Teleconsultation in vascular surgery: a 13 year single centre experience

Influences of governance mechanisms on patients' usage intention: A study on web-based consultation platforms

The study object is the doctor-patient online community, an online health service model with the greatest growth potential during the global COVID-19 pandemic. In the web-based medical market, patients are in a weak position, relying on web-based medical platform operators to ensure medical service quality. Following social exchange theory, this empirical study divides governance mechanisms into three-supervision, reputation, and communication-to determine their influence on online patients willingness to use web-based medical platforms. It also explores the moderating effect of perceived uncertainty on the influence of social exchange and transaction cost theory. A questionnaire survey was conducted to determine online patients' attitudes toward medical service providers including physicians and medical websites. Hierarchical linear regression analysis showed the significant positive effect of the supervision, reputation, and communication mechanisms on online patients' usage willingness. Perceived uncertainty of doctors' behavior has a significant moderating effect on the relationship between the three mechanisms and online patients' usage willingness. Website-perceived uncertainty moderates the relationship between the supervision and reputation mechanisms and online patients' usage willingness. This study provides a reference for improving online patients' usage willingness through the platform governance of Internet medical treatment.

Systematic Review of Telemedicine and eHealth Systems Applied to Vascular Surgery

OBJECTIVE

The objective of this paper is to review and analyze the current state of telemedicine and ehealth in the field of vascular surgery.

METHODS

This paper collects the relevant information obtained after reviewing the articles related to telemedicine in vascular surgery, published from 2012 to 2022 contained in scientific databases. In addition, the results obtained are statistically studied based on various factors, such as the year of publication or the search engine. In this way, we obtain a complete vision of the current state of telemedicine in the field of vascular surgery.

RESULTS

After performing this search and applying selection criteria, 29 articles were obtained for subsequent study and discussion, of which 20 were published in the second half of the decade, representing 70% of the results. In the analysis carried out according to the search criteria used, it can be seen that using the word telemedicine we obtained 69% of the articles while with the criteria mHealth and eHealth we only obtained 22% and 9% of the results, respectively. It can be seen that the filter with the most potential content articles was "vascular surgery AND telemedicine". In the analysis performed according to the search engine, it was observed that the Google Scholar database contains 93% of the articles found in the massive search and the relevant articles contained therein represent 52% of the total.

CONCLUSION

An upward trend has been observed in recent years, with a clear increase in the number of publications and much lower figures in the first years. One aspect to highlight is that 47.8% of the articles analyzed focus only on postoperative treatment, which may be due to the help provided by telemedicine in detecting surgical site infections by sending images and videos, this being one of the most common postoperative complications. The analyzed works show the importance of telemedicine in vascular surgery and identify possible future lines of research. In the analysis carried out on the origin of the selected relevant papers, an important interest of the US in this topic is demonstrated since more than 50% of the research contains authors from this country, it is also observed that there is no research from Spain, so this research would be an initial step to determine the weaknesses of telemedicine in this field of medicine and a good opportunity to open a research gap in this branch.

In-home vascular testing program during the COVID-19 pandemic

This is a retrospective review of a pilot program to provide in home vascular testing to patients during the COVID-19 Pandemic. Results: Eighty-four patients underwent a total of 105 vascular imaging tests as part of the program. Two patients required hospitalization secondary to imaging findings. A description of the program, the results of the testing and patient experience with in-home vascular testing is discussed.

Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website

Background

Web-based medical consultation, which has been adopted by patients in many countries, requires a large number of doctors to provide services. However, no study has provided an overall picture of the doctors who provide online services.

Objective

This study sought to examine doctors’ participation in medical consultation practice in an online consultation platform. This paper aimed to address the following questions: (1) which doctors provide Web-based consultation services, (2) how many patients do the doctors get online, and (3) what price do they charge. We further explored the development of market segments in various departments and various provinces.

Methods

This study explored the dataset including all doctors providing consultation services in their spare time on a Chinese Web-based consultation platform. We also brought in statistics for doctors providing offline consultations in China. We made use of Bonferroni multiple comparison procedures and z test to compare doctors in each group.

Results

There are 88,308 doctors providing Web-based consultation in their spare time on Haodf, accounting for 5.25% (88,308/1,680,062) of all doctors in China as of September 23, 2017. Of these online doctors, 49.9% (44,066/88,308) are high-quality doctors having a title of chief physician or associate chief physician, and 84.8% (74,899/88,308) come from the top, level 3, hospitals. Online doctors had an average workload of 0.38 patients per doctor per day, with an online and offline ratio of 1:14. The average price of online consultation is ¥32.3. The online ratios for the cancer, internal medicine, ophthalmology-otorhinolaryngology, psychiatry, gynecology-obstetrics-pediatrics, dermatology, surgery, and traditional Chinese medicine departments are 16.1% (2,983/18,481), 4.4% (16,231/372,974), 6.3% (8,389/132,725), 9.5% (1,600/16,801), 5.8% (12,955/225,128), 18.0% (3,334/18,481), 10.8% (24,030/223,448), and 3.8% (8,393/22,3448), respectively. Most provinces located in eastern China have more than 4000 doctors online. The online workloads for doctors from most provinces range from 0.3 to 0.4 patients per doctor per day. In most provinces, doctors’ charges range from ¥20 to ¥30.

Conclusions

Quality doctors are more likely to provide Web-based consultation services, get more patients, and charge higher service fees in an online consultation platform. Policies and promotions could attract more doctors to provide Web-based consultation. The online submarket for the departments of dermatology, psychiatry, and gynecology-obstetrics-pediatrics developed better than other departments such as internal medicine and traditional Chinese medicine. The result could be a reference for policy making to improve the medical system both online and offline. As all the data used for analysis were from a single website, the data might be biased and might not be a representative national sample of China.

Comparison of virtual visit versus traditional clinic for management of varicose veins

Introduction

The objective of this study is to compare the clinical outcomes of patients with varicose veins managed in the telemedicine clinic and traditional clinic.

Methods

Retrospective analysis of all vein procedures in the institutional Vascular Quality Initiative Varicose Vein Registry (VQI VVR) was performed from January 2015 to August 2017. Patients were divided into two groups: Telemedicine versus Traditional Clinic. Comparison data included patient demographics, past medical history, clinical outcomes, patient-reported outcomes and postoperative complications. Statistical testing included chi-square test for categorical variables and student t-test for continuous variables using the SPSS statistical software.

Results

A total of 1034 varicose vein procedures were performed during the 31-month study period. There were 75 virtual encounters in the Telemedicine Clinic (Group A) and 959 face-to-face encounters in the Traditional Clinic (Group B). Most of the demographics characteristics were clinically similar in both groups. Comparing Group A and Group B, there were no differences in age, sex, race and body mass index. Early 3-month follow up was 100% in Group A and 90.7% in Group B. Both groups had low complication rates of haematoma (1.3% vs 0.3%, p = 0.884), paraesthesia (1.3% vs 0.6%, p = 0.767) and recanalisation (1.3% vs 4.0%, p = 0.383) during the early follow up period.

Discussion

Synchronous virtual visits for patient care are feasible for the management of chronic venous disease. Patients with varicose veins who choose to undergo telemedicine evaluations have similar pre-operative demographics, clinical classification and patient outcomes.

Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the Potential?

Since the first telegraphic transmission of an electrocardiogram in 1906, technological developments have allowed telemedicine to flourish. It has become a multi-billion pound industry encompassing many areas of medical practice and education. Telemedicine is now widely used in surgery from performing operations to teaching and can be divided into three main components; telesurgery, telementoring and teleconsultation. Developments across these fields have led to remarkable achievements such as intercontinental telesurgery and telementoring. However, barriers to the further implementation of telemedicine remain. In this review, the developments and recent advances of telemedicine across the three domains are discussed together with the challenges and limitations that need to be overcome.