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Kulkarni AJ, Thiagarajan AB, Skolarus TA, Krein SL, Ellimoottil C. Attitudes and barriers toward video visits in surgical care: Insights from a nationwide survey among surgeons. Surgery 2024; 176:115-123. [PMID: 38734503 PMCID: PMC11447857 DOI: 10.1016/j.surg.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/16/2024] [Accepted: 03/21/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Surgeons rapidly adopted video visits during the COVID-19 pandemic. However, video visit use among surgeons has significantly declined, pointing to the need to better understand current attitudes and barriers to their use in surgical care. METHODS From August 2022 to March 2023, a nationwide survey was conducted among practicing surgeons in 6 specialties. The survey included multiple-choice and free-response questions based on an implementation determinants framework, covering demographics, provider, patient, and organizational factors. RESULTS A total of 170 surgeons responded (24% response rate). Overall, 67% of surgeons said their practice lacked motivation for video visit implementation. Additionally, 69% disagreed with using video visits as the sole means for preoperative surgical consultation, even with relevant medical history, labs, and imaging. Nearly 43% cited the need for a physical examination, whereas 58% of surgeons said video visits carried a greater malpractice risk than in-person visits. Other barriers included technological limitations, billing, and care quality concerns. Nevertheless, 41% agreed that video visits could improve outcomes for some patients, and 60% expressed openness to using video visits exclusively for postoperative consultations in uncomplicated surgeries. CONCLUSION Surgeons recognize the potential benefits of video visits for certain patients. However, perceived barriers include the need for a physical examination, technological limitations, care quality concerns, and malpractice risks.
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Affiliation(s)
- Ashwin J Kulkarni
- Department of Urology, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI.
| | - Anagha B Thiagarajan
- Helen Diller Family Comprehensive Cancer Center at UCSF, San Francisco, CA; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Ted A Skolarus
- Department of Surgery, Section of Urology, University of Chicago, IL
| | - Sarah L Krein
- University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI; Department of Veterans Affairs, Ann Arbor Healthcare System, MI
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI. https://twitter.com/chadellimoottil
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Le DQ, Burton BN, Tejeda CJ, Jalilian L, Kamdar N. Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis. Cureus 2024; 16:e60805. [PMID: 38910741 PMCID: PMC11189693 DOI: 10.7759/cureus.60805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Amidst the coronavirus disease 2019 (COVID-19) pandemic, the sudden demand for virtual medical visits drove the expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge of the impact of telehealth on appointment adherence, particularly in preoperative anesthesia evaluations. This study aims to describe the impact of telemedicine-based anesthesia evaluation and its effects on appointment completion. Methods: This was a retrospective, non-randomized, cohort study of adult patients at the University of California, Los Angeles, United States, who received preoperative anesthesia evaluations by telemedicine or in-person in an academic medical center. From January to September 2021, we evaluated telemedicine and in-person appointment completion in patients scheduled for surgery. The primary outcome was the incidence of appointment completion. The secondary outcomes included appointment no-shows and cancellations. Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%), fewer cancellations (12.55% vs 19.41%), and no statistical difference in appointment no-shows (6.07% vs 3.99%). Compared to the in-person group, patients who received telemedicine evaluations were younger (55.81 ± 18.38 vs 65.97 ± 15.19), less likely Native American and Alaska Native (0.31% vs 1.60%), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%), required less interpreter services (4.18% vs 9.31%), had more private insurance coverage (53.45% vs 37.50%) and less Medicare coverage (37.03% vs 50.53%). CONCLUSIONS This study demonstrates that telemedicine can improve preoperative anesthesia appointment completion and decrease appointment cancellations. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. These inequities highlight potential avenues to increase equity and access to telemedicine.
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Affiliation(s)
- Danny Q Le
- Anesthesiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Brittany N Burton
- Anesthesiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Christian J Tejeda
- Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Laleh Jalilian
- Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Nirav Kamdar
- Quality Improvement and Clinical Operations, Huntington Hospital, Pasadena, USA
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Schultis K, Ostdiek-Wille G, Deibert CM. Patient Portal Engagement Affects Postvasectomy Semen Analysis Completion. Urology 2024; 185:137-141. [PMID: 38367713 DOI: 10.1016/j.urology.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To identify factors that affect completion of postvasectomy semen analysis (PVSA) in men receiving telehealth prevasectomy counseling. Telehealth visits have become increasingly common for prevasectomy consultations. Prior studies have shown that men prefer telehealth vasectomy consultations over in-person options. Postvasectomy semen testing should be completed to confirm sterilization. METHODS Three hundred and seventy-one men aged 19 and older who saw a single physician for a telehealth prevasectomy consultation and completed an in-office vasectomy were included in the study. Demographic information such as age, patient relationship status, and distance from the clinic were accessed via electronic medical record. Patients were assessed based on their engagement with electronic preprocedure instructions, and the primary outcome measured was completion of PVSA. RESULTS 45.6% of men completed a PVSA. There was no significant difference in completion of the PVSA between those who opened their electronic instructions before their vasectomy and those who did not (46.1% vs 44.4%, P = .77). Of those who messaged the clinic for any reason at least once after their consultation, 62% completed their PVSA; 41% who did not contact the clinic completed the PVSA (P = .0009). CONCLUSION While there was no difference in completion of PVSA in patients who opened their instructions vs those who did not, patients with a higher level of engagement with the patient portals were more likely to complete their semen test. By understanding factors influencing patient compliance with postvasectomy semen testing, healthcare professionals can develop targeted interventions to ensure safe and successful outcomes.
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Affiliation(s)
- Kaitlyn Schultis
- College of Medicine; University of Nebraska Medical Center, Omaha, NE
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Duong T, Kieran K. Comparing Telemedicine and In-Person Clinical Evaluations for Pediatric Urology Concerns. J Surg Res 2024; 295:281-288. [PMID: 38056354 DOI: 10.1016/j.jss.2023.11.026] [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] [Received: 03/03/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Telemedicine may promote equitable health care delivery, particularly in rural and underserved regions. While patient and provider satisfaction with telemedicine appear to be high, it remains unclear if telemedicine accomplishes the same clinical goals as in-person clinic visits. We undertook this study to compare the differences in history-taking, physical examination, and recommended follow-up in new pediatric urology patients seen via telemedicine and in-person. METHODS This cross-sectional study was performed by retrospectively reviewing the charts of all new patients visiting the general pediatric urology clinic at a single freestanding children's hospital in January and April of three consecutive years (2019, 2020, 2021). Data were abstracted on patient demographics, comprehensiveness of history of present illness, completeness of physical examination, and recommended follow-up. Patients seen by telemedicine and in-person were compared. RESULTS Of 1354 patients, 1244 (91.9%) had in-person and 110 (8.1%) telemedicine visits. Telemedicine patients had a median of 4 history of present illness components recorded; in-person patients had 3 (P < 0.0001). Patients seen in-person had a more comprehensive physical examination recorded compared with telemedicine patients (median 12 vs 2 systems, P < 0.0001). Significantly fewer telemedicine patients were discharged from clinic after the initial visit (2.7% vs 16.5%), and significantly more were asked to return for additional evaluation (39.1% vs 23.2, P < 0.0001). CONCLUSIONS Initial pediatric urology telemedicine consultations gathered more historical and fewer physical examination components and were more likely to require an additional clinic visit for evaluation. Goals of care should be considered when selecting a visit modality.
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Affiliation(s)
- Trang Duong
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, Washington; Department of Urology, University of Washington, Seattle, Washington.
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Restrepo JA, Henriquez R, Torre D, Graber ML. The physical exam and telehealth: between past and future. Diagnosis (Berl) 2024; 11:1-3. [PMID: 38033192 DOI: 10.1515/dx-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Jorge A Restrepo
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
| | - Richard Henriquez
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
| | - Dario Torre
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
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Chao GF, Telem DA. Telehealth Policy Change for Surgical Updates: A Win-Win-Win. Am J Surg 2023; 226:322-323. [PMID: 37414609 DOI: 10.1016/j.amjsurg.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Grace Faith Chao
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Dana Alexa Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Matulewicz RS, Fankhauser CD, Sheinfeld J, Bagrodia A. Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review. Transl Androl Urol 2023; 12:1016-1022. [PMID: 37426604 PMCID: PMC10323446 DOI: 10.21037/tau-22-855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Objective Surveillance is the preferred management strategy for most men with clinical stage I testicular cancer after orchiectomy. However, frequent office visits, imaging tests, and laboratory studies place a significant burden on patients, which may contribute to poor compliance with guideline-recommended surveillance regimens. Identifying strategies to overcome these barriers may help improve quality of life, reduce costs, and improve adherence for patients. We reviewed evidence for three strategies that may help with surveillance redesign: telemedicine, implementing microRNA (miRNA) as a biomarker, and novel imaging protocols. Methods A web-based literature search for novel imaging strategies, diagnostic utility of miRNA, and telehealth as they relate to early-stage testicular germ cell cancer was completed during the month of August 2022. We focused our search on contemporary PubMed-indexed and Google Scholar-registered manuscripts written in English. Supportive data sourced from current guideline statements were also included. Evidence was compiled for narrative review. Key Content and Findings Telemedicine is a safe and acceptable platform for urologic cancer follow-up care, but it requires further study specifically among men with testicular cancer. Access to care may either be improved or reduced depending on system- and patient-level characteristics and should be implemented with this in mind. miRNA may potentially be a helpful biomarker for men with localized disease, but further research on diagnostic accuracy and marker kinetics are needed before implementing it into routine surveillance strategies or using it to deviate from long-standing surveillance regiments. Novel imaging strategies with less frequent imaging and the use of magnetic resonance imaging (MRI) instead of computed tomography (CT) appear to be non-inferior in clinical trials. However, use of MRI requires expert radiologist availability and may be more costly with a lower ability to detect small, early recurrences when used in routine practice. Conclusions Using telemedicine, integrating miRNA as a tumor marker, and adopting less intensive imaging strategies may improve guideline-concordant surveillance for men with localized testicular cancer. Future studies are needed to assess the risks and benefits of using these novel approaches separately or together.
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Affiliation(s)
- Richard S. Matulewicz
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian D. Fankhauser
- University of Zurich, Zurich, Switzerland
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Joel Sheinfeld
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aditya Bagrodia
- Department of Urology, University of California at San Diego, San Diego, CA, USA
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