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Lua-Mailland LL, Nowacki AS, Paraiso MFR, Park AJ, Wallace SL, Ferrando CA. Virtual Compared With In-Office Postoperative Visits After Urogynecologic Surgery: A Randomized Controlled Trial. Obstet Gynecol 2024:00006250-990000000-01127. [PMID: 39116443 DOI: 10.1097/aog.0000000000005694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/20/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To compare patient satisfaction, health care resource utilization, and adverse events among patients receiving a virtual video compared with in-office postoperative visit after urogynecologic surgery. We hypothesized that virtual video visits would be noninferior to in-office visits. METHODS This was a randomized noninferiority clinical trial of patients undergoing surgery for pelvic organ prolapse and urinary incontinence at a single academic tertiary referral center. Participants were randomized to receive either a virtual video postoperative visit or a standard in-office postoperative visit. The primary outcome was patient satisfaction measured by the validated PSQ-18 (Patient Satisfaction Questionnaire-18) (noninferiority margin 5 points) at the 6-week postoperative visit. Secondary outcomes included PSQ-18 domain scores (noninferiority margin 0.5 points) and composite health care resource utilization and adverse events after the 6-week postoperative visit up to 12 weeks after surgery (noninferiority margin 10%). A sample size of 100 participants (50 per group) would allow 80% power to assess a 5-point noninferiority margin on the total PSQ-18 with an SD of 10 and α=0.05. RESULTS From January 2023 to September 2023, 265 patients were screened for eligibility, and 104 were randomized. A total of 100 participants (50 per arm) completed the study and were included in the analysis. The mean±SD age of all participants was 57.0±13.2 years. The mean±SD PSQ-18 total score was 75.18±8.15 in the virtual group and 75.14±8.7 in the in-office group. The mean PSQ-18 total score was 0.04 points higher (ie, greater degree of satisfaction) in the virtual group, with a 95% CI of -2.75 to 2.83, which met the criterion for noninferiority. Between-group differences for all PSQ-18 domain scores likewise met criterion for noninferiority. Composite health care resource utilization was 14.0% lower in the virtual group than in the in-office group (20.0% vs 34.0%, 95% CI, -28.0% to 1.0%). For composite adverse events, the between-group difference was 2.0% (2.0% in virtual group vs 0.0% in in-office group, 95% CI,-3.0% to 8.0%). CONCLUSION Virtual video postoperative visits were noninferior to in-office visits with regard to patient satisfaction, health care resource utilization, and adverse events and can be offered as an alternative to in-office visits for postoperative follow-up after urogynecologic surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT05641077.
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Affiliation(s)
- Lannah L Lua-Mailland
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics and Gynecology Institute, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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Hatef E, Wilson RF, Zhang A, Hannum SM, Kharrazi H, Davis SA, Foroughmand I, Weiner JP, Robinson KA. Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: a systematic review. NPJ Digit Med 2024; 7:157. [PMID: 38879682 PMCID: PMC11180098 DOI: 10.1038/s41746-024-01152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/31/2024] [Indexed: 06/19/2024] Open
Abstract
In this systematic review, we compared the effectiveness of telehealth with in-person care during the pandemic using PubMed, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from March 2020 to April 2023. We included English-language, U.S.-healthcare relevant studies comparing telehealth with in-person care conducted after the onset of the pandemic. Two reviewers independently screened search results, serially extracted data, and independently assessed the risk of bias and strength of evidence. We identified 77 studies, the majority of which (47, 61%) were judged to have a serious or high risk of bias. Differences, if any, in healthcare utilization and clinical outcomes between in-person and telehealth care were generally small and/or not clinically meaningful and varied across the type of outcome and clinical area. For process outcomes, there was a mostly lower rate of missed visits and changes in therapy/medication and higher rates of therapy/medication adherence among patients receiving an initial telehealth visit compared with those receiving in-person care. However, the rates of up-to-date labs/paraclinical assessment were also lower among patients receiving an initial telehealth visit compared with those receiving in-person care. Most studies lacked a standardized approach to assessing outcomes. While we refrain from making an overall conclusion about the performance of telehealth versus in-person visits the use of telehealth is comparable to in-person care across a variety of outcomes and clinical areas. As we transition through the COVID-19 era, models for integrating telehealth with traditional care become increasingly important, and ongoing evaluations of telehealth will be particularly valuable.
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Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Renee F Wilson
- Johns Hopkins Evidence-based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, University, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins Evidence-based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, University, Baltimore, MD, USA
| | - Susan M Hannum
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hadi Kharrazi
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stacey A Davis
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iman Foroughmand
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen A Robinson
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins Evidence-based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, University, Baltimore, MD, USA
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Selle JM, Hanson KT, Habermann EB, Gebhart JB, Trabuco EC, Occhino JA, Young AD, Linder BJ. The Impact of an Overactive Bladder Care Pathway on Longitudinal Patient Management. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:330-336. [PMID: 38484250 DOI: 10.1097/spv.0000000000001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Implementation of an overactive bladder (OAB) care pathway may affect treatment patterns and progression. OBJECTIVES This study aimed to assess the effect of OAB care pathway implementation on treatment patterns for women with OAB. STUDY DESIGN This retrospective cohort study evaluated women with OAB, before (January 1, 2015-December 31, 2017) and after (January 1, 2019-December 31, 2021) care pathway initiation. Care pathway use included standardized counseling, early introduction of therapy, and close follow-up. Primary outcomes included OAB medication use, follow-up visits, third-line therapy, and time to third-line therapy. RESULTS A total of 1,349 women were included: 1,194 before care pathway implementation and 155 after. Patients after implementation were more likely to have diabetes mellitus (P = 0.04) and less likely to smoke (P = 0.01). Those managed via a care pathway were more likely to use any medication or third-line therapy within 1 year after consultation (61.3% vs 25.0%; P < 0.001). This included higher proportions receiving a medication (50.3% [95% confidence interval (CI), 41.8%-57.6%] vs 23.3% [95% CI, 20.9%-25.7%]; P < 0.001) and progressing to third-line therapy (22.6% [95% CI, 15.7%-28.9%] vs 2.9% [95% CI, 2%-3.9%]; P < 0.001). Among those who underwent third-line treatment, care pathway use was associated with shorter time to third-line therapy (median, 10 days [interquartile range, 1-56 days] vs 29 days [interquartile range, 7-191 days]; P = 0.013). Those managed via a care pathway were less likely to have additional clinic visits for OAB within 1 year after initial consultation (12.3% vs 23.9%; P < 0.001). CONCLUSIONS Use of an OAB care pathway was associated with higher rates of oral medication and third-line therapy yet decreased follow-up office visits. Use of an OAB care pathway may promote consistent and efficient care for women with OAB.
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Affiliation(s)
| | - Kristine T Hanson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
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Naik N, Talyshinskii A, Rassweiler J, Hameed BMZ, Somani BK. Digital health innovations in urology: telemedicine, wearables, and mobile applications - a systematic review of literature. Curr Opin Urol 2024; 34:116-127. [PMID: 38038411 DOI: 10.1097/mou.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges. RECENT FINDINGS There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality. SUMMARY Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.
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Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Jens Rassweiler
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Al Mutair A, Saha C, Alhuqbani W, Alhuqbani MN, AlQahtani MN, Abogosh AK, Alsedrah AM, Alhindi AH, Alfehaid RH, Al-Omari A. Utilization of Telemedicine during COVID-19 in Saudi Arabia: A Multicenter Study. Cureus 2023; 15:e41541. [PMID: 37554605 PMCID: PMC10404792 DOI: 10.7759/cureus.41541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The outbreak of the novel Coronavirus disease 2019 (COVID-19) has influenced all aspects of life and significantly impacted healthcare services. It has collectively necessitated the use of telemedicine in providing healthcare. Through this study, we aim to report the statistics on telemedicine utilization and satisfaction across the Kingdom of Saudi Arabia during COVID-19. METHODS This is a cross-sectional study to report the utilization and patient satisfaction with telemedicine services across Saudi Arabia. The data was collected retrospectively from March 2020 to July 2020 on 22,620 patients who used telemedicine services for consultations, medicine refills, and home healthcare visits during COVID-19. RESULTS The patients received a quick response to their calls within a mean (± SD) waiting time of 2.54 (± 6.8) minutes corresponding to a median (IQR) of 0 (0-1) minutes. Home healthcare services were presented within a median (IQR) time of 20.16 (4.64 - 42.28) hours, and patients received medication at home with a median (IQR) time of 18.8 (12.15 - 36.1) hours. Conversations over the phone varied for a median (IQR) time of 5 (3-7) minutes. The highest number of telemedicine calls were for family medicine consultations, i.e., 6729 (29.7%), and the lowest was for infectious diseases 04 (0.1%), followed by cardiology consultations, i.e., 635 (2.8%). A total of 13,154 (58.15) rated their overall satisfaction, of which 11,684 (88.82%) found telemedicine services satisfactory. CONCLUSION The utilization of telemedicine across Saudi Arabia results have shown telemedicine to be a satisfactory service for convenient and safe communication between patients and their healthcare providers. It can thus be established as a smart and indissoluble service across the kingdom. However, there is a need to raise awareness of insurance coverage for such services to make them more feasible and accessible to the public.
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Affiliation(s)
| | - Chandni Saha
- Research Center, Almoosa Health Group, Al Ahsa, SAU
| | - Waad Alhuqbani
- Research, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | | | - Ahmad K Abogosh
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
| | | | | | - Reema H Alfehaid
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
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Dobrusin A, Hawa F, Montagano J, Walsh CX, Ellimoottil C, Gunaratnam NT. Patients With Gastrointestinal Conditions Consider Telehealth Equivalent to In-Person Care. Gastroenterology 2023; 164:156-158.e2. [PMID: 36206831 PMCID: PMC9579048 DOI: 10.1053/j.gastro.2022.09.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Avi Dobrusin
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Fadi Hawa
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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