Tandon, U., M. Ertz, M. Sajid and M. Kordi (2024). "Understanding Telehealth Adoption among the Elderly: An Empirical Investigation." Information 15 (9): 552. Torres Stone, R. A., E. V. Cardemil, K. Keefe, P. Bik, Z. Dyer and K. E. Clark (2020). "A community mental health needs assessment of a racially and ethnically diverse population in New England: Narratives from community stakeholders." Community Mental Health Journal 56 : 947-958. Wilson, D., A. Sheikh, M. Görgens, K. Ward and W. Bank (2021). "Technology and Universal Health Coverage: Examining the role of digital health." Journal of Global Health 11 : 16006. Zhang, T., J. Mosier and V. Subbian (2021). "Identifying barriers to and opportunities for telehealth implementation amidst the COVID-19 pandemic by using a human factors approach: a leap into the future of health care delivery?" JMIR human factors 8 (2): e24860. Additional Declarations No competing interests reported. Supplementary Files Questionaire.docx Cite Share Download PDF Status: Published Journal Publication published 11 Dec, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 18 Sep, 2025 Reviews received at journal 01 Sep, 2025 Reviewers agreed at journal 27 Aug, 2025 Reviews received at journal 26 Aug, 2025 Reviewers agreed at journal 26 Aug, 2025 Reviewers invited by journal 25 Aug, 2025 Editor assigned by journal 05 Aug, 2025 Editor invited by journal 13 Jul, 2025 Submission checks completed at journal 10 Jul, 2025 First submitted to journal 10 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6902014","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508712746,"identity":"a54e672a-d57a-40d2-9038-48ba76f1edbc","order_by":0,"name":"Tooba Malik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIie3OsUrDQBzH8X84+Gf52zpGYu0TCA2BLCp9lYRAs7g4uhUKcRGyRtB3cOpqJHAufYDAf0n3Lm4RgvSu4CJprJvIfYcchPvwOwCT6W+Gu+9AoFWr05r/dJ++CAoUEwg1EYcSQHQOIlN7IesGlmO0cXb70ZSjzM0KQe0SzvOwe4Vk4t0De6lAyRSW/sNjCeIoZQiqPcS5DhwCtlJhq2thGT1XsSLzfnLSAk81uWkUedGE2n7iqpVIPwxIrziaYA9ZycQ/BY4ViV2aJX5exZPXp5QpWNWdxL5byPUG+CobSu+9ubwYZXm0rjctnwVv3Su7rM9vPwq9D8c9ZE/D4tfEZDKZ/mVbmEdawz6Ghp8AAAAASUVORK5CYII=","orcid":"","institution":"Universiti Sains Malaysia","correspondingAuthor":true,"prefix":"","firstName":"Tooba","middleName":"","lastName":"Malik","suffix":""},{"id":508712747,"identity":"03f05d32-4768-41d1-bef1-86316f292321","order_by":1,"name":"Siew Chin Ong","email":"","orcid":"","institution":"Universiti Sains Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Siew","middleName":"Chin","lastName":"Ong","suffix":""},{"id":508712748,"identity":"6ca84a6c-999f-41c6-82b9-3da8c34a504b","order_by":2,"name":"Muhammad Daoud Butt","email":"","orcid":"","institution":"Universiti Sains Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Daoud","lastName":"Butt","suffix":""}],"badges":[],"createdAt":"2025-06-16 06:08:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6902014/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6902014/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13820-4","type":"published","date":"2025-12-11T15:58:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":98244237,"identity":"1ecc270d-64bc-4c66-ae3d-d9d4c3ace23b","added_by":"auto","created_at":"2025-12-15 16:13:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":980221,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6902014/v1/82525989-22cb-497a-af2a-4d8e29511f67.pdf"},{"id":90392134,"identity":"41753142-88c5-484b-b6e5-16a9e4d842ae","added_by":"auto","created_at":"2025-09-02 08:44:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":29237,"visible":true,"origin":"","legend":"","description":"","filename":"Questionaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-6902014/v1/8e298f162738488deb0ff693.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing Healthcare Access Through Telehealth: Patient-Centered Insights from Pakistan’s Primary Care Sector","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealthcare innovation has consistently aimed to enhance human well-being, increase life expectancy, and improve access to quality medical services. From ancient practices to contemporary advancements, the evolution of healthcare has been shaped by the need to reach populations efficiently and equitably.(Kvedaravičienė and Pukelienė \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Among the most transformative innovations is \u003cem\u003etelehealth\u003c/em\u003e—a system that uses digital technologies to connect patients and providers across physical distances, thus redefining the delivery of healthcare.(Adeghe, Okolo et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eTelehealth, derived from the Greek “tele” (meaning “at a distance”), goes beyond clinical consultations to encompass preventive care, health education, remote monitoring, and chronic disease management.(Pallotta \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) This holistic approach to healthcare has gained global traction, especially in low- and middle-income countries where healthcare disparities are pronounced. The COVID-19 pandemic further accelerated its adoption, validating its role in sustaining care delivery amid widespread health system disruptions.(Zhang, Mosier et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eCountries across the world—from Denmark to India—have leveraged telehealth to address physician shortages, improve chronic disease outcomes, and bridge access gaps.(Naik and Sarkar) Africa, for instance, bears a quarter of the global disease burden with only a fraction of health workers and funding. In response, telemedicine initiatives have become vital in regions where traditional care systems fall short.(Omboni, Padwal et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) Similarly, countries like Canada, Germany, and Brazil have developed national telehealth platforms to enhance service delivery and patient engagement.(Hashiguchi \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn Pakistan, where healthcare challenges are compounded by underfunding, infrastructure gaps, and an unequal urban-rural distribution of providers, telehealth presents a promising solution.(Choudhry, Iqbal et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) With public health expenditure below 1% of GDP and millions lacking adequate access to care, digital health services can significantly reduce access barriers.(Wilson, Sheikh et al. \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Platforms like EZShifa—deploying video-linked health kiosks in underserved regions—demonstrate the potential of technology to connect patients with physicians, diagnostics, and education without the cost and complexity of travel.(Osipov and Skryl \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eHowever, despite these advances, telehealth adoption in Pakistan remains uneven. Infrastructure limitations, technological illiteracy, and socio-cultural concerns such as privacy, trust, and communication preferences pose significant barriers.(Maqsood, Gul et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) While telehealth has shown effectiveness in maternal health, chronic disease management, and health worker training, much of the existing research focuses on system-level outcomes or provider perspectives, leaving a critical gap in patient-centered evaluations.(Bailey, Gurgol et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eGlobally, studies confirm that telehealth can improve outcomes in diabetes, cardiovascular disease, COPD, and mental health. Yet acceptance varies by age, condition, and digital literacy.(Anisha, Sen et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) Children and adolescents may embrace app-based care, whereas older adults often prefer face-to-face interactions. These nuances underscore the importance of designing telehealth services that reflect patient preferences, context, and comfort—especially in culturally complex environments like Pakistan.(Cugini \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn the context of primary healthcare—often the first and most essential point of contact—telehealth can transform service delivery by reducing geographical, financial, and social barriers.(Sutarsa, Kasim et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) But its long-term success depends on patient trust, satisfaction, and willingness to engage with digital platforms. As such, patient-centered research is vital to understanding how telehealth is experienced, accepted, and valued within diverse communities.(Bailey, Gurgol et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThis study seeks to address this gap by exploring telehealth use in Pakistan’s primary healthcare sector from the patient’s perspective. It aims to evaluate patient satisfaction, trust, perceived barriers, cost effectiveness and the effectiveness of telehealth services in improving access and care quality. The findings will offer actionable insights for policymakers, providers, and technology developers seeking to strengthen telehealth implementation in low-resource settings.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cb\u003eStudy Design and Setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study adopted a quantitative, cross-sectional research design to evaluate the effectiveness and cost-efficiency of telehealth services in delivering primary healthcare from the patient’s perspective. The central objective was to assess both the quality of care and the potential financial benefits associated with remote healthcare delivery. Data were collected from May to December 2023 across various districts in Pakistan, with the capital city, Islamabad, serving as the primary coordination center. EZShifa, a telehealth provider with nationwide coverage, was selected as the focal platform due to its wide accessibility and diverse user base. This setting enabled the capture of data from patients in urban, semi-urban, and rural areas, thereby providing a comprehensive view of telehealth implementation across varying healthcare contexts.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Population and Sampling\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study population consisted of EZShifa patients who had completed teleconsultations and were accessible through the provider’s customer support database. Participants were eligible for inclusion if they were 18 years or older, had utilized telehealth services for chronic conditions not requiring hospitalization, could communicate effectively in the consultation languages, and had provided informed consent to participate in the study. Patients requiring hospital admission or emergency care, those unable to communicate effectively, or those working as healthcare professionals within EZShifa were excluded.\u003c/p\u003e\u003cp\u003eFrom a total of 3,458 teleconsultation sessions conducted during the study period, 1,581 patients met the inclusion criteria. Using Raosoft sample size calculation software with a 95% confidence level and 5% margin of error, the minimum required sample size was determined to be 310. A random convenience sampling approach was used to distribute the survey to eligible patients, and a total of 532 valid responses were obtained for analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInstrumentation and Data Collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo assess patient satisfaction and related outcomes, the questionnaire was adapted and modified from the internal patient satisfaction form used by EZShifa, with validation input from experts at the Health Services Academy. A pilot study involving 20 participants was conducted to evaluate the tool's reliability and clarity. Feedback from the pilot phase informed final adjustments to the questionnaire, ensuring its contextual accuracy and content validity. The final version used in this study is available as a Supplementary File.\u003c/p\u003e\u003cp\u003eThe survey captured information across multiple domains, including access to care, quality of services, connectivity and consultation response time, diagnostic accuracy, behavior and professionalism of healthcare providers, and transparency in consultation fees. In addition to clinical and satisfaction indicators, the survey included a dedicated section focusing on the economic dimension of telehealth, enabling a pharmacoeconomic evaluation of the service.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePharmacoeconomic Assessment of Telehealth\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo assess the cost-effectiveness of telehealth from the patient’s perspective, a structured economic section was included in the survey. Patients were divided into two groups both had used telehealth but one group was asked to report the actual consultation fee they paid, along with related expenses such as the cost of prescribed medications. They were then prompted to estimate how much they would typically spend for an equivalent in-person visit, including transport costs (e.g., fuel, ride-hailing fares), time taken off work, childcare, and any additional incidental expenses. To enhance accuracy, response options were categorized into cost ranges (e.g., \"\u0026lt; PKR 500,\" \"PKR 500–1,000\") and respondents were guided with examples. For indirect costs, participants indicated the number of work hours or days missed and their average income to approximate productivity loss. This data enabled a comparative cost analysis between telehealth and physical visits, with mean consultation costs calculated for each mode. Effectiveness was assessed using patient acceptance (Likert scale: 1–5) and comfort (scale: 8–40), and independent samples t-tests compared outcomes across both groups. These inputs were then used to compute an Incremental Cost-Effectiveness Ratio (ICER).\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eQuantitative data collected from patient responses were analyzed using IBM® SPSS Statistics version 25. Descriptive statistics were used to summarize socio-demographic characteristics and economic data. Continuous variables, such as age and cost figures, were reported as means with standard deviations, while categorical variables were expressed as frequencies and percentages. The relationship between patient demographics and satisfaction scores was assessed using the Chi-square test, while binary logistic regression was applied to identify significant predictors of patient satisfaction.\u003c/p\u003e\u003cp\u003eTo evaluate the economic implications of telehealth, patient-reported costs were aggregated and compared to conventional care benchmarks, allowing for a quantifiable measure of cost savings. Hypotheses were tested at a significance level of α ≤ 0.05, with 95% confidence intervals used to interpret the strength and precision of the findings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\u003cp\u003efor the study was obtained from the Institutional Review Board (IRB) at the Health Services Academy. All participants received an informed consent form detailing the purpose of the study, the voluntary nature of their participation, and the measures in place to ensure the confidentiality and anonymity of their responses. Only de-identified data were used for analysis, and all research procedures adhered to the ethical standards set forth in the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eThe sociodemographic parameters as shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provide a rich foundation for understanding the context in which this study unfolds, with characteristics that reveal intricate patterns shaping health-seeking behaviors, healthcare accessibility, and health outcomes. Age distribution is a significant factor, as it influences health dynamics within the population. For instance, participants aged 18–25 may be more susceptible to lifestyle-related health issues, while those in the 51–79 age range could experience chronic diseases and age-related health challenges. The majority of participants are aged 26–50, accounting for roughly 75% of the sample, with 26.12% in the 51–79 age group, underscoring the importance of addressing age-specific health needs. Analyzing the intersection between age and healthcare preferences is essential for a comprehensive understanding.\u003c/p\u003e\u003cp\u003eGender composition further enriches the study, as gender dynamics play a crucial role in healthcare utilization. While the sample is nearly gender-balanced, with slightly more males (51.1%) than females (48.9%), it is crucial to recognize gender as a spectrum. This distribution highlights the need for gender-sensitive healthcare approaches, exploring gender-specific health behaviors and the impact of societal norms on healthcare decisions. Geographical distribution across provinces adds a regional dimension, reflecting health disparities driven by infrastructure, socioeconomic conditions, and cultural factors. Punjab has the highest representation (43.2%), followed by Sindh (19.73%) and Islamabad Capital Territory (9.83%), suggesting a diverse geographic spread. This enables an analysis of health outcomes within regional contexts to identify disparities and inform targeted interventions.\u003c/p\u003e\u003cp\u003eOccupational diversity further enhances the study, linking lifestyle, income, and healthcare access. Private sector employees constitute the largest occupational group (32.92%), followed by government employees (24.24%) and business owners (18.79%). Each occupational category brings unique health challenges; for instance, the health needs of private sector employees might differ from those of government employees or retirees, underscoring the value of workplace-specific health programs. Educational attainment is also pivotal, as it affects health literacy, shaping how individuals understand health information and interact with healthcare systems. Participants with university education represent the largest group (46.05%), followed by postgraduates (33.27%), indicating relatively high educational levels. This demographic could benefit from tailored health communication strategies that align with different literacy levels.\u003c/p\u003e\u003cp\u003eTransportation habits reveal accessibility factors that impact healthcare access. Most participants (72.36%) own a vehicle, while 21.61% rely on hired services, such as taxis or Uber, indicating good overall accessibility. For those dependent on others for transportation, barriers like potential delays could hinder timely healthcare access, which could otherwise go unnoticed. Physical state status offers further insight into participants' health, with 61.5% reporting full activity without restrictions, indicative of generally good physical health. However, around 13% of participants report health-related limitations, pointing to specific challenges that may necessitate targeted interventions to improve health outcomes.\u003c/p\u003e\u003cp\u003eThe presence of chronic diseases among participants emphasizes the need for a focused approach, as 63.1% report at least one chronic condition, with diabetes (35.90%) and hypertension (26.69%) being most prevalent. By examining chronic disease distribution across sociodemographic factors, the study can inform preventive strategies and healthcare planning. Lastly, different chronic conditions present unique challenges, impacting both disease management and quality of life. An in-depth analysis of the prevalence and sociodemographic associations of these chronic conditions will provide a comprehensive understanding of the health landscape. This exploration into sociodemographic parameters contributes to a nuanced perspective on healthcare needs, utilization, and outcomes, forming a basis for targeted, data-driven healthcare strategies.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio demographic characteristics of study population.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSociodemographic Parameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18–25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26–35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36–50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e51–79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e272\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eResidence province\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePunjab\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSindh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKhyber Pakhtunkhwa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBalochistan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslamabad Capital Territory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGilgit-Baltistan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAzad Jammu and Kashmir\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate sector employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBusiness owner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eHighest level of education\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle school or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostgraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eTransportation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI have my own transportation method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI hire a transportation method (Taxi, Uber)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI get driven by Family/Friend\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eWhich best describes your physical state status?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy health makes it impossible for me to engage in most activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy health makes it impossible for me to engage in some activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy health makes it difficult for me to engage in some activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am able to go about my daily activities with minimal difficulty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFully active without restrictions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e327\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePresence of chronic disease\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e336\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eType of chronic disease\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsthma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypothyroidism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThe findings of the study reveal a generally positive response to telehealth services among patients, particularly concerning aspects such as internet connectivity, trust in treatment, the behavior of healthcare providers and support staff, consultation fees, and connectivity during consultations. Internet connectivity was rated positively, with most respondents marking it as good (337) or excellent (168), highlighting its importance in maintaining effective communication during telehealth consultations. However, a minority (26 respondents) rated connectivity as poor, suggesting a potential area for enhancement.\u003c/p\u003e\u003cp\u003ePatient trust in the treatment and findings of telehealth doctors was substantial, with 303 respondents expressing satisfaction and 127 indicating high satisfaction. This reflects positively on the perceived credibility of healthcare professionals involved in the service, although a small number (13 respondents) expressed dissatisfaction, warranting further investigation into their specific concerns. The behavior of telehealth doctors also garnered overwhelmingly positive feedback, with 514 respondents happy with their interactions, underscoring the value of effective communication and empathy in virtual healthcare settings.\u003c/p\u003e\u003cp\u003eSupport staff and operators received similar commendation, with 522 respondents reporting satisfaction with their service, while only 4 expressed dissatisfactions, highlighting the role of support staff in facilitating a smooth telehealth experience. The satisfaction with consultation fees was high, with 522 respondents expressing approval, suggesting a well-received and accessible pricing structure.\u003c/p\u003e\u003cp\u003eConnectivity time during consultations was also positively rated; 263 respondents expressed satisfaction and 250 were very satisfied, with relatively low dissatisfaction (19), indicating an effective handling of connectivity issues that is aligned with patient expectations. Moreover, recommendations to friends and family are high indicators of overall satisfaction, with 320 respondents expressing willingness to recommend Telehealth Services, which reflects strong word-of-mouth potential for the service.\u003c/p\u003e\u003cp\u003eRegarding prescribed medicine usage, patient satisfaction levels were significant (67.7%), with 42.9% very satisfied and 24.8% satisfied. However, 30.7% of respondents expressed dissatisfaction, pointing to potential improvements in prescription and medication management processes within telehealth.\u003c/p\u003e\u003cp\u003eThe study underscores the success of Telehealth Services in providing quality virtual healthcare, with high levels of satisfaction observed across most dimensions. Areas requiring further improvement, especially in prescribed medicine usage, emphasize the importance of continuous assessment and refinement to enhance patient experience. Detailed feedback sessions, targeted improvement initiatives, and addressing specific patient concerns are recommended to strengthen the quality and reliability of telehealth services, reinforcing Telehealth Services as a patient-centric healthcare provider. The comfort of patients in discussing symptoms, undergoing assessments, and managing follow-up care remotely reflects telehealth's potential in offering accessible healthcare, with this study providing valuable insights into patient perspectives and experiences\u003c/p\u003e\u003cp\u003eThe analysis of patient comfort levels in telehealth interactions as mentioned in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reveals a diverse range of responses across various scenarios, highlighting key areas for enhancing patient-centered virtual care. When discussing new symptoms and concerns, 2.63% of participants reported extreme discomfort, while 24.97% felt somewhat uncomfortable. Conversely, 35.3% were somewhat comfortable, and 23.4% were extremely comfortable, underscoring the need for deeper insights into factors that influence patient comfort in sharing health-related issues remotely.\u003c/p\u003e\u003cp\u003eComfort in discussing sensitive or personal information also varied, with 12.40% feeling extremely uncomfortable and 27.26% somewhat uncomfortable. Meanwhile, 21.26% were extremely comfortable, suggesting that while some patients are at ease, a significant portion may benefit from enhanced security assurances to improve comfort in sharing personal health information.\u003c/p\u003e\u003cp\u003eRegarding discussions of diagnosis, treatment, and follow-up recommendations, 5.08% of respondents reported extreme discomfort, and 10.90% were somewhat uncomfortable. However, a considerable 42.42% felt somewhat comfortable, and 32.64% were extremely comfortable, suggesting that patients generally find structured medical discussions more manageable in telehealth settings.\u003c/p\u003e\u003cp\u003eWhen reviewing imaging and lab tests, comfort levels were again varied; 4.51% expressed extreme discomfort, while 10.52% were somewhat uncomfortable. Notably, 30.26% felt extremely comfortable, and 35.35% were somewhat comfortable, indicating that telehealth may effectively support the review of complex medical information for many patients.\u003c/p\u003e\u003cp\u003eInitial clinic visits, especially with new providers, revealed a mixed comfort level. Around 18.42% were extremely uncomfortable and 19.73% somewhat uncomfortable, while only 14.30% were extremely comfortable. These findings suggest that the familiarity with a provider may play a significant role in telehealth comfort.\u003c/p\u003e\u003cp\u003ePost-operative follow-up visits had more favorable responses, with 4.70% expressing extreme discomfort and 19.73% somewhat uncomfortable, while 27.77% were extremely comfortable and 33.3% somewhat comfortable. This suggests a relatively high level of comfort with post-operative telehealth follow-ups, which could reduce the need for in-person visits.\u003c/p\u003e\u003cp\u003eConfidence in the privacy and security of telehealth video communications was generally positive, with only 7.33% feeling extremely uncomfortable, while 19.37% felt extremely comfortable, indicating a widespread belief in telehealth’s security measures, which is crucial for patient acceptance.\u003c/p\u003e\u003cp\u003eThese findings underscore the importance of tailoring telehealth services to enhance patient comfort. Key factors, including interaction type, familiarity with providers, and perceptions of privacy, should be carefully addressed to improve patient satisfaction. Further refinement of privacy measures, increased patient education, and ongoing research into patient feedback can help align telehealth services more closely with patient needs, promoting a patient-centered approach in the evolving virtual healthcare landscape.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient Comfort with Telehealth Services Across Various Healthcare Scenarios\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eStatements\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eExtremely uncomfortable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSomewhat uncomfortable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eNeither comfortable nor uncomfortable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eSomewhat comfortable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eExtremely comfortable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Discussing new symptoms and concerns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003cp\u003e(2.63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e130\u003c/p\u003e\u003cp\u003e(24.97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73\u003c/p\u003e\u003cp\u003e(13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e194\u003c/p\u003e\u003cp\u003e(35.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e121 (23.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Discussing sensitive and personal information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003cp\u003e(12.40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e145\u003c/p\u003e\u003cp\u003e(27.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e65\u003c/p\u003e\u003cp\u003e(12.21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e143 (26.87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e113\u003c/p\u003e\u003cp\u003e(21.26%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Discussing diagnosis, treatment and follow-up recommendations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003cp\u003e(5.08%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003cp\u003e(10.90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e53\u003c/p\u003e\u003cp\u003e(8.96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e213\u003c/p\u003e\u003cp\u003e(42.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e179\u003c/p\u003e\u003cp\u003e(32.64%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Review imaging and laboratory tests\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(4.51%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003cp\u003e(10.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e103\u003c/p\u003e\u003cp\u003e(19.36%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e188 (35.35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e161\u003c/p\u003e\u003cp\u003e(30.26%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Undergoing an initial clinic visit with a new provider\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003cp\u003e(18.42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003cp\u003e(19.73%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e106\u003c/p\u003e\u003cp\u003e(19.92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e147\u003c/p\u003e\u003cp\u003e(27.63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76 (14.30%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Undergoing an initial clinic visit with a provider in the\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(1.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e97\u003c/p\u003e\u003cp\u003e(18.23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003cp\u003e(13.16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e207\u003c/p\u003e\u003cp\u003e(39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e150 (28.11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epresence of my established physician\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Completing post-operative follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003cp\u003e(4.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003cp\u003e(19.73%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77\u003c/p\u003e\u003cp\u003e(14.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e178\u003c/p\u003e\u003cp\u003e(33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e147 (27.77%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. I am confident that communications using video calls are private and secure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003cp\u003e(7.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146\u003c/p\u003e\u003cp\u003e(27.44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92\u003c/p\u003e\u003cp\u003e(17.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e152\u003c/p\u003e\u003cp\u003e(28.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e103 (19.37%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThe ordinal regression analysis shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e was conducted to explore the factors influencing the population's willingness to accept virtual video calls from their healthcare providers (HCPs). The dependent variable, \"Acceptance,\" is categorized into ordinal levels, representing the degree of willingness. The following factors were considered in the analysis: Age, Education, Transportation, Comfort score, Gender, Physical state of health, Comfort with technology, and Quality of care perception.\u003c/p\u003e\u003cp\u003eThe analysis provides insights into factors affecting the acceptance of virtual video calls for healthcare among different demographic groups. Age appears to have a limited impact on acceptance, with age groups 18–25, 26–35, and 36–50 all showing non-significant differences in odds ratios (OR) compared to the reference group of 51–79 years (e.g., OR for 18–25 is 0.916, p = 0.84). This suggests that age alone may not strongly predict acceptance of virtual healthcare services. Similarly, educational attainment does not significantly affect acceptance. Although individuals with higher education show a lower odds ratio of 0.822 compared to those with a high school education or less, this finding is not statistically significant (p = 0.563).\u003c/p\u003e\u003cp\u003eTransportation status, analyzed based on car ownership, also does not significantly impact acceptance. Those without a car have a slightly higher odds ratio (1.132) than car owners, yet this difference is not statistically significant (p = 0.576). Gender, too, does not significantly influence acceptance, with males showing an odds ratio of 0.72 compared to females (p = 0.37). Physical health status similarly lacks statistical significance, with odds ratios ranging from 0.357 to 1.732, indicating no strong relationship between self-reported health status and virtual care acceptance.\u003c/p\u003e\u003cp\u003eOn the other hand, the comfort score—a composite measure reflecting ease and confidence in using telehealth—emerges as a significant predictor. Compared to a Low comfort score (8–18), individuals with Moderate (19–29) and High (30–40) scores show significantly higher odds of acceptance, with odds ratios of 4.148 (p = 0.008) and 20.27 (p \u0026lt; 0.0001), respectively. Comfort with technology, while positive, does not achieve statistical significance (OR = 1.405, p = 0.452).\u003c/p\u003e\u003cp\u003ePerception of care quality in virtual settings is also a strong predictor. Those who perceive virtual consultations as providing comparable quality to in-person visits show significantly higher odds of acceptance (OR = 2.585, p = 0.004). Thus, while sociodemographic factors like age, education, transportation, and gender do not significantly influence virtual care acceptance, subjective factors such as comfort score and perceived care quality substantially contribute to acceptance levels. These insights highlight the importance of enhancing patient comfort and maintaining high care standards in telehealth to foster wider acceptance of virtual healthcare services.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOrdinal Regression Analysis of Factors Influencing Population's Acceptance of Virtual Video Calls from Healthcare Providers (HCPs)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFactor\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u003cem\u003eSignificance\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e18–25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.916\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.393–2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e26–35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.323–2.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e36–50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.227–1.670\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e51–79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHigh school or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDiploma or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.829–3.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTransportation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDoes not own a car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.424–1.593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOwns a car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eComfort score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLow (8–18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eModerate (19–29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e4.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e1.444–11.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.008∗\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHigh (30–40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e20.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e6.415–64.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u0026lt; 0.0001∗\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.351–1.475\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eWhich best describes your physical state of health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e1. My health makes it impossible for me to engage in most activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.732\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.324–9.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e2. My health makes it impossible for me to engage in some activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.089–1.425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e3. My health makes it difficult for me to engage in some activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.704\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.277–1.786\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e4. I am able to go about my daily activities with minimal difficulty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.907\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.447–1.546\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e5. Fully active without restriction Comfort with technology: ease of use Strongly agree or agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eComfort with technology: ease of use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eStrongly agree or agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.405\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.579–3.409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.452\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eStrongly disagree or disagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eQuality of care: I believe I can get the same quality of care from a video call as from an in-person visit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eStrongly agree or agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e2.585\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e1.364–4.896\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.004∗\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eStrongly disagree or disagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThe cost-effectiveness analysis in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e compared the economic and patient-centered outcomes of telehealth consultations versus traditional in-person visits from the patient's perspective. The cost per telehealth consultation was estimated based on reported consultation fees and savings on transportation and time. The average cost for a telehealth visit was PKR 2,000, while the average cost of an in-person visit—including consultation fee, transport, and incidental costs—was estimated at PKR 4,800.\u003c/p\u003e\u003cp\u003eEffectiveness was assessed using two validated proxies: patient acceptance of video consultations (scored on a 1–5 Likert scale) and comfort score (scale: 8–40). Patients using telehealth services reported significantly higher levels of acceptance and comfort compared to those attending physical clinics.\u003c/p\u003e\u003cp\u003eIndependent samples t-tests revealed statistically significant differences in both outcomes between the two groups. The mean acceptance score for telehealth users was 3.8 (± 0.8) compared to 2.9 (± 1.1) for in-person visits (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). Similarly, the mean comfort score for telehealth users was 30.2 (± 6.1), significantly higher than 22.5 (± 5.4) in the in-person group (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\u003cp\u003eUsing these outcomes, the Incremental Cost-Effectiveness Ratio (ICER) was calculated. The ICER for acceptance score improvement was:\u003c/p\u003e\u003cp\u003eThe negative ICER indicates that telehealth is a dominant strategy, offering better outcomes at lower cost compared to in-person consultations. These findings support the cost-effectiveness and sustainability of virtual care models in the Pakistani healthcare context.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Cost-Effectiveness Analysis and Statistical Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTelehealth (n = 315)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIn-Person (n = 240)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDifference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean Cost per Consultation (PKR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2,800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3,024 to -2,576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean Acceptance Score (1–5 scale)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.8 (± 0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.9 (± 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+ 0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.67 to 1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean Comfort Score (8–40 scale)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.2 (± 6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.5 (± 5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+ 7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.45 to 8.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncremental Cost-Effectiveness Ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePKR\u003c/p\u003e\u003cp\u003e-3,111.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined patient perspectives on the effectiveness, satisfaction, and cost-effectiveness of telehealth services within Pakistan\u0026rsquo;s primary healthcare system. The findings highlight both the strengths and areas for improvement in virtual healthcare delivery.\u003c/p\u003e\u003cp\u003eThe demographic characteristics of the study population offer important context for interpreting patient responses. A substantial proportion of participants were younger adults aged 18\u0026ndash;35, suggesting a generational openness to digital healthcare solutions.(Clarke, Fruhling et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) This observation aligns with global patterns where younger, more technologically adept individuals exhibit higher telehealth acceptance.(Tandon, Ertz et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) Female participants slightly outnumbered males, reflecting established healthcare-seeking trends that show women\u0026rsquo;s higher likelihood to engage in health services. Regionally, most respondents were from Punjab and Sindh, indicating strong telehealth uptake in urban and semi-urban areas. These trends underscore the potential of telehealth to meet the growing healthcare demands in densely populated regions.(Adeghe, Okolo et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe high prevalence of chronic diseases among participants\u0026mdash;including diabetes, hypertension, and asthma\u0026mdash;further emphasizes telehealth\u0026rsquo;s utility in chronic disease management.(Omboni, Campolo et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) Teleconsultations offer a practical means for long-term monitoring, especially where in-person access to specialist care is limited.(Mann, Turner et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) This is particularly relevant in Pakistan, where healthcare resources are unevenly distributed and rural populations often face significant barriers to accessing regular care.(Habib, Jamal et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003ePatients' responses revealed high overall satisfaction with various aspects of telehealth services, including consultation quality, healthcare provider behavior, and affordability. Most participants rated internet connectivity positively; however, a small subset reported poor connectivity, signaling an infrastructure gap that may hinder the broader scalability of telehealth.(Aashima, Nanda et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Enhancing network reliability, particularly in underserved areas, will be essential for consistent and high-quality virtual care delivery.(Fujioka, Budhwani et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eComfort levels in virtual consultations varied across clinical scenarios. Patients reported being relatively comfortable discussing new symptoms and follow-up care but showed less comfort when addressing sensitive or personal health issues.(Campbell, Greenfield et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) These findings suggest that concerns over privacy and data security continue to influence patient openness during virtual consultations. Increasing awareness of security protocols and reinforcing privacy safeguards may help improve patient confidence in discussing personal matters remotely.(Almathami, Win et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe high level of trust in telehealth providers and diagnoses, coupled with the willingness to recommend telehealth services to others, reflects strong patient endorsement of virtual healthcare.(Barr \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) This positive perception has the potential to influence health-seeking behaviors through word-of-mouth advocacy. Nonetheless, issues related to prescribed medication use were more nuanced.(Torres Stone, Cardemil et al. \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) While a majority of patients expressed satisfaction, nearly one-third were dissatisfied, suggesting a need for more detailed guidance during teleconsultations regarding medication use, adherence, and potential side effects.(Hashiguchi \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eA key strength of the study lies in its exploration of patient comfort and technology use as predictors of telehealth acceptance.(An, You et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) The ordinal regression analysis identified comfort score and perceived quality of virtual care as statistically significant predictors, underscoring the role of subjective experience in shaping telehealth utilization.(Mardenborough \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) These findings support the notion that technical functionality alone is insufficient; patient-centered approaches that prioritize comfort, trust, and communication quality are equally vital.(Shafik \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eImportantly, the cost-effectiveness analysis revealed that telehealth services were significantly less expensive than traditional in-person consultations. (Snoswell, Taylor et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) With an average consultation cost of PKR 2,000 compared to PKR 4,800 for face-to-face visits, and a favorable incremental cost-effectiveness ratio (ICER) of PKR \u0026minus;\u0026thinsp;3,111.11, telehealth emerged as a dominant option\u0026mdash;offering both economic and experiential advantages.(Dooley, Simpson et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) These findings align with global evidence positioning telehealth as a cost-saving, accessible, and scalable model for healthcare delivery, particularly in resource-constrained settings.(Singh, Chand et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite these strengths, certain limitations should be noted. The study employed convenience sampling, which may limit generalizability. In addition, cost data were estimated based on patient-reported information rather than direct billing records, which may introduce recall bias. However, the large sample size, geographical representation, and validated survey tool enhance the reliability of the findings.(Aithal and Aithal \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eOverall, this study underscores the potential of telehealth to improve primary healthcare accessibility, particularly in managing chronic conditions, reducing healthcare costs, and enhancing patient satisfaction. For telehealth to realize its full potential in Pakistan, targeted efforts are needed to address technological gaps, improve privacy assurances, and strengthen patient-provider communication.(Al-Worafi \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) These findings contribute to the growing body of evidence supporting telehealth integration into mainstream healthcare systems and provide actionable insights for policymakers and healthcare providers aiming to design patient-centered virtual care models.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePromoting health and wellness is critical to improving quality of life, and efficient healthcare delivery is a key societal goal, especially in light of resource limitations and advancements in technology. Collaboration between technology experts, health scientists, and healthcare professionals is essential to address the barriers in achieving these goals.\u003c/p\u003e\u003cp\u003eAs a developing nation, Pakistan faces significant challenges in providing comprehensive healthcare services, particularly due to inadequate infrastructure, limited transportation, poverty, and low health literacy. This has led to substantial disparities in healthcare access between rural and urban areas. Telemedicine has emerged as a potential solution to bridge these gaps, providing timely diagnostic and treatment options to individuals in remote regions.\u003c/p\u003e\u003cp\u003eThis study, potentially the first of its kind in Pakistan, investigates public willingness to engage in virtual healthcare, providing a foundation for the development of a telehealth framework that can be integrated into routine medical practice. A core element of this research is the assessment of patient perceptions of telehealth across dimensions of quality, comfort, and ease of use, which will be crucial in guiding system design to prioritize confidentiality, privacy, accessibility, and high-quality care.\u003c/p\u003e\u003cp\u003eBy addressing this gap in the literature, the study aims to provide insights into the public's perception of telehealth in Pakistan, with an emphasis on factors like acceptance, comfort, ease of use, perceived quality of care and cost effectiveness. The findings are intended to support healthcare stakeholders in making informed decisions on telehealth implementation, expanding access to healthcare information, expediting diagnoses, and improving overall accessibility for patients. Despite limitations related to time, budget, and the exclusion of \"grey literature,\" this research emphasizes the importance of telehealth applications for decision-makers in developing nations.\u003c/p\u003e\u003cp\u003eThe study\u0026rsquo;s recommendations include the need for targeted telehealth interventions across different age groups, user-friendly platform design, investments in digital infrastructure, gender-inclusive strategies, and awareness campaigns to engage communities and address cultural concerns. Additional recommendations stress the importance of enhancing connectivity, addressing dissatisfaction related to medication usage, and providing healthcare professionals with telehealth training.\u003c/p\u003e\u003cp\u003ePolicy implications for the government include implementing education and awareness campaigns to foster telehealth acceptance, establishing regulatory frameworks to safeguard privacy, and integrating telehealth into national health policies to improve healthcare access in underserved regions. These strategies will guide stakeholders in developing a robust telehealth system that supports high-quality, cost-effective healthcare delivery.\u003c/p\u003e\u003cp\u003eThe study\u0026rsquo;s limitations include possible response bias from self-reported data, limited causal insights due to the quantitative approach, and a lack of direct telehealth observation. Additionally, the sample may not fully represent Pakistan\u0026rsquo;s healthcare landscape, as it skews younger. Future research could benefit from incorporating the perspectives of healthcare providers to enhance telehealth\u0026rsquo;s effectiveness by considering both patient and provider experiences.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The study received ethical approval from the Institutional Review Board (IRB) of the Health Services Academy, Islamabad. Written informed consent was obtained from all participants before data collection. I confirm that all methods were performed following the relevant guidelines and regulations, and that the study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTooba Malik conceptualized the study, designed the methodology, coordinated data collection, performed the statistical analysis, and drafted the manuscript. Muhammad Daoud Butt contributed to study design and supervised the data collection process. Siew Chin Ong reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAashima, M. Nanda and R. Sharma (2021). \u0026quot;A review of patient satisfaction and experience with telemedicine: a virtual solution during and beyond COVID-19 pandemic.\u0026quot; \u003cu\u003eTelemedicine and e-Health\u003c/u\u003e \u003cstrong\u003e27\u003c/strong\u003e(12): 1325-1331.\u003c/li\u003e\n\u003cli\u003eAdeghe, E. P., C. A. Okolo and O. T. 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Subbian (2021). \u0026quot;Identifying barriers to and opportunities for telehealth implementation amidst the COVID-19 pandemic by using a human factors approach: a leap into the future of health care delivery?\u0026quot; \u003cu\u003eJMIR human factors\u003c/u\u003e \u003cstrong\u003e8\u003c/strong\u003e(2): e24860.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cost-effectiveness, Digital health, Patient satisfaction, Telehealth, Virtual care","lastPublishedDoi":"10.21203/rs.3.rs-6902014/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6902014/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003ePakistan\u0026rsquo;s healthcare system faces critical challenges, including limited infrastructure and disparities in access between urban and rural regions. Telehealth has emerged as a promising solution to improve accessibility, but patient-centered evidence on its effectiveness and cost-efficiency remains limited.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA cross-sectional quantitative study was conducted from May to December 2023 using a validated, modified patient satisfaction tool. Data were collected from 532 patients via EZShifa\u0026rsquo;s telehealth platform across Pakistan. Key indicators included satisfaction, trust, comfort, accessibility, and cost. Statistical analyses included chi-square tests, ordinal regression, and independent samples t-tests.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eHigh satisfaction was reported with internet connectivity (94.9%), provider behavior (96.6%), consultation fees (93.9%), and diagnostic trust (80.8%). While 67.7% were satisfied with prescribed medications, 30.7% expressed dissatisfaction. Comfort was highest for follow-ups and lab reviews but lower for initial visits with new providers and sensitive discussions. Regression analysis identified comfort score (OR: 20.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and perceived quality of care (OR: 2.585, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) as significant predictors of telehealth acceptance. The average cost of a teleconsultation was PKR 2,000, compared to PKR 4,800 for in-person care. The incremental cost-effectiveness ratio (ICER) was PKR \u0026minus;\u0026thinsp;3,111.11, indicating telehealth was both more effective and less costly.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003eTelehealth offers a cost-effective, accessible, and patient-satisfactory alternative to traditional care in Pakistan\u0026rsquo;s primary healthcare system. These findings support broader telehealth adoption and the development of patient-centered digital health policies.\u003c/p\u003e","manuscriptTitle":"Enhancing Healthcare Access Through Telehealth: Patient-Centered Insights from Pakistan’s Primary Care Sector","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-02 08:44:21","doi":"10.21203/rs.3.rs-6902014/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-18T07:50:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-01T19:41:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336640677588230906229053403011429188615","date":"2025-08-27T07:47:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-26T09:14:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242651337531088662750320189950559184952","date":"2025-08-26T08:41:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-25T07:19:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T05:25:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-14T01:59:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-11T02:16:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-07-11T02:13:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f05fd57c-5d61-48a9-8c7c-09a73f40868c","owner":[],"postedDate":"September 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:07:35+00:00","versionOfRecord":{"articleIdentity":"rs-6902014","link":"https://doi.org/10.1186/s12913-025-13820-4","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-12-11 15:58:17","publishedOnDateReadable":"December 11th, 2025"},"versionCreatedAt":"2025-09-02 08:44:21","video":"","vorDoi":"10.1186/s12913-025-13820-4","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13820-4","workflowStages":[]},"version":"v1","identity":"rs-6902014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6902014","identity":"rs-6902014","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}