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Antezana LA, Xie KZ, Yin LX, Bowen AJ, Yeakel S, Nassiri AM, Moore EJ. Performing parotidectomy postoperative follow-ups via telemedicine: Experience at a tertiary care, multiple-surgeon otolaryngology center. J Telemed Telecare 2024; 30:739-746. [PMID: 35549759 DOI: 10.1177/1357633x221095319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We examined the suitability of using a video visit platform to perform postoperative parotidectomy evaluation at a tertiary care, multiple-surgeon otolaryngology center. METHODS A retrospective case review was conducted of patients who underwent parotidectomy and postoperative video visits between November 2019 and December 2020. Success of video visit, plan if applicable, and post-visit outcomes were reviewed. Video visits were designated as successful if the physician could assess for complications in the postoperative course (e.g. first bite pain, Frey syndrome, ear numbness, unplanned visits to the emergency department, unplanned return to the operating room), perform examination of facial nerve function, and formulate care recommendations per clinical judgement without deferment of recommendations for a subsequent in-person visit. RESULTS There were 96 postoperative video visits with 91 unique parotidectomy patients. Demographics: 28/63 male/female; average age, 54y. All video visits were suitable for successful postoperative parotidectomy patient evaluation. Eight visits (8.3%) consisted of patients presenting with common postoperative complications (e.g. eye dryness, first bite pain) and warranted care recommendations. In only two cases did the patient require further in-person procedural (hematoma evacuation, seroma aspiration) follow-ups. For the other 91.7% of visits (n = 88), no additional recommendations were required as patients experienced uncomplicated postoperative courses. Of all the patients, 26.1% (n = 23) were instructed to follow-up for routine surveillance. All other patients, 73.9% (n = 65) were instructed to follow-up as needed. CONCLUSION Postoperative parotidectomy evaluation is highly amenable to being performed by video. A telemedicine option offers convenience for patients in the majority of cases without compromising clinical assessment and judgment for the physician.
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Affiliation(s)
- Luis A Antezana
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Katherine Z Xie
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ashley M Nassiri
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Montalbaron MB, Achlatis E, Johnson AM, Ma Y, Young VN, Rosen CA, Amin MR, Kwak PE. Presumptive Diagnosis in Tele-Health Laryngology: A Multi-Center Observational Study. Ann Otol Rhinol Laryngol 2023; 132:1511-1519. [PMID: 37070580 DOI: 10.1177/00034894231165811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Early in the COVID-19 pandemic, outpatient visits were adapted for the virtual setting, forcing laryngologists to presume certain diagnoses without the aid of laryngoscopy, solely based on history and the limited physical exam available via video visit. This study aims to examine the accuracy of presumptive diagnoses made via telemedicine, compared to subsequent in-person follow up, where endoscopic examination could confirm or refute suspected diagnoses. METHODS A retrospective chart review was conducted of 38 patients evaluated for voice-related issues at NYU Langone Health and the University of California-San Francisco. Presumptive diagnoses at the initial telemedicine encounter were noted, along with diagnostic cues used for clinical reasoning and recommended treatment plans. These presumptive diagnoses were compared to diagnoses and plans established following laryngoscopy at follow-up in-person visits. RESULTS After laryngoscopy at the first in-person visit, 38% of presumptive diagnoses changed, as did 37% of treatment plans. The accuracy varied among conditions. Muscle tension dysphonia and Reinke's edema were accurately diagnosed without laryngoscopy, but other conditions, including vocal fold paralysis and subglottic stenosis, were not initially suspected, relying on laryngoscopy for diagnosis. CONCLUSIONS While some laryngologic conditions may be reasonably identified without in-person examination, laryngoscopy remains central to definitive diagnosis and treatment. Telemedicine can increase access to care, but it may provide more utility as a screening tool, triaging which patients should present more urgently for in-person laryngoscopy. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Michael B Montalbaron
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Efstratios Achlatis
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Aaron M Johnson
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Yue Ma
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - VyVy N Young
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Paul E Kwak
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Choi L, Riedinger C, Gardner K, Ziegler C, Brinson R, Sutton E. Gauging the Acceptance of Telemedicine in Postoperative Evaluation of Uncomplicated Laparoscopic Appendectomy and Cholecystectomy. TELEMEDICINE REPORTS 2023; 4:259-265. [PMID: 37637377 PMCID: PMC10457610 DOI: 10.1089/tmr.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/29/2023]
Abstract
Background Telemedicine is a rising field, with continuous expansion into different realms of health care delivery. However, minimal research has been done to analyze the utilization in surgical specialties. This study aims to assess satisfaction and acceptance of postoperative telehealth care after uncomplicated general surgery cases. Methods Patients who had undergone uncomplicated laparoscopic cholecystectomy or uncomplicated laparoscopic appendectomy were eligible to be enrolled in this study. Patients with gangrenous gallbladder, malignancy, operative complications, or appendix perforation were excluded. The experimental group underwent postoperative follow-up within a web-based platform (http://bluejeans.com), whereas the control group had an in-person clinic visit. Survey results containing satisfaction, comfort, and time usage were obtained. Likert scale 1-5 was utilized to quantify responses. Results Thirty patients were enrolled into this prospective single intervention trial (20 experimental, 10 control). Ninety percent (n = 18) of the experimental group stated satisfaction with their visit, and 75% (n = 15) would suggest telemedicine usage to other physicians. Postoperative visit satisfaction was not statistically different between the experimental and control groups (4.2 vs. 4.5, p = 0.124). A higher percentage of the control group took >3 h for the visit than the telemedicine group (30% vs. 15%), with two individuals in the control group dedicating their full day to the visit, compared with zero individuals in the experimental group. Comfort with technology used during the visit was not statistically different between the telemedicine and in-person groups (4.35 vs. 4.5, p = 0.641). Conclusions Telemedicine for postoperative evaluation on selective general surgery cases is feasible and provides adequate patient satisfaction and improved time utilization.
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Affiliation(s)
- Lily Choi
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA
| | - Courtney Riedinger
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kent Gardner
- Office of Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Craig Ziegler
- Office of Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Reginald Brinson
- Office of Information Technology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erica Sutton
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
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Gupta T, Bhutta MF. Outcomes of remote versus face-to-face ear, nose and throat outpatient consultation on patient pathways. Ann R Coll Surg Engl 2023; 105:561-567. [PMID: 36688846 PMCID: PMC10313455 DOI: 10.1308/rcsann.2022.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Remote consultation has potential benefits in increasing patient pathway efficiency and has been found to reduce costs and carbon emissions. Previous studies of remote consultation in ear, nose and throat (ENT) practice have reported mixed results and used relatively small sample sizes. The aim of this article is to study the impact of remote telephone consultation on ENT clinic outcomes and pathway efficiency, compared with in-person review, within new and follow-up patient cohorts and subspeciality, where previous studies demonstrate mixed and inconclusive results. METHODS This was a comparison of remote clinic appointment outcomes over a 2-month period from a single ENT referral centre (426) with an equivalent data set of face-to-face clinic appointments over a similar time frame (1,533). Statistical analysis included chi-squared test for clinic outcomes and two-sample t-squared test for mean hand-off between both cohorts (p < 0.05). RESULTS For new referrals, remote consultation was associated with statistically significantly greater rates of follow-up (p < 0.00001), investigation (p = 0.00251) and hand-off (p < 0.00013) than patients seen face-to-face - particularly where presenting with head and neck symptoms. For follow-up patients, remote consultation had similar rates of investigation (p = 0.11071) or further follow-up (p = 0.08) and mean hand-off (p < 0.11764) to those seen face-to-face. CONCLUSIONS Remote consultation in ENT could become the norm for follow-up patients, but should be used with caution in the initial consultation of new patients.
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Affiliation(s)
- T Gupta
- Brighton and Sussex University Hospital NHS Foundation Trust, UK
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5
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Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:108. [PMID: 35922663 PMCID: PMC9349203 DOI: 10.1038/s41746-022-00655-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022] Open
Abstract
The Sars-CoV-2 pandemic catalysed integration of telemedicine worldwide. This systematic review assesses it’s accuracy for diagnosis of Surgical Site Infection (SSI). Databases were searched for telemedicine and wound infection studies. All types of studies were included, only paired designs were taken to meta-analysis. QUADAS-2 assessed methodological quality. 1400 titles and abstracts were screened, 61 full text reports were assessed for eligibility and 17 studies were included in meta-analysis, mean age was 47.1 ± 13.3 years. Summary sensitivity and specificity was 87.8% (95% CI, 68.4–96.1) and 96.8% (95% CI 93.5–98.4) respectively. The overall SSI rate was 5.6%. Photograph methods had lower sensitivity and specificity at 63.9% (95% CI 30.4–87.8) and 92.6% (95% CI, 89.9–94.5). Telemedicine is highly specific for SSI diagnosis is highly specific, giving rise to great potential for utilisation excluding SSI. Further work is needed to investigate feasibility telemedicine in the elderly population group.
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6
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Bray JO, Sutton TL, Akhter MS, Iqbal E, Orenstein SB, Nikolian VC. Outcomes of Telemedicine-Based Consultation among Rural Patients Referred for Abdominal Wall Reconstruction and Hernia Repair. J Am Coll Surg 2022; 235:128-137. [PMID: 35703970 DOI: 10.1097/xcs.0000000000000213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perioperative telemedicine use has increased as a result of the COVID-19 pandemic and may improve access to surgical care. However, studies assessing outcomes in populations at risk for digital-health disparities are lacking. We sought to characterize the pre- and postoperative outcomes for rural patient populations being assessed for hernia repair and abdominal wall reconstruction with telehealth. METHODS Patients undergoing telehealth evaluation from March 2020 through May 2021 were identified. Rurality was identified by zip code of residence. Rural and urban patients were compared based on demographics, diagnosis, treatment plan, and visit characteristics and outcomes. Downstream care use related to supplementary in-person referral, and diagnostic testing was assessed. RESULTS Three hundred-seventy-three (196 preoperative, 177 postoperative) telehealth encounters occurred during the study period (rural: 28% of all encounters). Rural patients were more likely to present with recurrent or incisional hernias (90.0 vs 72.7%, p = 0.02) and advanced comorbidities (American Society of Anesthesiologists status score > 2: 73.1 vs 52.1%, p = 0.009). Rural patients derived significant benefits related to time saved commuting, with median distances of 299 and 293 km for pre- and postoperative encounters, respectively. Downstream care use was 6.1% (N = 23) for additional in-person evaluations and 3.4% (N = 13) for further diagnostic testing, with no difference by rurality. CONCLUSIONS Perioperative telehealth can safely be implemented for rural populations seeking hernia repair and may be an effective method for reducing disparities. Downstream care use related to additional in-person referral or diagnostic testing was minimally impacted in both the preoperative and postoperative settings. These findings suggest that rurality should not deter surgeons from providing telemedicine-based surgical consultation for hernia repair.
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Affiliation(s)
- Jordan O Bray
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Thomas L Sutton
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Mudassir S Akhter
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Emaad Iqbal
- Department of Surgery, Columbia University Medical Center, New York, NY (Iqbal)
| | - Sean B Orenstein
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Vahagn C Nikolian
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
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7
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Xie KZ, Antezana LA, Bowen AJ, Yin LX, Yeakel S, Nassiri A, Moore EJ. Telemedicine evaluation of new head and neck patients at a tertiary academic clinic during the coronavirus disease 2019 pandemic. J Telemed Telecare 2022:1357633X221100054. [PMID: 35668638 PMCID: PMC9177817 DOI: 10.1177/1357633x221100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 accelerated the use of virtual visits within health care. We examined the utility of telemedicine for conducting visits in a tertiary head and neck practice. METHODS A retrospective study was conducted on patients presenting via video to a tertiary-level head and neck clinic between January 2020 and December 2020. Patient demographics were collected in addition to visit indication, diagnostic imaging/tests at the time of visit, and post-visit plan. Visits were deemed successful if evaluation by video was sufficient in determining a clinical plan and did not require deferment of recommendations for subsequent in-person consult visits and/or work-up (labs, imaging). Logistic regression was performed to identify variables that served as significant predictors of successful video visits. RESULTS A total of 124 video visits were reviewed. Video visits were successful for the initial evaluation 88.7% of the time (n = 110). Computerized tomographic scans were the most available diagnostic test, available for 54% of patients (n = 67), followed by biopsy report 30.6% (n = 38). Visit indication had a statistically significant effect on whether a treatment plan could be made (p = 0.024). For new patients with parotid masses (n = 42), definitive treatment plans could be made 97.6% of the time (n = 41). Patients presenting with an indication of thyroid mass (odds ratio: 0.19 (confidence interval: 0.00072-0.50), p = 0.018) and other neck mass (odds ratio: 0.035 (confidence interval: 0.0014, 0.90), p = 0.043) were at significantly lesser odds than parotid patients to have a successful video visit. DISCUSSION In this study, virtual visits were successful for a high percentage of head and neck visits, particularly among patients seeking evaluation for parotid-related concerns.
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Affiliation(s)
- Katherine Z Xie
- Mayo Clinic Alix School of
Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luis A Antezana
- Mayo Clinic Alix School of
Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Ashley Nassiri
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
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Dhillon K, Manji J, Tapia Céspedes M, Prasad J, Kleid S, Flatman S, Nguyen K, McLean T, Magarey M. Use of telemedicine consultations in head and neck cancer: patient perceptions, acceptability and accessibility. ANZ J Surg 2022; 92:1415-1422. [PMID: 35490336 DOI: 10.1111/ans.17722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUNDS Telemedicine has been effective in the management of various medical conditions, however, there is limited knowledge of its use in head and neck oncosurveillance. This is of importance currently while trying to mitigate the risk of transmission during the COVID-19 pandemic. This study aims to evaluate acceptability, satisfaction and perceptions of telemedicine technology among outpatients for head and neck oncologic surveillance. METHODS A cross-sectional study was conducted for head and neck surgical oncology patients who attended telemedicine consultations between March and October 2020 at the Peter MacCallum Cancer Centre. Data on demographic, socioeconomic and acceptability variables was collected, utilizing Likert scale questions. The primary outcome measures were patient satisfaction and perceptions, while the secondary outcome was access to technology. RESULTS One hundred and fifteen patients were invited to participate, and 100 were included in the final analysis; 95% of patient's had a positive experience with telemedicine appointments and were willing to have future telemedicine appointments. Regional and rural patients were more accepting of telemedicine consultations, citing savings in travel time and the minimal disruption to normal day-to-day activities. All participants had access to telecommunication devices, with 63% having three or more devices. Issues identified include a lack of physical examination by clinician for 65% of participants and the inability to self-examine for 88% of participants. CONCLUSION The study demonstrates patients' acceptance of telemedicine appointments as a component of outpatient surveillance for head and neck surgical oncology. This has benefits during the COVID-19 pandemic in addition to increasing accessibility for rural patients.
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Affiliation(s)
- Kaman Dhillon
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jamil Manji
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mario Tapia Céspedes
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jessica Prasad
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen Kleid
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Samuel Flatman
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kevin Nguyen
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Timothy McLean
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Matthew Magarey
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
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Holtmann LC, Deuß E, Meyer M, Kaster F, Bastian T, Schleupner MC, Hagedorn E, Lang S, Arweiler-Harbeck D. Detection accuracy of soft tissue complications during remote cochlear implant follow-up. Cochlear Implants Int 2022; 23:249-256. [PMID: 35477412 DOI: 10.1080/14670100.2022.2067644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear implant centre's portfolio. The aim of this study was to evaluate the accuracy of photographs of the skin covering the implant to reliably detect skin irritations or soft tissue complications. METHODS During routine follow-up consultations, 109 CI patients were examined in person and asked to take a photograph of the skin covering the implant using their smartphones. Photographs were digitally and remotely evaluated by two CI physicians who were blinded to the findings during the in-person examination. RESULTS In nine cases, skin abnormalities were detected by the CI physician upon in-person examination, seven of which required immediate treatment. Both digital evaluators reliably detected all treatment-requiring conditions. Overall, more skin irritations were suspected digitally compared to in-person examination. Without additional information from the patients' medical record, sensitivity was 100% and specificity was 63%; with additional information provided, sensitivity was 100%, and specificity increased to 65.3%. CONCLUSION Digital photographic assessment of the skin covering the implant is a highly sensitive method to detect skin irritations and could reduce the number of necessary in-person consultations.
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Affiliation(s)
- L C Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Deuß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - F Kaster
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - T Bastian
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M C Schleupner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Hagedorn
- CIC Ruhr Acoustics Bagus, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - D Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
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Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review. World J Surg 2022; 46:1855-1869. [PMID: 35428920 PMCID: PMC9012517 DOI: 10.1007/s00268-022-06549-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/11/2022]
Abstract
Background Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs). Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence on telemedicine use in surgical care in LMICs is lacking. Aim To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs. Methods This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs, following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021. Results A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%). Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes. Conclusion Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required. Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06549-2.
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Petrescu M, Popa F, Purcărea VL. How could perioperative anxiety be addressed via surgical team communication approaches? Findings from a scoping review. Hosp Pract (1995) 2022; 50:159-169. [PMID: 35345958 DOI: 10.1080/21548331.2022.2059979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Surgical patients and their families experience high rates of perioperative anxiety, which determine a negative impact on their surgery-related outcomes. Understanding what communicational aspects positively impact perioperative anxiety may help promote more efficient, patient-centered communication approaches which could address this issue. The aim of this scoping review was to synthesize published research on communication between surgical employees and adult patients and their relatives, and its role in managing perioperative anxiety. METHODS A scoping review approach was used across four international databases to search for publications detailing communicational interventions and approaches employed in surgical contexts and their impact on surgical patients' and their caregivers' perioperative anxiety levels. Results were narratively synthesized. RESULTS Twenty-two studies were included in this scoping review, which were grouped according to their communication intervention into one of five categories: technology-assisted interventions, interpersonal communication, educational programs, tools for facilitating exchange of information and theory-derived communication strategies. Records reported mixed results in terms of reducing perioperative anxiety. Facilitating and hindering factors in interpersonal communication in this context were further synthesized. CONCLUSION A multitude of communicational approaches and their effect on anxiety have been investigated within surgical settings, with varying results. Existing evidence suggests that it is vital to address surgical patients' anxiety through personalized empathetic communication, tailored to an individual's case, preferences, and needs. Key aspects of patient-healthcare professional communication which may impact perioperative anxiety were identified and may be utilized in future trainings for communication skills among surgical teams.
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Affiliation(s)
- Mariana Petrescu
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Florian Popa
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
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Baldor D, Lewis PR, Tadlock MD. Routine in-person post-operative follow-up for uncomplicated laparoscopic appendectomy does not change management. Surg Endosc 2022; 36:3775-3780. [PMID: 34468847 PMCID: PMC8409267 DOI: 10.1007/s00464-021-08693-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Eliminating points in the continuum of care that do not change management is a safe strategy for cost containment and workflow efficiency in health systems. As a process improvement initiative, we sought to identify whether routine, outpatient follow-up changes management in laparoscopic appendectomy in a military hospital. METHODS We performed a retrospective chart review of adult patients undergoing laparoscopic appendectomy during a one-year period. The primary outcome was identification of a change in management during routine in person follow-up. Secondary outcomes included location of patient presentation with a post-operative event (clinic, emergency department, primary care provider), and if those visits changed management. Events were defined as any deviation from the typical post-operative course within 6 weeks of surgery, including abnormal specimen pathology. RESULTS One-hundred and seventy-six appendectomies were performed over one year, and 148 patients met inclusion criteria (median age = 27, 66.9% male). Perforation was identified in 10.1% of patients. Seventeen-point-five percent of patients had a post-operative event, of which persistent pain was the most common. Only 2.0% of all patients saw a change in management at their routine in person follow-up appointment. Eighty percent of patients with any post-operative events sought care outside of their routine in person follow up appointments. No variable was independently associated with a change in management. CONCLUSION Routine in-person clinical follow-up for laparoscopic appendectomy almost never changes management. Perforated appendicitis may be an indication for in-person follow-up. Considering a telemedicine model for post-operative follow-up of laparoscopic appendectomy patients will provide a safe and effective alternative to in-person clinic visits, while saving patients time and allowing providers the clinic freedom to prioritize more urgent and new patients.
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Affiliation(s)
- Daniel Baldor
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA
| | - Paul R Lewis
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA.
- Department of Surgery, Naval Medical Center San Diego, FPO AP 96362, 34800 Bob Wilson Dr., PSC 482 Box 2629, San Diego, CA, 92134, USA.
| | - Matthew D Tadlock
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA
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13
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Harren DMAK, Klietz ML, Aitzetmüller DDMM, Dittrich DMF, Hirsch PDMT. Requirements for an app from the perspective of patients in plastic and reconstructive surgery. J Plast Reconstr Aesthet Surg 2022; 75:2027-2032. [DOI: 10.1016/j.bjps.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/19/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
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14
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Jeraq MW, Mulder MB, Kaplan D, Lew JI, Farra JC. Telemedicine During COVID-19 Pandemic: Endocrine Surgery Patient Perspective. J Surg Res 2021; 274:125-135. [PMID: 35150945 PMCID: PMC8712268 DOI: 10.1016/j.jss.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/02/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
Introduction In response to the COVID-19 pandemic, many medical providers have turned to telemedicine as an alternative method to provide ambulatory patient care. Perspectives of endocrine surgery patients regarding this mode of healthcare delivery remains unclear. The purpose of this study is to evaluate the opinions and perspectives of endocrine surgery patients regarding telemedicine. Methods The first 100 adult patients who had their initial telemedicine appointment with two endocrine surgeons were contacted at the conclusion of their visit. The survey administered assessed satisfaction with telemedicine, the provider, and whether attire or video background played a role in their perception of the quality of care received using a 5-point Likert scale. Differences in responses between new and returning patients were also evaluated. Results Telemedicine endocrine surgery patients stated excellent satisfaction with their visit (4.89 out of 5) and their provider (4.96 out of 5). Although there was less consensus that telemedicine was equivalent to in-person or face-to-face clinic visits (4.15 out of 5), patients would recommend a telemedicine visit to others and most agreed that this modality made it easier to obtain healthcare (4.7 out of 5). Attire of the provider and video background did not influence patient opinion in regard to the quality of care they received. Returning patients were more likely to be satisfied with this modality (4.94 versus 4.73, P = 0.02) compared to new patients. Conclusions This study shows that telemedicine does not compromise patient satisfaction or healthcare delivery for patients and is a viable clinic option for endocrine surgery.
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Affiliation(s)
- Mohammed W Jeraq
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
| | - Michelle B Mulder
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Dina Kaplan
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Josefina C Farra
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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15
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Lin JC, Welle N, Ding J, Chuen J. A look to the future: Pandemic-induced digital technologies in vascular surgery. Semin Vasc Surg 2021; 34:139-151. [PMID: 34642034 PMCID: PMC8502076 DOI: 10.1053/j.semvascsurg.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.
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Affiliation(s)
- Judith C Lin
- Michigan State University College of Human Medicine 4660 S. Hagadorn Rd. Ste. #600 East Lansing, MI 48823.
| | - Nicholas Welle
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Joel Ding
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
| | - Jason Chuen
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
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16
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Nikolian VC, Akhter M, Iqbal EJ, Sutton T, Samhan A, Orenstein SB, Rosen MJ, Poulose BK. A National Evaluation of Surgeon Experiences in Telemedicine for the Care of Hernia and Abdominal Core Health Patients. World J Surg 2021; 46:76-83. [PMID: 34604922 PMCID: PMC8487675 DOI: 10.1007/s00268-021-06332-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 12/11/2022]
Abstract
Background Surgeons are increasingly utilizing telemedicine to provide perioperative services to patients. Safety, satisfaction, and feasibility of these programs in general populations have been established, but it is unclear how telemedicine can be integrated into subspecialty care. We report results of a national survey related to telehealth practices among members of the Abdominal Core Health Quality Collaborative (ACHQC).
Methods Survey responses were analyzed to determine current strategies in telemedicine utilization. Surgeon preferences, perceptions of validity, and identified barriers to implementation of telemedicine were assessed. Results Forty surgeons within the ACHQC responded, with 90% of respondents reporting use of telemedicine to deliver perioperative care to patients with hernias and abdominal core health concerns. Surgeons appeared to be more comfortable managing preoperative patients with image-confirmed diagnoses of hernias. Surgeons were universally more comfortable delivering postoperative care via telemedicine. Connectivity, patient engagement, and reimbursement were identified as potential barriers to expansion of telemedicine. Seventy-eight percent of respondents reported that they would increase telemedicine utilization if current regulations were maintained in the future. Conclusions This study found that hernia specialists are utilizing telemedicine at a higher rate than before the COVID-19 pandemic, with surgeons reporting interest in continued use of this modality beyond the pandemic. These findings suggest that future work in telemedicine optimization may improve the quality of care that can be delivered to patients with abdominal core health concerns. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06332-9.
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Affiliation(s)
- Vahagn C Nikolian
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Mudassir Akhter
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Emaad J Iqbal
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Thomas Sutton
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ashraf Samhan
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Sean B Orenstein
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Michael J Rosen
- Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Ohio State University, Columbus, OH, USA
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17
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Zheng H, Rosen JE, Bader NA, Lai V. Endocrine Surgery Patients' and Providers' Perceptions of Telemedicine in the COVID Era. J Surg Res 2021; 269:76-82. [PMID: 34525429 PMCID: PMC8435064 DOI: 10.1016/j.jss.2021.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022]
Abstract
Background Telemedicine has become a key modality for health care delivery during the COVID-19 pandemic, including for endocrine surgery. Little data exists on patients’ and referring endocrinologists’ perspectives of its use. The study aimed to assess and compare endocrine surgery patients’ attitudes about telemedicine to that of referring endocrinologists. Method Patients from a regional endocrine surgery practice and referring endocrinologists were sent surveys about their perspectives on telemedicine use. Results Fifty two patients responded: average age was 58.3 years; 78% were female; 33% were Black. Sixteen referring endocrinologists responded: average age was 52.4 years; 62.5% were female. Nearly all patients (92%) and providers (100%) would try telemedicine or use it again. Providers were more likely than patients to use telemedicine because of COVID-19 (100% versus 70.6%, P = 0.03). Patients were more concerned about the lack of personal connection with telemedicine than providers (60.8% versus 25.0%, P = 0.02). Endocrinologists were more interested in using telemedicine to review abnormal results (81.3% versus 35.3%, P <0.01), and more patients were specifically disinterested in reviewing abnormal results via telemedicine (54.9% versus 6.3%, P = 0.04). Patients were more interested in its use for postoperative visits (47.1% versus 0%, P <0.01). More endocrinologists were specifically disinclined to conduct new consultations with telemedicine (87.5% versus 58.8%, P <0.01). Conclusion Telemedicine is a mutually acceptable method for patients and their referring providers for endocrine surgery delivery, although in-person visits continue to have their place. Telemedicine use may continue to expand after the pandemic as an important point of access for endocrine surgery.
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Affiliation(s)
- Hui Zheng
- Division of Endocrine Surgery, MedStar-Washington Hospital Center, Washington, District of Columbia 20010
| | - Jennifer E Rosen
- Division of Endocrine Surgery, MedStar-Washington Hospital Center, Washington, District of Columbia 20010
| | - Nicholas A Bader
- Georgetown University School of Medicine, Washington, District of Columbia 20007
| | - Victoria Lai
- Division of Endocrine Surgery, MedStar-Washington Hospital Center, Washington, District of Columbia 20010.
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18
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Rathod R, Arora K, Chettuvati K, Abraham S, Angrish P, Sharma V, Agarwal G, Muraleedharan M, Raj R, Panda NK, Bakshi J, Mohindra S, Gupta R, Verma R, Bansal S, Ramavat A, Nayak G, Patro SK, Kumar A, Virk RS. Tele-Otolaryngology at a Tertiary Care Center in North India During COVID-19 Pandemic Lockdown: A Validated Patient Feedback Questionnaire Based Study. Indian J Otolaryngol Head Neck Surg 2021; 74:2985-2998. [PMID: 34104634 PMCID: PMC8175936 DOI: 10.1007/s12070-021-02666-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Providing medical care using the telecommunication networks holds the promise of increased access and efficiency of healthcare particularly during global emergencies like the Coronavirus disease 2019 (COVID-19) pandemic. Most of the hospital setups worldwide have put telemedicine into practice ever since the onset of the COVID-19 pandemic. This study aimed at assessing the effectiveness of Tele-otolaryngology (TO) at a tertiary care centre during the pandemic lockdown. A validated patient feedback questionnaire was developed and distributed to 2577 patients who utilised the TO mobile health service at our institute. Patient feedback-based assessment of TO effectiveness during COVID-19 lockdown was carried out. The validated questionnaire in English and Hindi was statistically robust with Cronbach’s alpha value of 0.808 and 0.886 respectively. 1751 patients completed their feedback to the questionnaire. 97.5% utilised WhatsApp for TO consultation. 15.2% patients were detected of Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection with TO guidance. Up to 75% patients had a positive response to the questionnaire and 91.1% opined of savings achieved either with travel time, cost incurred or the treatment time. With respect to patient health status, 71.5% recovered, 20.1% had no change and 8.4% deteriorated with a mortality rate of 1.65%. Telehealth in otolaryngology during the COVID-19 pandemic lockdown was indispensable in managing exigencies. Redesigning of clinical protocol and technical constraints, clinician training and a validated patient feedback questionnaire would effectively bestow upon the global emergencies.
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Affiliation(s)
- Ramya Rathod
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Arora
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthika Chettuvati
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sajith Abraham
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prerna Angrish
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Sharma
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganesh Agarwal
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjul Muraleedharan
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reshma Raj
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh K. Panda
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyawati Mohindra
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rijuneeta Gupta
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshan Verma
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Bansal
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anurag Ramavat
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gyanaranjan Nayak
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabha K. Patro
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep S. Virk
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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19
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Wang JC, Elson NC, Epperson MV, Doarn CR, Altaye M, Tabangin ME, Patil RD, Patil YJ. A Report on the Use of Telehealth in Otolaryngology: In the Pre COVID-19 Era. Telemed J E Health 2021; 28:334-343. [PMID: 34028286 DOI: 10.1089/tmj.2021.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the integration of and barriers to the utilization of telehealth technology and its components (telemedicine, e-Health, m-health) in daily otolaryngologic practice before the SARS CoV-2 (COVID-19) pandemic. Methods: This cross-sectional study was conducted at a tertiary academic center. A national survey of members of the American Academy of Otolaryngology-Head and Neck Surgery was administered. Descriptive analyses were performed to determine how telehealth was employed in otolaryngologists' practices. Results: A total of 184 surveys were completed. Telehealth technology was used by 50% of otolaryngologists surveyed. Regions with the largest percentage of physicians using telehealth were the Mid-Atlantic region (84%) and West Coast (67%). Most otolaryngologists indicated that they were familiar with telehealth or any of its components and how it is used in practice (52-83%), they had heard of telehealth or any of its components but were unsure what the terms specifically entailed (17-42%); 53% were satisfied with their current use of telehealth and electronic medical record (EMR); and 72% were comfortable utilizing smart devices for patient care. Most otolaryngologists (65%) indicated reimbursement as the biggest limitation to implementing telehealth, and 67% believed that typing was a hindrance to EMR utility. Conclusion: Half of the surveyed otolaryngologists used some form of telehealth at the time of the survey. The most commonly cited obstacle to physician adoption of telehealth was reimbursement. Although the adoption of telehealth technology was still limited in the field of otolaryngology based on this study, we are now seeing significant change due to the COVID-19 pandemic.
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Affiliation(s)
- James C Wang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Nora C Elson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Madison V Epperson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Charles R Doarn
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Yash J Patil
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
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20
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Gonzalez JN, Axiotakis LG, Yu VX, Gudis DA, Overdevest JB. Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19. Otolaryngol Head Neck Surg 2021; 166:417-424. [PMID: 34003046 DOI: 10.1177/01945998211013751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has spurred widespread adoption and advancement in telehealth activities, representing a marked change in otolaryngology practice patterns. The present study undertakes a scoping review of research focused on telehealth in otolaryngology (teleotolaryngology) to identify key themes and commonly utilized outcome measures that will assist future development in this growing field. DATA SOURCES PubMed, Embase, and Cochrane databases and reference review. REVIEW METHODS Per guidelines of the PRISMA Extension for Scoping Reviews, we performed database queries using a comprehensive search strategy developed in collaboration with research librarians at the Columbia University Irving Medical Center. We identified 596 unique references to undergo title and abstract review by 2 independent reviewers, leaving 439 studies for full-text review. RESULTS We included 285 studies for extraction of notable findings, leaving 262 unique studies after accounting for content overlap. We identified core outcome measures, including patient and provider satisfaction, costs and benefits, quality of care, feasibility, and access to care. Publication volume increased markedly over time, though only 4% of studies incorporated randomized study group assignment. Using an iterative approach to thematic development, we organized article content across 5 main themes: (1) exploration of teleotolaryngology evolution, (2) role in virtual clinical encounters, (3) applications in interdisciplinary care and educational initiatives, (4) emerging and innovative technologies, and (5) barriers to implementation. CONCLUSION This scoping review of teleotolaryngology documents its evolution and identifies current use cases, limitations, and emerging applications, providing a foundation from which to build future studies, inform policy decision making, and facilitate implementation where appropriate.
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Affiliation(s)
- Joseph N Gonzalez
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Lucas G Axiotakis
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Victoria X Yu
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David A Gudis
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathan B Overdevest
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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21
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Brown-Johnson CG, Spargo T, Kling SMR, Saliba-Gustafsson EA, Lestoquoy AS, Garvert DW, Vilendrer S, Winget M, Asch SM, Maggio P, Nazerali RS. Patient and surgeon experiences with video visits in plastic surgery-toward a data-informed scheduling triage tool. Surgery 2021; 170:587-595. [PMID: 33941389 DOI: 10.1016/j.surg.2021.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronavirus disease 2019 provided the impetus for unprecedented adoption of telemedicine. This study aimed to understand video visit adoption by plastic surgery providers; and patient and surgeon perceptions about its efficacy, value, accessibility, and long-term viability. A secondary aim was to develop the proposed 'Triage Tool for Video Visits in Plastic Surgery' to help determine visit video eligibility. METHODS This mixed-methods evaluation assessed provider-level scheduling data from the Division of Plastic and Reconstructive Surgery at Stanford Health Care to quantify telemedicine adoption and semi-structured phone interviews with patients (n = 20) and surgeons (n = 10) to explore stakeholder perspectives on video visits. RESULTS During the 13-week period after the local stay-at-home orders due to coronavirus disease 2019, 21.4% of preoperative visits and 45.5% of postoperative visits were performed via video. Video visits were considered acceptable by patients and surgeons in plastic surgery in terms of quality of care but were limited by the inability to perform a physical examination. Interviewed clinicians reported that long-term viability needs to be centered around technology (eg, connection, video quality, etc) and physical examinations. Our findings informed a proposed triage tool to determine the appropriateness of video visits for individual patients that incorporates visit type, anesthesia, case, surgeon's role, and patient characteristics. CONCLUSION Video technology has the potential to facilitate and improve preoperative and postoperative patient care in plastic surgery but the following components are needed: patient education on taking high-quality photos; standardized clinical guidelines for conducting video visits; and an algorithm-assisted triage tool to support scheduling.
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Affiliation(s)
- Cati G Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA.
| | - Tavish Spargo
- Division of Plastic and Reconstructive Surgery, Stanford Health Care, Stanford, CA
| | - Samantha M R Kling
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Anna Sophia Lestoquoy
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Donn W Garvert
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Stacie Vilendrer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Marcy Winget
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Paul Maggio
- Department of Surgery, Stanford Health Care, Stanford, CA
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Stanford Health Care, Stanford, CA
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22
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Muñoz-Duyos A, Abarca-Alvarado N, Lagares-Tena L, Sobrerroca L, Costa D, Boada M, Ureña D, Delgado-Rivilla S. [Teleconsultation in a coloproctology unit during the COVID-19 pandemic. Preliminary results]. Cir Esp 2021; 99:361-367. [PMID: 38620628 PMCID: PMC7342026 DOI: 10.1016/j.ciresp.2020.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 01/15/2023]
Abstract
Introduction During the state of alarm established in Spain due to the COVID-19 pandemic, most of the face-to-face outpatient consultations were cancelled and a telephone consultation was established to follow up coloproctological patients. The objective of this study was to analyse the efficacy of telemedicine (by telephone) in monitoring patients in a coloproctology unit, in the context of the COVID-19 pandemic. Method Prospective descriptive study of consecutive patients in a single centre. The result of the teleconsultation was classified as discharge, resolved visit or reprogramming and was analysed by different diagnostic groups. Results From March 19th to April 17th, 2020, the teleconsultation of 190 patients was carried out. The response rate was 94.2% (179). The diagnostic categories of the patients attended were: 51 (26.9%) colorectal neoplasia, 48 (25.3%) proctological pathology, 72 (37.9%) pelvic floor dysfunctions and 19 (10%) other benign pathologies. 105 (55.26%) could be recited as if they had come in person. Eleven (5.8%) patients were discharged. No significant differences were found between the different diagnostic categories and the resolution of the teleconsultation. The reasons for reprogramming are analyzed in the study. Conclusion In the context of a pandemic, teleconsultation has allowed 61% of follow-up visits to be definitively solved, avoiding the reprogramming of 116 patients. The new social and health paradigm after the pandemic will require a rethinking of our healthcare model, and in many aspects, telemedicine can offer tools for this.
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Affiliation(s)
| | | | | | | | - Daniel Costa
- Hospital Universitari Mútua Terrassa, Tarrasa, España
| | - Mercè Boada
- Hospital Universitari Mútua Terrassa, Tarrasa, España
| | - Dolors Ureña
- Hospital Universitari Mútua Terrassa, Tarrasa, España
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Muñoz-Duyos A, Abarca-Alvarado N, Lagares-Tena L, Sobrerroca L, Costa D, Boada M, Ureña D, Delgado-Rivilla S. Teleconsultation in a coloproctology unit during the COVID-19 pandemic. Preliminary results. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2021. [PMID: 32811680 PMCID: PMC8075819 DOI: 10.1016/j.cireng.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction During the state of alarm established in Spain due to the COVID-19 pandemic, most of the face-to-face outpatient consultations were cancelled and a telephone consultation was established to follow up coloproctological patients. The objective of this study was to analyse the efficacy of telemedicine (by telephone) in monitoring patients in a coloproctology unit, in the context of the COVID-19 pandemic. Method Prospective descriptive study of consecutive patients in a single centre. The result of the teleconsultation was classified as discharge, resolved visit or reprogramming and was analysed by different diagnostic groups. Results From March 19th to April 17th, 2020, the teleconsultation of 190 patients was carried out. The response rate was 94.2% (179). The diagnostic categories of the patients attended were: 51 (26.9%) colorectal neoplasia, 48 (25.3%) proctological pathology, 72 (37.9%) pelvic floor dysfunctions and 19 (10%) other benign pathologies. 105 (55.26%) could be recited as if they had come in person. Eleven (5.8%) patients were discharged. No significant differences were found between the different diagnostic categories and the resolution of the teleconsultation. The reasons for reprogramming are analyzed in the study. Conclusion In the context of a pandemic, teleconsultation has allowed 61% of follow-up visits to be definitively solved, avoiding the reprogramming of 116 patients. The new social and health paradigm after the pandemic will require a rethinking of our healthcare model, and in many aspects, telemedicine can offer tools for this.
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24
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Gupta T, Gkiousias V, Bhutta MF. A systematic review of outcomes of remote consultation in ENT. Clin Otolaryngol 2021; 46:699-719. [PMID: 33754458 DOI: 10.1111/coa.13768] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/11/2021] [Accepted: 03/14/2021] [Indexed: 12/18/2022]
Abstract
AIMS Remote or tele-consultation has become an emerging modality of consultation in many specialities, including ENT. Advantages include increasing accessibility, potential to reduce costs and, during the COVID-19 pandemic, reduced risk of infection transmission. Here, we systematically collate and synthesise the evidence base on outcomes from remote consultation in adult and paediatric ENT services. METHODS We performed a review in accordance with PRISMA guidelines. We searched Medline and Embase for relevant articles. Outcomes include specific patient pathway efficiency measures (including number of healthcare visits, lead time, touch time and handoff), patient/clinician satisfaction, cost analysis and safety implications. RESULTS From 6325 articles screened, 53 met inclusion criteria. Publications included studies on remote consultation for initial, preoperative and follow-up assessment (including postoperative). In most instances, remote consultation reduced costs and time from referral to assessment and was associated with high patient satisfaction. However, a face-to-face follow-up appointment was required in 13%-72% of initial consultations, suggesting that remote consultation is only appropriate in selected cases. CONCLUSION Remote consultation is appropriate and preferable for ENT consultation in specific conditions and circumstances. Future research should look to better define those conditions and circumstances, and report using recognised quality standards and outcome measures.
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Affiliation(s)
- Tanya Gupta
- Ear, Nose and Throat Department, Royal Sussex County Hospital, Brighton, UK
| | | | - Mahmood F Bhutta
- Ear, Nose and Throat Department, Royal Sussex County Hospital, Brighton, UK.,Brighton & Sussex Medical School, Falmer, Brighton, UK
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25
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Telemedicine for Surgical Consultations - Pandemic Response or Here to Stay?: A Report of Public Perceptions. Ann Surg 2021; 272:e174-e180. [PMID: 32520742 PMCID: PMC7299120 DOI: 10.1097/sla.0000000000004125] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aims to determine the public's perception of telemedicine surgical consultations, during the COVID-19 pandemic and beyond. SUMMARY BACKGROUND DATA With rapid expansion and uptake of telemedicine during the pandemic, many have posited that virtual visits will endure even as in-person visits are reinstated. The public's perception of telemedicine for an initial surgical consultation has not been previously studied. METHODS A 43-question survey assessed respondents' attitudes toward telemedicine for initial consultations with surgeons, both in the context of COVID-19 and during "normal circumstances." Participants were recruited through Amazon Mechanical Turk, an online crowd-sourcing marketplace. RESULTS Based on 1827 analyzable responses, we found that a majority (86%) of respondents reported being satisfied (either extremely or somewhat) with telemedicine encounters. Interestingly, preference for in-person versus virtual surgical consultation reflected access to care, with preference for telemedicine decreasing from 72% to 33% when COVID-related social distancing ends. Preferences for virtual visits decreased with increasing complexity of the surgical intervention, even during the pandemic. A majority felt that "establishing trust and comfort" was best accomplished in person, and the vast majority felt it was important to meet their surgeons before the day of surgery. CONCLUSIONS The public views telemedicine as an acceptable substitute for in-person visits, especially during the pandemic. However, it seems that an in-person interaction is still preferred when possible for surgical consultations. If telemedicine services are to persist beyond social distancing, further exploration of its impact on the patient-surgeon relationship will be needed.
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26
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Lee S, Hitt WC. Clinical Applications of Telemedicine in Gynecology and Women's Health. Obstet Gynecol Clin North Am 2021; 47:259-270. [PMID: 32451017 DOI: 10.1016/j.ogc.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telemedicine and telehealth (TM/TH) are the 2 terms used interchangeably focusing on the delivery of health care services at a long distance using telecommunication technology. TM/TH has several gynecologic applications, including the well-woman visits, preventive care, preconception counseling, family planning including contraception and medical abortion, infertility workup, teleradiology, cervical cancer screening and colposcopy, mental health, and telesurgery. The goals of TM/TH are not only improving quality of health care in patients and building a virtual community of physicians but also increasing convenience, efficacy, and decreasing medical cost. In gynecology, TM/TH plays an important role, especially in well-woman care.
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Affiliation(s)
- Siwon Lee
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA
| | - Wilbur C Hitt
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA.
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Cabrera CI, Ning AY, Cai Y, D'Anza B. Systematic Review of Telehealth Cost Minimization for Patients and Health Systems in Otolaryngology. Laryngoscope 2020; 131:1741-1748. [PMID: 33355932 DOI: 10.1002/lary.29321] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS The COVID-19 pandemic has resulted in telehealth becoming commonplace in many health care fields. Telehealth benefits include improving access, decreasing costs, and elevating patient's experience. A review of cost minimization (CM) analyses was performed in order to explore scientific studies associated with integrating tele-otolaryngology in clinical practice. Our primary objective was to evaluate published literature for cost related to the implementation of telemedicine across otolaryngology, and to determine CM when compared to in-person visits. STUDY DESIGN Systematic Literature Review. METHODS We performed a systematic review using PubMed, EMBASE, and Cochrane in May 2020, to identify studies with a cost analysis of tele-otolaryngology care. Inclusion criteria focused on articles citing CM data from telehealth services. Literature quality was assessed using the MINORS scoring system. RESULTS From 380 original articles screened only nine evaluated cost in otolaryngology. CM in the US ranged from $68 to $900 per visit. Cost was evaluated in general otolaryngology, sleep medicine, otology, and head and neck cancer surgery, the latter had the most benefit. The most common types of telehealth visits were routine follow-up and screening. Data were insufficient for meta-analysis. CONCLUSIONS Telemedicine has been trialed across various otolaryngology subspecialties; its incorporation is projected to have a meaningful impact on access to specialty care. This research suggests that the delivery of virtual care reduces cost with the potential of increasing net revenue across multiple otolaryngology subspecialties. Further studies are needed to better discern the entirety of cost savings and the best settings for integration. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1741-1748, 2021.
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Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Anne Y Ning
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Yida Cai
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Brian D'Anza
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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28
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Bautista-Mesa RJ, Lopez-Villegas A, Peiro S, Catalan-Matamoros D, Robles-Musso E, Lopez-Liria R, Leal-Costa C. Long-term cost-utility analysis of remote monitoring of older patients with pacemakers: the PONIENTE study. BMC Geriatr 2020; 20:474. [PMID: 33198629 PMCID: PMC7670660 DOI: 10.1186/s12877-020-01883-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022] Open
Abstract
Background Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of older patients with pacemakers, 5 years after implant. Methods Under a controlled, not randomized, nor masked clinical trial, 83 patients with pacemakers were initially selected. After five years of follow-up, a total of 55 patients (CM = 34; RM = 21) completed the study. A cost-utility analysis of RM in terms of costs per gained quality-adjusted life years (QALYs) was conducted. The costs from the Public Health System (PHS) as well as patients and their relatives were taken into account for the study. The robustness of the results was verified by the probabilistic analyses through Monte-Carlo simulations. Results After a five-year follow-up period, total costs were lower in the RM group by 23.02% than in the CM group (€274.52 versus €356.62; p = 0.033) because of a cost saving from patients’ perspective (€59.05 versus €102.98; p = 0.002). However, the reduction of in-hospital visits derived from RM exhibited insignificant impact on the costs from the PHS perspective, with a cost saving of 15.04% (€215.48 vs. €253.64; p = 0.144). Costs/QALYs obtained by the RM group were higher as compared to the CM group, although there were no significant differences. The incremental cost-effectiveness ratio of CM in comparison to RM became positive (€301.16). Conclusions This study confirms RM of older patients with pacemakers appears still as a cost-utility alternative to CM in hospital after 5 years of follow-up. Trial registration ClinicalTrials.gov: (Identifier: NCT02234245). Registered 09 September 2014 - Prospectively registered.
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Affiliation(s)
| | - Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, El Ejido, s/n, 04700, Almeria, Spain.
| | - Salvador Peiro
- Health Services Research Unit, FISABIO-PUBLIC HEALTH, Valencia, Spain
| | - Daniel Catalan-Matamoros
- Department of Communication Studies, University Carlos III of Madrid, Madrid, Spain.,Health Sciences CTS-451 Research Group, University of Almería, Almería, Spain
| | - Emilio Robles-Musso
- Pacemaker Unit, Intensive Care Unit, Hospital de Poniente, El Ejido, Almería, Spain
| | - Remedios Lopez-Liria
- Department of Nursing Science, Physiotherapy and Medicine, Hum-498 Research Team, Health Research Centre, University of Almería, Almería, Spain
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29
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Miller LE, Rathi VK, Kozin ED, Naunheim MR, Xiao R, Gray ST. Telemedicine Services Provided to Medicare Beneficiaries by Otolaryngologists Between 2010 and 2018. JAMA Otolaryngol Head Neck Surg 2020; 146:816-821. [PMID: 32701120 DOI: 10.1001/jamaoto.2020.1911] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Clinicians are increasingly adopting telemedicine in an effort to expand patient access and efficiently deliver care. However, the extent to which otolaryngologists provide telemedicine services is unclear. Objective To characterize recent trends in the use of telemedicine by otolaryngologists to deliver care to Medicare beneficiaries. Design, Setting, and Participants A retrospective cross-sectional analysis was conducted between January 1, 2010, and December 31, 2018, using publicly available Medicare Physician/Supplier Procedure Summary data on physicians practicing in the field of otolaryngology and benchmark specialties (dermatology and psychiatry) that provided telemedicine services to Medicare beneficiaries. Main Outcomes and Measures Primary outcomes were the mean annual number of telemedicine services delivered per active physician and mean annual payment per active physician for these services. Secondary outcomes included the number, setting, and complexity of telemedicine services. Results Between 2010 and 2018, otolaryngologists provided 2127 total telemedicine services (7 unique service types) to Medicare beneficiaries and received $88 574 in total payment for these services. During this period, the mean number of telemedicine services increased at a compound annual growth rate (CAGR) of 11.0%, and the mean Medicare payment per otolaryngologist increased at a CAGR of 21.8%. In comparison, telemedicine use during this period generally increased at a higher rate in the fields of dermatology (mean number of services per active physician at CAGR of 13.0%; mean Medicare payment per active physician at CAGR of 12.5%) and psychiatry (mean number of services per active physician at CAGR of 25.8%; mean Medicare payment per active physician at CAGR of 26.6%). In 2018, outpatient evaluation and management visits accounted for most telemedicine services provided (337 of 353 [95.5%]) and the payments received ($17 542.13 of $18 470.47 [95.0%]) by otolaryngologists. In contrast, physicians in other specialties also provided substantial portions of telemedicine services in the inpatient (psychiatry, 18 403 of 198 478 [9.3%]; dermatology, 231 of 1034 [22.3%]) and skilled nursing facility settings (psychiatry, 14 690 of 198 478 [7.4%]; dermatology, 46 of 1034 [4.4%]). Conclusions and Relevance This study suggests that the extent to which otolaryngologists used telemedicine to deliver care to Medicare beneficiaries between 2010 and 2018 was rare. Although there was relative growth in the use of telemedicine by otolaryngologists during this period, absolute growth remained low. Policy makers and provider organizations should support otolaryngologists in the adoption of telemedicine technologies, especially while coronavirus disease 2019 (COVID-19) viral suppression efforts necessitate prolonged restriction of physical clinic throughput.
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Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Vinay K Rathi
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Business School, Boston, Massachusetts
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Matthew R Naunheim
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Roy Xiao
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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30
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Irarrázaval MJ, Inzunza M, Muñoz R, Quezada N, Brañes A, Gabrielli M, Soto P, Dib M, Urrejola G, Varas J, Valderrama S, Crovari F, Achurra P. Telemedicine for postoperative follow-up, virtual surgical clinics during COVID-19 pandemic. Surg Endosc 2020; 35:6300-6306. [PMID: 33140151 PMCID: PMC7605475 DOI: 10.1007/s00464-020-08130-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
Summary and background data Recent coronavirus outbreak and “stay at home” policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after gastrointestinal surgery during COVID-19 outbreak. Methods Prospective study that included all abdominal surgery patients operated since the COVID-19 outbreak. On discharge, patients were given the option to perform their postoperative follow-up appointment by telemedicine or by in-person clinics. Demographic, perioperative, and follow-up variables were analyzed. Results Among 219 patients who underwent abdominal surgery, 106 (48%) had their postoperative follow-up using telemedicine. There were no differences in age, gender, ASA score, and COVID-19 positive rate between groups. Patients who preferred telemedicine over in-person follow-up were more likely to have undergone laparoscopic surgery (71% vs. 51%, P = 0.037) and emergency surgery (55% vs. 41%; P = 0.038). Morbidity rate for telemedicine and in-person group was 5.7% and 8%, (P = 0.50). Only 2.8% of patients needed an in-person visit following the telemedicine consult, and 1.9% visited the emergency department. Conclusions In the current pandemic, telemedicine follow-up can be safely and effectively performed in selected surgical patients. Patients who underwent laparoscopic and emergency procedures opted more for telemedicine than in-person follow-up.
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Affiliation(s)
- María J Irarrázaval
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martin Inzunza
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Rodrigo Muñoz
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Nicolás Quezada
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Alejandro Brañes
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Mauricio Gabrielli
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pedro Soto
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martín Dib
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Gonzalo Urrejola
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Julian Varas
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Sebastián Valderrama
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Fernando Crovari
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pablo Achurra
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile.
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Morisada MV, Hwang J, Gill AS, Wilson MD, Strong EB, Steele TO. Telemedicine, Patient Satisfaction, and Chronic Rhinosinusitis Care in the Era of COVID-19. Am J Rhinol Allergy 2020; 35:494-499. [PMID: 33115249 DOI: 10.1177/1945892420970460] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Telemedicine has become increasingly popular in the care of rhinologic patients during the COVID-19 pandemic. This change in practice patterns may place patients at risk of a perceived lower-quality exchange with their healthcare provider, which may in turn impact satisfaction. OBJECTIVE This study compares patient satisfaction scores between in-person clinic visits and telemedicine video visits in patients with chronic rhinosinusitis (CRS). METHODS Sixty-nine patients with CRS presenting to an academic rhinology clinic between March to April 2020 were retrospectively divided into video visits (VV) and clinic visits (CV) groups based on mandated state quarantine orders on March 19. Patient demographics, disease severity measures, and Patient Satisfaction Questionnaire-18 (PSQ-18) scores were collected and analyzed. Chi square test and Fisher's exact test were performed. RESULTS There were no significant differences in age (p = 0.81), gender (p = 0.55), CRS phenotype (p = 0.16), and disease severity measures (Sinonasal Outcomes Test-22 (SNOT-22) (p = 0.92); Lund-Mackay score (p = 0.96)) between the video and clinic visit groups. There were no significant differences in PSQ-18 total scores (VV PSQ-18 mean score = 78.1, CV PSQ-18 mean score = 78.4; p = 0.67) or the following subdomain scores between the two groups: general satisfaction (p = 0.73), technical quality (p = 0.62), interpersonal manner (p = 0.41), communication (p = 0.31), financial aspects (p = 0.89), time spent with doctor (p = 0.88), and accessibility and convenience (p = 0.47). CONCLUSION Patient satisfaction with telemedicine in the COVID-19 pandemic parallels that of traditional in-person visits. Video visits can serve as a viable alternative to clinic visits, while still maintaining high satisfaction.
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Affiliation(s)
- Megan V Morisada
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California
| | - Joshua Hwang
- School of Medicine, University of California, Davis, Sacramento, California
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California
| | - Machelle D Wilson
- Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California, Davis, Sacramento, California
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California.,VA Northern California Healthcare System, Sacramento, California
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Scherer J, Keller F, Pape HC, Osterhoff G. Would patients undergo postoperative follow-up by using a smartphone application? BMC Surg 2020; 20:229. [PMID: 33028309 PMCID: PMC7542718 DOI: 10.1186/s12893-020-00889-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
Background eHealth applications have been proposed as an alternative to monitor patients in frequent intervals or over long distances. The aim of this study was to assess whether patients would accept an application on their smartphone to be monitored by their physicians. Methods During September 2017 and December 2017 a survey amongst smartphone users was conducted via paper and web-based questionnaires. Results More than half of the 962 participants (54%) were older than 55 years of age. The majority of the participants (68.7%) would accept a follow-up by a smartphone application obtaining personal healthcare data. 72.6% of all patients older than 55 years of age would use the application. The most prevalent reason against installing the application was data protection. Patients being currently treated in an orthopaedic practice and pedestrians were more eager to accept a follow-up by a mobile app than participants from social media. Conclusion The majority of participants would accept a mobile application, collecting personal health-related data for postoperative follow-up, and saw a direct benefit for the patient in such an application.
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Affiliation(s)
- Julian Scherer
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Frank Keller
- Orthozentrum Rosenheim, Äußere Münchener Straße 94, 83026, Rosenheim, Germany
| | - Hans-Christoph Pape
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Georg Osterhoff
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Feasibility of Perioperative eHealth Interventions for Older Surgical Patients: A Systematic Review. J Am Med Dir Assoc 2020; 21:1844-1851.e2. [PMID: 32694000 DOI: 10.1016/j.jamda.2020.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES EHealth interventions are increasingly being applied in perioperative care but have not been adequately studied for older surgical patients who could potentially benefit from them. Therefore, we evaluated the feasibility of perioperative eHealth interventions for this population. DESIGN A systematic review of prospective observational and interventional studies was conducted. Three electronic databases (PubMed, EMBASE, CINAHL) were searched between January 1999 and July 2019. Study quality was assessed by Methodological Index for Non-Randomized Studies (MINORS) with and without control group. SETTING AND PARTICIPANTS Studies of surgical patients with an average age ≥65 years undergoing any perioperative eHealth intervention with active patient participation (with the exception of telerehabilitation following orthopedic surgery) were included. MEASURES The main outcome measure was feasibility, defined as a patient's perceptions of usability, satisfaction, and/or acceptability of the intervention. Other outcomes included compliance and study completion rate. RESULTS Screening of 1569 titles and abstracts yielded 7 single-center prospective studies with 223 patients (range n = 9-69 per study, average age 66-74 years) undergoing oncological, cardiovascular, or orthopedic surgery. The median MINORS scores were 13.5 of 16 for 6 studies without control group, and 14 of 24 for 1 study with a control group. Telemonitoring interventions were rated as "easy to use" by 89% to 95% of participants in 3 studies. Patients in 3 studies were satisfied with the eHealth intervention and would recommend it to others. Acceptability (derived from consent rate) ranged from 71% to 89%, compliance from 53% to 86%, and completion of study follow-up from 54% to 95%. CONCLUSIONS AND IMPLICATIONS Results of 7 studies involving perioperative eHealth interventions suggest their feasibility and encourage further development of technologies for older surgical patients. Future feasibility studies require clear definitions of appropriate feasibility outcome measures and a comprehensive description of patient characteristics such as functional performance, level of education, and socioeconomic status.
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Ning AY, Cabrera CI, D'Anza B. Telemedicine in Otolaryngology: A Systematic Review of Image Quality, Diagnostic Concordance, and Patient and Provider Satisfaction. Ann Otol Rhinol Laryngol 2020; 130:195-204. [PMID: 32659100 DOI: 10.1177/0003489420939590] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Telemedicine allows for the remote delivery of patient care and has been found to have a wide range of uses in otolaryngology. In order to achieve best practices in telemedicine, a platform must be effective and both patients and providers must be satisfied with the use of technology. As telemedicine becomes more widely used in otolaryngology clinics, particularly in the face of the current COVID-19 pandemic, it is important to assess its applicability in this field. The goal of this study was to evaluate existing literature on telemedicine and assess overall image quality, diagnostic concordance, and patient and provider satisfaction with telemedicine technologies. METHODS A systematic review was conducted on PubMed and MEDLINE according to the PRISMA 2009 guidelines for articles from 1982 to 2019 relating to telemedicine in otolaryngology. English language studies with primary or secondary endpoints pertaining to image quality, diagnostic concordance, or patient or provider satisfaction were included. Descriptive studies, editorials, and literature reviews were excluded. RESULTS A total of 32 studies were included in our review. Studies assessing imaging quality and diagnostic concordance reported adequate results but with some heterogeneity. Patient and provider satisfaction were consistently high. CONCLUSIONS The literature supports telemedicine delivery of otorhinolaryngologic care as having achieved high rates of patient and provider satisfaction with adequate image quality and heterogeneity in diagnostic concordance. Variability in diagnostic accuracy was reported, but appears improved given proper clinical context. More standardized studies are needed specific to telemedicine in the field of otolaryngology.
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Affiliation(s)
- Anne Y Ning
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brian D'Anza
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Portney DS, Ved R, Nikolian V, Wei A, Buchmueller T, Killaly B, Alam HB, Ellimoottil C. Understanding the cost savings of video visits in outpatient surgical clinics. Mhealth 2020; 6:32. [PMID: 33437830 PMCID: PMC7793011 DOI: 10.21037/mhealth-20-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/26/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Expansion of telehealth is a high-priority strategic initiative for many health systems. Surgical clinics' implementation of video visits has been identified as a way to improve patient and provider experience. However, whether using video visits can reduce the cost of an outpatient visit is unknown. METHODS Prospective case study using time-driven activity-based costing at two outpatient surgical clinics at an academic institution. We conducted stakeholder interviews and in-person observations to map outpatient clinic flow and measure resource utilization of four key steps: check-in, vitals collection and rooming, clinician encounter, and check-out. Finally, we calculated the resource cost for each step using representative salary information to calculate total visit cost. RESULTS Video visits did not systematically reduce the amount of time clinicians spent with patients. Mean [standard deviation (SD)] visit costs were as follows: traditional clinic visits, $26.84 ($10.13); physician-led video visits, $27.26 ($9.69); and physician assistant-led video visits, $9.86 ($2.76). There was no significant difference in the total cost associated with physician-led traditional clinic visits and video visits (P=0.89). However, physician assistant-led video visits were significantly lower cost than physician-led video visits (P<0.001). CONCLUSIONS Using physician-led video visits does not reduce the cost of outpatient surgical visits when compared to traditional clinic visits. However, the use of less expensive clinician resources for video visits (e.g., physician-assistants) may yield cost savings for clinics.
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Affiliation(s)
- David S. Portney
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Rohan Ved
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Vahagn Nikolian
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Wei
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tom Buchmueller
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - Brad Killaly
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - Hasan B. Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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DeAntonio JH, Kang HS, Cockrell HC, Rothstein W, Oiticica C, Lanning DA. Utilization of a handheld telemedicine device in postoperative pediatric surgical care. J Pediatr Surg 2019; 54:1005-1008. [PMID: 30782441 DOI: 10.1016/j.jpedsurg.2019.01.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to assess the utilization of a handheld telemedicine (TM) device in the postoperative care of pediatric surgical patients. METHODS We performed postoperative TM evaluations using an advanced medical tablet immediately prior to seeing the patients in clinic as well as at two different time points from their home. The caregivers and physicians were surveyed about their overall satisfaction. RESULTS Twenty-four postoperative patients who underwent a variety of general surgical operations were included. There were no changes to the TM plan of care following "in person" evaluations (n = 12) and no complications, missed diagnoses, emergency department visits, or additional clinic visits in those who only had TM postoperative evaluations (n = 12). Caregiver satisfaction ratings were 3.92 ± 0.28 out of 4 (4 = very satisfied). Ninety-two percent of caregivers responded that they would be comfortable with a TM-only postoperative evaluation in the future. The physician was able to formulate an accurate assessment and plan using the device. The average travel distance saved was 44.7 ± 45.5 miles (range = 10-150 miles). CONCLUSIONS These preliminary data suggest safe and effective care with high caregiver and physician satisfaction can be provided by utilizing TM in the postoperative care of pediatric surgical patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jonathan H DeAntonio
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Hae Sung Kang
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Hannah C Cockrell
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - William Rothstein
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Claudio Oiticica
- Children's Hospital of Richmond at Virginia Commonwealth University, Children's Pavilion, Richmond, VA
| | - David A Lanning
- Children's Hospital of Richmond at Virginia Commonwealth University, Children's Pavilion, Richmond, VA.
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Financial implications of telemedicine visits in an academic endocrine surgery program. Surgery 2019; 165:617-621. [DOI: 10.1016/j.surg.2018.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 11/18/2022]
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Abstract
Primary hyperparathyroidism is the most common cause of hypercalcemia. Follow-up can be resource-intensive and costly. The aim of this study was to determine if there is a subset of patients who can be defined cured earlier than six months. This was a retrospective study of patients who underwent parathyroidectomy between January 2012 and March 2014. Patients with a history of multiple endocrine neoplasia syndrome, and secondary or tertiary hyperparathyroidism were excluded. Patients with normal preoperative calcium and parathyroid hormone (PTH) and those without six months follow-up were excluded. Patients were divided into two groups: cured and not cured. Data analysis was performed between the two groups. A total of 509 patients were screened, and 214 met our inclusion criteria: 202 in the cured category and 12 in the not cured category (94% cure rate). There was no significant difference between age, gland weight, or pre-operative PTH. There was a statistically significant difference between final intraoperative PTH (IOPTH) (37 vs 55, P = 0.008) and per cent PTH decrease (69 vs 43%, P < 0.0001). There was a significant difference between intraoperative cure rate (P < 0.0006), imaging concordance (P = 0.0115), and solitary versus multiglandular disease (P = 0.0151). Subgroup analysis in patients with concordant imaging, solitary parathyroid adenoma, and IOPTH decrease by 50 per cent to normal or near-normal correlated with a six-month cure rate of 97 per cent. Patients with primary hyperparathyroidism with concordant imaging, single-adenoma pathology, and IOPTH decrease by 50 per cent to normal or near-normal levels (15–65 pg/mL) can be considered cured and may need less frequent follow-up.
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Affiliation(s)
- Anatoliy V. Rudin
- Division of Breast, Endocrine, Metabolic and Gastrointestinal Surgery, Mayo Clinic-Rochester, Rochester, Minnesota
| | - Travis J. McKenzie
- Division of Breast, Endocrine, Metabolic and Gastrointestinal Surgery, Mayo Clinic-Rochester, Rochester, Minnesota
| | - Roberta Wermer
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic-Rochester, Rochester, Minnesota
| | - Geoffrey B. Thompson
- Division of Breast, Endocrine, Metabolic and Gastrointestinal Surgery, Mayo Clinic-Rochester, Rochester, Minnesota
| | - Melanie L. Lyden
- Division of Breast, Endocrine, Metabolic and Gastrointestinal Surgery, Mayo Clinic-Rochester, Rochester, Minnesota
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Philips R, Seim N, Matrka L, Locklear B, Moberly AC, Inman M, Essig G. Cost savings associated with an outpatient otolaryngology telemedicine clinic. Laryngoscope Investig Otolaryngol 2019; 4:234-240. [PMID: 31024993 PMCID: PMC6476262 DOI: 10.1002/lio2.244] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 11/04/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To test the null hypothesis that there is no difference in patient cost savings between the telemedicine and traditional face‐to‐face approach. The second objective was to assess the financial impact on the peripheral healthcare system, as compared with staffing a conventional clinic with “on‐site” otolaryngologist. Methods Twenty‐one patients were enrolled. To assess “patient‐benefit” cost savings, a model was formulated that would utilize a certified nurse practitioner (CNP) to conduct a general otolaryngology clinic at the peripheral site, as compared with having to travel to the tertiary referral center. A “peripheral site‐benefit” cost analysis was performed to assess costs of initiating and operating a telemedicine clinic at the peripheral site, compared with having an on‐site otolaryngologist. Results The total patient‐benefit cost savings would be $182.09 per patient per encounter and $333.22 per patient annually. The fixed cost to the peripheral site to initiate the telemedicine system was $9,895. Two hundred sixty telemedicine encounters would be needed to offset the initial cost, and 537 encounters would be needed to surpass revenue of the conventional clinic. Conclusion A real‐time telemedicine otolaryngology clinic provides significant cost savings for both patients and the peripheral healthcare system. This pilot study supports telemedicine as a cost‐effective approach to providing general otolaryngology care to rural patients. Level of Evidence 4
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Affiliation(s)
- Ramez Philips
- Ohio State University College of Medicine Columbus Ohio U.S.A
| | - Nolan Seim
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Brittany Locklear
- Division of Regional Outreach Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Mark Inman
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Garth Essig
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
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Pilot Study to Evaluate the Safety, Feasibility, and Financial Implications of a Postoperative Telemedicine Program. Ann Surg 2018; 268:700-707. [DOI: 10.1097/sla.0000000000002931] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brown S, Bhutiani N, Quillo AR. Alternative Strategies to Maximize Follow-Up after Parathyroidectomy. Am Surg 2018. [DOI: 10.1177/000313481808400501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen Brown
- Department of Radiology University of Louisville Louisville, Kentucky
| | - Neal Bhutiani
- Department of Surgery University of Louisville Louisville, Kentucky
| | - Amy R. Quillo
- Department of Surgery University of Louisville Louisville, Kentucky
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Snyder SR. Editorial. Telemedicine for elective neurosurgical routine follow-up care: a promising patient-centered and cost-effective alternative to in-person clinic visits. Neurosurg Focus 2018; 44:E18. [DOI: 10.3171/2018.2.focus1889] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lopez-Villegas A, Catalan-Matamoros D, Robles-Musso E, Bautista-Mesa R, Peiro S. Cost-utility analysis on telemonitoring of users with pacemakers: The PONIENTE study. J Telemed Telecare 2018; 25:204-212. [PMID: 29621908 DOI: 10.1177/1357633x18767184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Few studies have confirmed the cost-saving of telemonitoring of users with pacemakers (PMs). The purpose of this controlled, non-randomised, non-masked clinical trial was to perform an economic assessment of telemonitoring (TM) of users with PMs and check whether TM offers a cost-utility alternative to conventional follow-up in hospital. METHODS Eighty-two patients implanted with an internet-based transmission PM were selected to receive either conventional follow-up in hospital ( n = 52) or TM ( n = 30) from their homes. The data were collected during 12 months while patients were being monitored. The economic assessment of the PONIENTE study was performed as per the perspectives of National Health Service (NHS) and patients. A cost-utility analysis was conducted to measure whether the TM of patients with PMs is cost-effective in terms of costs per gained quality-adjusted life years (QALYs). RESULTS There was a significant cost-saving for participants in the TM group in comparison with the participants in the conventional follow-up group. From the NHS's perspective, the patients in the TM group gained 0.09 QALYs more than the patients in the conventional follow-up group over 12 months, with a cost saving of 57.64% (€46.51 versus €109.79, respectively; p < 0.001) per participant per year. In-office visits were reduced by 52.49% in the TM group. The costs related to the patient perspective were lower in the TM group than in the conventional follow-up group (€31.82 versus €73.48, respectively; p < 0.005). The costs per QALY were 61.68% higher in the in-office monitoring group. DISCUSSION The cost-utility analysis performed in the PONIENTE study showed that the TM of users with PMs appears to be a significant cost-effective alternative to conventional follow-up in hospital.
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Affiliation(s)
- Antonio Lopez-Villegas
- 1 Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, Almeria, Spain.,2 Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø. Norway
| | - Daniel Catalan-Matamoros
- 3 Department of Journalism and Communication, University Carlos III of Madrid, Madrid, Spain.,4 Health Sciences CTS-451 Research Group, University of Almeria, Almería, Spain
| | | | | | - Salvador Peiro
- 7 Health Services Research Unit, FISABIO-PUBLIC HEALTH, Valencia, Spain
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Saadi R, Goldenberg D, Goldenberg D. Using Technology in Global Otolaryngology. Otolaryngol Clin North Am 2018; 51:555-561. [PMID: 29472013 DOI: 10.1016/j.otc.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Technology is integral to the diverse diagnostics and interventions of Otolaryngology. Historically, major advances in this field derive from advances of associated technologies. Challenges of visualization and surgical access are increasingly overcome by integrating endoscopic, electronic, and robotic instruments. Otolaryngology is often limited to urban areas and large academic centers, making it difficult to allocate care and resources to many underserved populations. The widespread use of technology has important implications in regards to global access to this field as telemedicine is most effectively applied to specialties that are heavily reliant on data and visuals that may be electronically disseminated.
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Affiliation(s)
- Robert Saadi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850 H091, Hershey, PA 17033, USA
| | - Dana Goldenberg
- Tulane University, 6823 Street, Charles Avenue, New Orleans, LA 70118, USA
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850 H091, Hershey, PA 17033, USA.
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A Cost Comparison for Telehealth Utilization in the Kidney Transplant Waitlist Evaluation Process. Transplantation 2018; 102:279-283. [DOI: 10.1097/tp.0000000000001903] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Asiri A, AlBishi S, AlMadani W, ElMetwally A, Househ M. The Use of Telemedicine in Surgical Care: a Systematic Review. Acta Inform Med 2018; 26:201-206. [PMID: 30515013 PMCID: PMC6195401 DOI: 10.5455/aim.2018.26.201-206] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Telemedicine describes a healthcare service where physicians communicate with patients remotely using telecommunication technologies. Telemedicine is being used to provide pre-/postoperative surgical consultation and monitoring as well as surgical education. Aim: Our purpose was to investigate the broad range of telemedicine technologies used in surgical care. Material and methods: MEDLINE, EMBASE, CINAHL, and Science Direct were searched for available literature from inception to March 30, 2018 with no language restrictions. The search terms included: cell phones, telemedicine, telecommunications, video, online, videoconferencing, remote consultation, surgery, preoperative, perioperative, postoperative, and surgical procedures. Studies were included if they used telemedicine in surgery for pre-, peri-, or post-surgery periods, and if they compared traditional surgical care with surgical telemedicine. We excluded case series, case reports, and conference abstracts from our review. Results: A total of 24 studies were included in our review. The study found that the use of telemedicine in preoperative assessment and diagnosis, evaluation after surgery and follow-up visits to be beneficial. Patients reported benefits to using telemedicine such as avoiding unnecessary trips to hospitals, saving time and reducing the number of working days missed. Conclusion: Telemedicine in surgical care can provide benefits to both patients and clinicians.
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Affiliation(s)
- Abdulmajid Asiri
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sara AlBishi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Wedad AlMadani
- Office of Research, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Ashraf ElMetwally
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard, Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mowafa Househ
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard, Health Affairs, Riyadh, Kingdom of Saudi Arabia
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Williams AM, Bhatti UF, Alam HB, Nikolian VC. The role of telemedicine in postoperative care. Mhealth 2018; 4:11. [PMID: 29963556 PMCID: PMC5994447 DOI: 10.21037/mhealth.2018.04.03] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/11/2018] [Indexed: 12/15/2022] Open
Abstract
Telemedicine has become one of the most rapidly-expanding components of the health care system. Its adoption has afforded improved access to care, greater resource efficiency, and decreased costs associated with traditional office visits and has been well established in a wide array of fields. Telemedicine has been adopted in several domains of surgical care. In recent years, the role of telemedicine in postoperative care has caught attention as it has demonstrated excellent clinical outcomes, enhanced patient satisfaction, increased accessibility along with reduced wait times, and cost savings for patients and health care systems. In this narrative review, we describe the history of telemedicine, its adoption in the field of surgery and its various modalities, its use in the postoperative setting, and the potential benefits to both patients and healthcare systems. As telemedicine continues to emerge as a powerful tool for health care delivery, we also discuss several barriers to its widespread adoption as well as the future utility of telemedicine in postoperative care.
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Affiliation(s)
- Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Umar F Bhatti
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Seim NB, Philips RHW, Matrka LA, Locklear B, Inman M, Moberly AC, Essig GF. Developing a synchronous otolaryngology telemedicine Clinic: Prospective study to assess fidelity and diagnostic concordance. Laryngoscope 2017; 128:1068-1074. [DOI: 10.1002/lary.26929] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Brittany Locklear
- Department of Regional Outreach Development; The Ohio State University Wexner Medical Center; Columbus Ohio U.S.A
| | - Mark Inman
- Department of Otolaryngology-Head and Neck Surgery
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Gunter R, Fernandes-Taylor S, Mahnke A, Awoyinka L, Schroeder C, Wiseman J, Sullivan S, Bennett K, Greenberg C, Kent KC. Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring. JMIR Mhealth Uhealth 2016; 4:e113. [PMID: 27683059 PMCID: PMC5062001 DOI: 10.2196/mhealth.6023] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/02/2016] [Accepted: 08/21/2016] [Indexed: 12/26/2022] Open
Abstract
Background Surgical patients are increasingly using mobile health (mHealth) platforms to monitor recovery and communicate with their providers in the postdischarge period. Despite widespread enthusiasm for mHealth, few studies evaluate the usability or user experience of these platforms. Objective Our objectives were to (1) develop a novel image-based smartphone app for postdischarge surgical wound monitoring, and (2) rigorously user test it with a representative population of vascular and general surgery patients. Methods A total of 9 vascular and general surgery inpatients undertook usability testing of an internally developed smartphone app that allows patients to take digital images of their wound and answer a survey about their recovery. We followed the International Organization for Standardization (ISO) 9241-11 guidelines, focusing on effectiveness, efficiency, and user satisfaction. An accompanying training module was developed by applying tenets of adult learning. Sessions were audio-recorded, and the smartphone screen was mirrored onto a study computer. Digital image quality was evaluated by a physician panel to determine usefulness for clinical decision making. Results The mean length of time spent was 4.7 (2.1-12.8) minutes on the training session and 5.0 (1.4-16.6) minutes on app completion. 55.5% (5/9) of patients were able to complete the app independently with the most difficulty experienced in taking digital images of surgical wounds. Novice patients who were older, obese, or had groin wounds had the most difficulty. 81.8% of images were sufficient for diagnostic purposes. User satisfaction was high, with an average usability score of 83.3 out of 100. Conclusion Surgical patients can learn to use a smartphone app for postoperative wound monitoring with high user satisfaction. We identified design features and training approaches that can facilitate ease of use. This protocol illustrates an important, often overlooked, aspect of mHealth development to improve surgical care.
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Affiliation(s)
- Rebecca Gunter
- Wisconsin Institute of Surgical Outcomes Research, University of Wisconsin, Madison, WI, United States.
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Kummerow Broman K, Vella MA, Tarpley JL, Dittus RS, Roumie CL. Identification of postoperative care amenable to telehealth. Surgery 2016; 160:264-71. [DOI: 10.1016/j.surg.2016.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/27/2016] [Accepted: 02/13/2016] [Indexed: 11/27/2022]
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