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Abstract

Telemedicine has rapidly evolved as an essential element of healthcare delivery in Saudi Arabia. This study explored a current perspective on the extent of utilization and level of beneficiaries’ satisfaction with telemedicine services in Saudi Arabia. A descriptive cross-sectional study was conducted in Saudi Arabia from January 2022 to June 2023. It used secondary data on telemedicine services extracted from 937-Medical call center and immediate virtual consultations (IVCs) via the Sehhaty health application, including offered, answered, abandoned, and non-assigned consultations; average talk time (ATT); and average waiting time or speed of answer (ASA). There were 7,481,259 offered calls to 937-Medical call center during the study period. The ASA was 13.2 ± 3.0 s, and the ATT was 2.04 ± 0.31 min. Around 97% of the offered calls were handled in the first half of 2023 with a shorter ASA of 10.5 ± 0.6 s. Most beneficiaries (94.9%) were satisfied with the 937-Medical call center. There were 712,984 offered IVCs during the study period. The ASA was 3.41 ± 1.07 min, and the ATT was 7.3 ± 0.7 min. Most beneficiaries (77.7%) were satisfied with the IVCs. This study provided an updated overview on the use of telemedicine services and beneficiaries’ satisfaction via 937-Medical call center and Sehhaty health application in Saudi Arabia between January 2022 and June 2023. 937-Medical call center service could handle about 96% of its received calls. Notably, most health seekers were satisfied with the healthcare services provided via the 937-Medical call center and Sehhaty health application.

Keywords

Telemedicine 937-Medical call center Sehhaty application immediate virtual consultations offered answered abandoned non-assigned consultations waiting time average talk time satisfaction kingdom of Saudi Arabia

Introduction

The World Health Organization (WHO) defines telehealth as “the delivery of healthcare services, where patients and providers are separated by distance. Telehealth involves the use of cost-effective and secure information communication technologies for the exchange of information for health surveillance, diagnosis and treatment of diseases and injuries, research and evaluation, and for the continuing education of health professionals.”^1,2 The term telehealth is frequently used interchangeably with the terms telemedicine or eHealth.³ However, telemedicine and eHealth represent separate domains within the larger framework of telehealth.⁴

Telemedicine refers to the delivery of clinical healthcare services from a distance using electronic information and communication technologies, such as computers, cameras, videoconferencing, and the internet.⁵ its primary focus is on direct patient care, including diagnosis, treatment, and prevention of disease and injuries, by facilitating medical interactions between healthcare professionals (HCPs) and patients who are geographically separated.⁶

Telemedicine has a lot of advantages mainly cost saving because delivering information is less expensive than transporting people to clinics or hospitals. Other advantages as immediate accessibility to medical expertise everywhere regardless their location, possible diagnoses and treatments, and shortening distance from rural to urban communities.^7-9

The importance of telemedicine became more obvious during COVID- 19 pandemic where the social distance is mandatory (Stay-at-home), patients avoid visiting hospitals and even emergency units, reduction in their needs to elective procedures.^10-13

So, the role of telemedicine has been emerged from its ability to minimize people's exposure to diseased persons and provide an on-demand alternative to traditional, in-person visits.^11,14-16

Also, patients with chronic illnesses or those who have risk factors for severe disease such as asthma or allergies can be evaluated through telemedicine service through delivering suitable disease management.¹⁷

A similar rationale can encourage the usage of telemedicine is to reach patients in areas having natural disasters or other conditions that may bring a risk to the patient and physician to the same location.¹⁸ Even many patients prefer the availability of telemedicine care service over the in-patient care (hospitals).¹⁹

Consequently, the usage of telemedicine service has increased considerably by health institutions in the United States from 35% to 76% from 2010 to 2017.⁸

The Federation of State Medical Boards defines telemedicine as “the practice of medicine using electronic communication, information technology, or other means between a physician in one location, and a patient in another location, with or without an intervening health care provider.”²⁰ The significance of telemedicine arises from its importance in countries with more rural areas or limited health infrastructure.^21,22

The Saudi Telemedicine Network (STN) was established in 2011.²³ The first service provided by the STN was 937-Medical call center in 2012. This free, confidential telephone service offers medical health care services in more than one language, 24/7, to beneficiaries. HCPs answer the received calls. They ask questions to determine the nature of the health problem and advise callers on how to manage their illness at home or recommend visiting a hospital if required.^24-26

The service offers four basic subservices: (1) medical consultations and other supportive surfaces as psychological consultations; (2) reporting complaints against public and private healthcare institutions; (3) appointment requests for primary healthcare centers and smoking cessation clinics; and (4) replying to inquiries such “How can I get information about infectious diseases, vaccinations, medical drugs availability, medical referrals, receiving suggestions or feedback about any health care service across the country, transaction follow-ups and offering technical support for applications introduced by MOH.”²⁷

In March 2018, the MOH, KSA decided to extend its telemedicine services by launching an internet-based service called Seha application.²⁸ In June 2021, Sehhaty application replaced the Seha application to provide the immediate virtual consultations (IVCs) service, which provides guidance via video and audio calls and text messages.^24,25

Prescribing medication is also available through Wasfaty (Sehhaty), allows patients to collect their medications from private and public pharmacies and providing them with the convenience of obtaining medications from their nearest pharmacy.²⁹ Wasfaty was launched on January 29, 2023, with 28,476 prescriptions had been prescribed up to June 30, 2023. Notably, physician drug prescribing practices have been linked to patient satisfaction.^30,31

The effectiveness and accessibility of telemedicine visits affect patients’ satisfaction with telemedicine, which is influenced by factors such as waiting times, comfort, convenience, and simplicity of access. Patients respect their privacy and confidentiality throughout telemedicine consultations.³² Telemedicine appointments typically have lower waiting times than conventional in-person appointments, explaining why patients are more satisfied.³³ We aimed to present an updated view of the utilization pattern and beneficiaries’ current satisfaction with 937-Medical call center and Sehhaty application in KSA.

Materials and Methods

Study Design and Participants

A descriptive cross-sectional study was conducted in KSA from January 2022 to June 2023. It used secondary data related to Saudi and non-Saudi beneficiaries of any age who used 937-Medical call center and/or Sehhaty application.

Data Collection and Analysis

This study used retrospectively extracted secondary data, which comprised 8,194,243 records for the two immediate telemedicine services: 937-Medical call center (7,481,259) and the IVC (712,984).

Data Collection Tools

The General Directorate of Medical Consultations in Seha Virtual Hospital (SVH), Saudi Ministry of Health was responsible for collecting the data from reports sent to the data department, SVH, concerning the 937- Medical call center and IVC extracted in an Excel sheet. All collected data, including beneficiary satisfaction scores and key call metrics, were stored on secure, password-protected servers. Access to the raw dataset was strictly limited to the research principal author and the data analyst, who were granted access through a secure, authenticated portal. No personally identifiable health information (PHI) was collected or stored as part of this study. The focus was on satisfaction scores and call metrics, which are not considered PHI under relevant regulations in the KSA.

Key Call Metrics

Nationally and regionally offered, answered, abandoned, and non-assigned calls, average talk time (ATT) and speed of answering (ASA; waiting time), and users’ evaluations were collected from 937-Medical call center. Offered calls were defined as calls that reached the queue to be forwarded to physicians, including answered, abandoned, and non-assigned calls. Answered calls were defined as calls that originated in a call queue and were handled by a physician. Abandoned calls were defined as calls that were discontinued by the caller 30 s after reaching the queue. Non-assigned calls were those that discontinued within 30 s of reaching the queue, usually due to technical issues, such as a poor internet network, especially for callers from rural areas. The ASA was defined as the time the caller had to wait to speak to a physician and was defined as the average consultation time with the caller. Offered and answered IVCs, ATT, ASA, and users’ evaluations of the service were collected for Sehhaty application. Answered IVCs were defined as all IVCs handled by physicians (Medically query answered), either completed successfully or those the patient ended/did not join.

The Beneficiaries’ Evaluation to Service

In 937, the beneficiary responds to a question about his experience with the service by Excellent, Good, or Bad. Satisfied beneficiary (number of calls evaluated as excellent or good/total number of evaluated calls). While in IVC, the beneficiary responds to nine questions about his satisfaction with service, the healthcare provider, and with the outcome of the encounter. Beneficiary evaluation was in five degrees: Acceptable, Good, Excellent, Weak and Bad. Satisfied beneficiary (number of calls evaluated as Acceptable, Good or Excellent /total number of evaluated calls).

The data were saved, organized, and analyzed using Excel (version 2019; Microsoft, Seattle, WA, USA) and SPSS (version 27; IBM Corp., Armonk, NY, USA). The following variables were analyzed descriptively using frequencies, percentages, or central tendency (mean ± standard deviation [SD]): offered calls, answered calls, abandoned calls, non-assigned calls, ASA, and ATT. Changes between the first half (H1) of 2022 and the H1 of 2023 (H1; January to June) were assessed using paired t-tests and chi-square tests, as appropriate, considering a significance level of 0.05.

Results

Performance and Beneficiaries’ Satisfaction with 937-Medical Call Center

As shown in Table 1, 937-Medical call center received 7,481,259 offered calls during 18-month study period (January 2022 to June 2023), of which 96% answered by 1162 physicians, 1% abandoned, and 2.84% non-assigned calls. The ASA was 13.2 ± 3.2 s, and ATT was 1.83 ± 0.37 min. The overall satisfaction rate was 94.9%.

Table 1.

Call Metrics and Satisfaction of the 937-Medical Call Center (January 2022-June 2023).

Regions	Offeredcalls	Answeredcalls	Abandoned(ABD) calls	Not assignedcalls	Average talk time (ATT)[min	Satisfaction
Regions	n (%)^b	n (%)^a	n (%)^a	n (%)^a	Mean ± SD	(%)
Central	3,037,527 (40.6)	2,935,304 (96.63)	27,978 (0.92)	74,245 (2.44)	1.82 ± 0.39	96.0
West	1,619,042 (21.6)	1,545,143 (95.4)	19,050 (1.18)	54,849 (3.39)	1.81 ± 0.33	95.4
South	1,440,389 (19.3)	1,376,728 (95.58)	18,314 (1.27)	45,346 (3.15)	1.78 ± 0.35	94.6
North	744,893 (10.0)	712,962 (95.71)	8791 (1.18)	23,140 (3.11)	1.76 ± 0.37	93.1
East	639,409 (8.5)	608,513 (95.17)	8217 (1.29)	15,010 (2.35)	2.21 ± 0.30	96.2
Overall	7,481,259	7,178,650 (96.0)	82,350 (1.10)	212,589 (2.84)	1.83 ± 0.37	94.9

Bold values represent overall areas or regions.

Out of the total offered calls during specific region January 2022-June 2023; [Row % in each region].

Out of the total offered calls during January 2022-June 2023 [ Column %].

Regionally, 937-Medical call center exhibited impressive performance. The Central region of the KSA had the highest call volume, with a relatively low abandonment rate of 0.92% and an impressive beneficiaries’ satisfaction rate of 96%. The West and South regions exhibited comparable metrics, albeit with slightly varying satisfaction levels of 95.4% and 94.6%, respectively. Conversely, North region had the lowest call volume and satisfaction rate of 93.1%. Despite receiving fewer calls, East region had the highest satisfaction rate of 96.2% (Table 1).

Performance and Beneficiaries’ Satisfaction with IVC Service

As shown in Table 2, the IVC answer rate was 91.6%, out of 712,984 offered consultations (January 2022-June 2023), ATT was 7.3 ± 0.7 min, and the beneficiaries’ satisfaction rate was 77.7%. The IVC service demonstrated a commendable performance across all regions. In the Central region of KSA, physicians answered 87.2% of IVC requests, and the beneficiaries’ satisfaction rate was 84.3%, indicating a positive overall experience. The ATT of 8.2 ± 0.9 min suggested thorough engagement with callers. In the East region, an impressive 97.5% of IVC requests were answered, the ATT was 7.3 ± 0.3 min, and the beneficiaries’ satisfaction rate was 83.6%. The North and South regions exhibited varying performance, with North region having a higher IVC answer rate but a lower beneficiaries’ satisfaction rate than the South region. However, both regions had similar ATTs, signaling consistency in service delivery. In the West region, while accounting for 35.0% of offered IVCs, the answer rate and beneficiaries’ satisfaction rate were comparatively lower. However, the ATT of 7.8 ± 0.2 suggested efficient IVC handling (Table 2).

Table 2.

Saudi Regional Data for Offered, and Medical Query Answered Consultations Through Immediate Virtual Consultations (IVC) (January 2022-June 2023) (n = 712,984).

Region	Offered consultations %^a	Medical query answered consultations % ^b	Satisfied(%)^c	Average talk time (ATT) (min.)mean ± SD
Central	80,567 (11.3)	70,255 (87.2)	59,225 (84.3)	8.2 ± 0.9
East	98,392 (13.8)	95,932 (97.5)	80,199 (83.6)	7.3 ± 0.3
North	101,244 (14.2)	97,396 (96.2)	73,145 (75.1)	6.9 ± 0.5
South	183,237 (25.7)	166,379 (90.8)	122,954 (73.9)	6.9 ± 0.5
West	249,544 (35.0)	215,357 (86.3)	171,209 (79.5)	7.8 ± 0.2
Overall	712,984 (100.0)	653,093 (91.6)	507,454 (77.7)	7.3 ± 0.7

Bold values represent overall areas or regions.

Satisfied = excellent and Good, ^aOut of the total offered calls, ^bOut of the total offered calls in specific region, ^cOut of total answered in specific region during June 2022-June 2023.

Comparing 937-Medical Call Center and IVCs in the First Halves of 2022 and 2023

As shown in Tables 3 and 4, the rate of answered calls for 937-Medical call center was greater in H1 of 2023 than H1 of 2022 (+2.02%), while the rate of abandoned calls was lower (−0.07%). In addition, the ASA for 937-Medical call center and IVC services was shorter (−6.5 s and −1.07 min, respectively). During H1 of 2023, the ATT was longer in the 937-Medical call center (+0.22 min) but shorter for IVCs (−2.26 min). Interestingly, beneficiaries’ satisfaction with 937-Medical call center was higher in the H1 of 2023 than in H1 of 2022 (98% vs 94%, respectively). Comparing beneficiaries’ satisfaction with IVCs between H1 of 2022 and H1 of 2023 was impossible because the data for this service was only available from June 2022.

Table 3.

Call Metrics of 937—Medical Call Center in Saudi Arabia in the First Half of 2022 Compared with First Half of 2023 (January 2022-June 2023).

	Offered calls	Answered calls (%)	Abandoned (ABD) calls (%)	Non-assigned calls^a (%)	Average waiting time (ASA)(sec.)(Mean ± SD)	Average talk time (ATT) (min.)(Mean ± SD)
H1 2022	3,529,172	3,364,942 (95.3%)	37,213 (1.1%)	127,017 (3.6%)	17.0 ± 1.2	1.95 ± 0.26
H1 2023	1,665,552	1,621,702 (97.36)	16,350 (0.98)	27,500 (1.65)	10.5 ± 0.6	2.17 ± 0.35
Difference^b	−1,863,620	+ 2.06%	− 0.12%	− 1.95%	− 6.5	+ 0.22
Effect size (Cohen)	NA	h = 0.13	h = 0.04	h = 0.12	d = −6.93	d = 0.72

Non-assigned calls: Calls that ended within 30 s from entering the queue; ABD, abandoned calls that missed after 30 s from entering the queue; ASA, average speed of answer; SD, standard deviation. H1: first half of the year; ^bH1 2023 statistics compared with H1 2022, h = Cohen's *h* (for proportions): small effect (h ≈ 0.2), medium (h ≈ 0.5), large (h ≥ 0.8). d = Cohen's *d* (for means):"Small (d ≈ 0.2), medium (d ≈ 0.5), large (d ≥ 0.8).

Table 4.

Study Variables Statistics of Immediate Virtual Consultations (IVC) in Saudi Arabia in the First Half of 2022 Compared with First Half of 2023.

Telemedicine service	Offered consultations	Average waiting time (min.)(Mean ± SD)	Average talk time (min.)(Mean ± SD)
H1 2022	222,000	4.32 ± 0.90	8.79 ± 0.69
H1 2023	211,423	3.25 ± 1.12	6.53 ± 0.33
Difference^a	−10,577	− 1.07	− 2.26
Effect size (Cohen)	h = 0.052	d = −1.05(large)	d = −4.9(very large)

H1 2023 statistics compared with H1 2022; SD: Standard deviation; H1 means first half of the year, h = Cohen's *h* (for proportions): Small effect (h ≈ 0.2), medium (h ≈ 0.5), large (h ≥ 0.8). d = Cohen's *d* (for means):"Small (d ≈ 0.2), medium (d ≈ 0.5), large (d ≥ 0.8).

Discussion

Telemedicine can expand healthcare access in KSA reliably and affordably easier. This study evaluated the capacity and user satisfaction of two immediate telemedicine services in KSA namely: 937-Medical call center and Immediate Virtual Consultations (IVCs) via the Sehhaty application from January 2022 to June 2023. Beneficiaries generally reported high efficiency and satisfaction for both the call center's services and the Sehhaty application. This aligns with a recent Riyadh-based study showing that the public increasingly favors telephone consultations through the Seha application and 937-Medical call center over traditional primary healthcare visits, with both patients and HCPs reporting satisfaction.³⁴

937-Medical Call Center

Over an 18-month period, from January 2022 to June 2023, the 937-Medical call center received nearly 7.5 million calls. An impressive 96% of these calls were answered by 1162 physicians, contributing to a high overall satisfaction rate of 94.9%. Only a small fraction of calls, 1%, were abandoned.

Previous studies in KSA have shown the impact of 937-Medical call center service in delivering healthcare to Saudi inhabitants.^34-36 Similarly, a study concluded that telemedicine has been widely received by both HCPs and patients.³⁷ Research in UK revealed 9% of respondents utilized the telephone health services provided by the National Health Service, and 59% were aware of these services.³⁸ The Saudi government's initiatives have led to increased public's use of telemedicine as an alternative method for non-emergency consultations.³⁵

The offered calls were greater in H1 of 2022 than in H1 of 2023. That period correlated to coronavirus 2019 disease (COVID-19) pandemic, appearance of new variants, and vaccination programs. The percentage of handled calls increased, while abandoned rate and ASA decreased in H1 of 2023.

This high utilization rate may be attributed to the government's initiatives that had led to encouragement and increase use of telehealth services throughout the kingdom as an alternative method for non-emergency situations together with increased public awareness that had born from the great role of telemedicine in combating COVID-19 and encouraging its vaccination.³⁵ In telemedicine, it should be noted that the rate of missed virtual visits is significantly lower in contrast with in-person encounters, that had financial implications.³⁹ According to one of the search results, teleconsultations take less time than in-person consultations, which makes it possible to provide medical care to more patients that is a crucial aspect of primary care.⁴⁰

According to a university of Iowa study by Nicholas et al in United States, hospitals that used telemedicine services experienced an average 6-min reduction in waiting times for patients when compared to those, which did not use the technology. The length of stay at the hospital's emergency room was shorter for patients who received telemedicine consultations. The authors speculate that the reason for this shorter time might be that staff members who are stationed remotely are finishing administrative and charting duties, allowing local staff members to focus on patient care.⁴¹

MOH exerted great efforts to enhance telemedicine services by performing widespread training programs for HCPs not only in the capital city but also extending to all regions of the country. The rate of abandoned calls was higher in early 2022, owed to less developed infrastructures and fewer HCPs relative to the offered calls. Telemedicine faces human, professional, technical, organizational, financial, and legal challenges.⁴² Another study in KSA showed public understands and use of telemedicine increased from 46% to 78% and 2% to 48%, respectively, from pre-COVID-19 to COVID-19 periods.²³ Many people preferred to consult HCPs by telephone due to shorter wait and travel times, ease of use, and flexibility.^43,44

Most beneficiaries were satisfied, consistent with local and global trends in satisfaction with telemedicine.^19,45,46 Even with the use of a single “satisfaction” question, the survey yielded positive general results that accurately reflect overall beneficiaries’ satisfaction across the kingdom. Globally several studies designated high satisfaction as Tanya Ngo's survey on patient satisfaction with telemedicine during the COVID-19 pandemic at a student-run free clinic found that 97.6% of patients were satisfied with their telehealth experience.⁴⁷ The consequences of a study by Sheena Bhuva exhibited that telehealth can be a device to give satisfactory and successful care, on account of which a more prominent number of patients favored a virtual consultation to a face-to-face experience.⁴⁸ Similarly, studies conducted in 2022 on telemedicine revealed satisfaction was highest among those living in USA (New York City and Los Angeles), Philippines, United Arab Emirates, KSA, India, and Iran.⁴⁹ A prior study reported that 83% of users were satisfied from 937-Medical call center.²⁸

Regionally, the 937-Medical Call Center showed strong performance across Saudi Arabia. The Central region experienced the highest call volume and an excellent 96% beneficiary satisfaction rate, coupled with a very low 0.92% abandonment rate. The West and South regions demonstrated similar performance, with satisfaction rates of 95.4% and 94.6%, respectively. In contrast, the North region had the lowest call volume and the lowest satisfaction rate at 93.1%. Interestingly, despite receiving fewer calls, the East region recorded the highest satisfaction rate of 96.2%.

Consistent with our study, a previous survey of awareness and usage of 937-Medical call center revealed that East region showed notable utilization.²⁶ In addition, a recent study in Jeddah (West region of KSA) showed high satisfaction and positive attitudes toward telemedicine services among patients who participated in telemedicine services of the MOH. Most (93%) acknowledged that telehealth services had enhanced healthcare access and showed a willingness to engage in future telemedicine consultations. They reported the highest satisfaction with the ability to talk freely over telemedicine and the ease of registration or scheduling.⁵⁰ Notably, individuals living in big cities of KSA, such as Riyadh (Central) and Jeddah (West), or East region were more knowledgeable about service than in other regions, likely explained by the financial support of large cities.⁵¹ In contrast, a previous study reported that individuals in rural areas were more aware of telehealth services than those in urban areas as they represent an easily accessible way of consultations.⁵²

Interestingly, higher satisfaction rates and decreased waiting time observed in H1 of 2023 than H1 2022 (98% and 10.5 ± 0.6 s than 94% and17 ± 1.2 s, respectively) are consistent with MOH's continuous development to keep pace with Vision 2030. A previous study conducted to define and measure patient satisfaction with medical care supposed that improving efforts to decrease waiting times can lead to increase satisfaction.⁵³

IVCs

Sehhaty application is widely used in KSA, with a substantial number of beneficiaries conducting e-consultations including IVCs,³² with relatively longer waiting times than 937-Medical call center. It is well known that utilizing mobile applications frequently involves technical problems, which could make the technology less accessible.⁵⁴

More than three-fourths of our beneficiaries were satisfied with IVC service. Expanding the prescription service in IVCs via Wasfaty expected to increase this satisfaction rate in the coming years. This is consistent with a USA study, found that satisfaction correlated positively with receiving telemedicine prescriptions.⁵⁵ Similarly, a study published in the British Journal of General Practice found that general practitioners who prescribed fewer antibiotics received lower patient satisfaction scores. The research indicated that a 25% reduction in antibiotic prescribing was associated with a 0.5-1.0% decrease in patient satisfaction scores, suggesting that patients often equate receiving antibiotics with better care, regardless of clinical appropriateness.⁵⁶

According to one study, 76% of users were generally satisfied with Sehhaty application, indicating a high acceptance rate.⁵⁷ The remarkably elevated levels of convenience and satisfaction correspond to previous studies in KSA, where more than 80% of surveyed participants stated that they were either very satisfied or satisfied with overall quality of care and experiences with telemedicine, both in general^50-51,58-61 and specialists contexts.^62-64 Moreover, one study examining general population of KSA found more than half of respondents used e-consultations, making it one of the most frequently used services. Another study reported that nearly half of respondents used the health check service in the application, showing a higher utilization rate in general population.^65-67

Saudi population used phone consultations extensively in 2022,³⁴ likely due to easy use and greater trust and acceptance of this technology.^68,69 MOH's initiatives to accelerate digital health transformation and empowerment by developing and maintaining high-quality telemedicine services also played a role.^34,70-72

Regarding our results of consultation services throughout all Saudi regions, The Central region showed the highest beneficiaries’ satisfaction (84.3%) and a relatively higher ATT of 8.2 ± 0.9 min indicating a positive overall experience and thorough caller-physician engagement. A previous study assessed access and disparities in telemedicine in KSA indicated telemedicine was predominantly used in urban regions. Guaranteeing that underserved populations in rural areas receive equitable access to healthcare services, including telemedicine, is essential.⁷³ A recent study in Riyadh, KSA, showed that participants lived in urban areas expressed high satisfaction with their IVCs despite technical difficulties.⁷⁴ According to one of the search results, teleconsultations take less time than in-person consultations, which makes it possible to provide medical care to more patients that is a crucial aspect of primary care.⁴⁰

Despite accounting for the highest percentage of received IVCs of 97.5%, beneficiaries’ satisfaction and ATT were lower (83.6% and 7.3 ± 0.3 min respectively) in East region than the Central region. This finding is consistent with a survey conducted in Al-Dammam, in East region, KSA, most HCPs expressed high telemedicine awareness and displayed a keen interest in incorporating it into their practice. This was influenced by their awareness, knowledge, prior experience, and affinity for telemedicine.⁷⁵

While West region had the highest percentage of offered IVCs (35%), the answered rate and beneficiaries’ satisfaction were comparatively lower (86.3% and 79.5%, respectively). With a relatively higher ATT of 7.8 ± 0.2 min suggesting efficient handling of IVCs.

Consistent with our findings, a previous study showed a higher percentage of Seha application users (prior to Sehhaty application) were from West region.⁶⁴ Paradoxically, a study in Jeddah, in the West region of KSA, reported high satisfaction with favorable telemedicine perceptions. Most participants agreed that telehealth services have enhanced accessibility and expressed their willingness to engage in future telemedicine consultations.⁵¹

Increased Sehhaty application utilization attributed to its continuous development by MOH and the Saudi Data and Artificial Intelligence Authority to achieve the MOH's targeted goals for Vision 2030.²⁴ Technical problems like those encountered in 2022 were linked to network and/or mobile applications, which are common barriers and associated with low utilization and satisfaction.⁶⁵

Conclusion

937-Medical call center in Saudi Arabia could handle 96% of its received calls and most health seekers were satisfied with it and IVCs Sehhaty application in providing healthcare services.

Ethical Consideration

This study was conducted in accordance with the Declaration of Helsinki and all applicable local regulations. The Central Institutional Review Board Committees (IRB) of the Ministry of Health, Riyadh, Saudi Arabia reviewed and approved this study after receiving the acceptance from Data Management Office of Ministry of Health on extraction of research data from the electronic records data base of General Directorate of Medical Consultations. Confidentiality and anonymity of the participants’ data were preserved. This study was dependent on anonymous secondary data; therefore, no consent for participation was required. No data was used other than the purpose stated and no one will access to data except the principal investigator and the data analyst.

Data Availability Statement

Ensuring the privacy of our research participants is paramount; therefore, the data supporting these findings are not publicly shared. Researchers interested in accessing the data for legitimate purposes may contact the corresponding author, Mona Elzohri, for a reasonable request.

Limitations

A thorough evaluation of the secondary data is needed to assess its relevance and accuracy. Moreover, it rarely provides all the answers you need as it provides us with collective data about the call-related dynamics and the total beneficiaries’ satisfaction per physician per month.

Unavailability of beneficiaries’ demographic characteristics or the nature of their complaints. This is important for understanding association between users’ characteristics and satisfaction. (eg, females give excellent evaluation than males, and younger people give excellent evaluation than older people.

Using automated one question to measure satisfaction in 937-Medical call center is considered another limitation as we could not determine this satisfaction or dissatisfaction was to either service or physicians.

Self-selection bias (volunteer bias): as the beneficiaries self-select selfies to respond to the satisfaction that affects the validity and generalizability of the data.

Recommendations

It is recommended to continue enhancement of telemedicine infrastructure and accessibility in all KSA regions by expanding high-speed internet coverage, especially in rural and underserved areas, developing user-friendly telemedicine platforms with multilingual support to improve accessibility and ensure platforms are mobile-friendly, as a significant portion of users access healthcare via smartphones. Launching comprehensive public awareness campaigns and continuous professional development opportunities for HCPs to improve their delivering skills, future research could assess and compare beneficiaries’ perspectives and healthcare providers’ satisfaction levels.

Footnotes

Acknowledgements

The authors would like to thank all individuals who facilitated this study.

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MHE, EED, AA, and MM. The first draft of the manuscript was written by AAA, YOD, MHE, and MA. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Code Availability

(software application or custom code): Not applicable.

Consent to Participate

Since this study used anonymous secondary data, informed consent from participants was waived. The data was only used for the stated purpose, and only the principal investigator and data analyst could access the data.

Consent for Publication

The principle author (Mona. H. Elzohri) has obtained all necessary permissions and approvals for publication of the research study.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Central Institutional Review Board Committees of the MOH, Riyadh, KSA (log number: 23-81 M) after being approved by the Data Management Office of the MOH to extract data for research. The confidentiality and anonymity of participants’ data were preserved.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Ali Abdulmana A Awadh

Mona H Elzohri

Eman D El Desouky

Abdullah Alkattan

Mohammed Aldossary

References

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World Health Organization. Global Diffusion of EHealth: Making Universal Health Coverage Achievable: Report of the Third Global Survey on EHealth. World Health Organization; 2017, https://www.who.int/publications/i/item/9789241511780 .

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