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Perrin A, Mainard N, Limousin M, Meyer E, Remy F, Strouk G, Norberciak L, Ridon PE. Satisfaction and feasibility of videoconsultation (VC) in orthopaedic and trauma surgery in the context of the COVID-19 pandemic: Prospective study of 783 patients. Orthop Traumatol Surg Res 2023; 109:103345. [PMID: 35671985 PMCID: PMC9167679 DOI: 10.1016/j.otsr.2022.103345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/07/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has required that specialists use videoconsultation (VC) to maintain continuity of care. As in-person consultations (IPCs) and surgical procedures were cancelled, VC became the tool of choice. No recent French study has assessed VC as the main consultation modality. The objective of this prospective study was to evaluate: 1) patient satisfaction, 2) access to and the future of VC, 3) and the reasons for VC refusal in the setting of the pandemic. HYPOTHESIS Patients responded favourably to VC. PATIENTS AND METHOD We conducted a prospective, single-centre, observational study of consecutive patients who were invited to switch from IPC to VC during the lockdown of March 16 to May 11, 2020, when IPCs were not available. All patients were included in the study, regardless of whether they accepted the VC. The reasons for refusal were recorded at the time of the invitation. The surgeons sent the patients who accepted an emailed satisfaction questionnaire after the VC. RESULTS Of the 783 patients with scheduled IPCs, 291 (37.2%) accepted a VC instead, 408 (52.1%) refused the VC, and 84 (10.7%) could not be contacted by telephone and were therefore excluded. The VC acceptance rate was 37% (291/783). Of the 291 VC patients, 233 (80.1%) returned the satisfaction questionnaire, although 2 questionnaires had too many missing data to be included, leaving 231 patients for the analysis. The VC was the first consultation with the surgeon for 66 (28.6%) patients. Of the 165 (71.4%) other patients, 51.6% (85/165) were receiving post-operative follow-up. On a 0-5 scale, the global VC experience was scored 4.3±0.8. Of the 231 VC patients, 161 (69.7%) felt that the VC was equivalent to an IPC, 18 (7.8%) that it was poorer, and 7 (3%) that it was better than an IPC; 45 (19.5%) had no opinion on this point. If choosing between a VC or an IPC had been possible during this first lockdown, 168/231 (72.7%) patients would have chosen an IPC. In contrast, 198/231 (85.7%) patients said they would choose an IPC after the lockdown. The group that refused the VC had a significantly older mean age (57.8±16.4 years vs. 48.0±14.4 years, p<0.0001) and lived closer to the institution (p<0.0001), whereas the sex distribution was comparable, with 42.9% of males (175/408) refusing and 46.8% (108/231) accepting the VC (p=0.39). The main reason for refusal was a wish for an in-person encounter with the surgeon (268/408, 65.7%). Patients aged ≥65 years were more likely to refuse due to technical considerations (access to electronic equipment and to the Internet), whereas patients ≤35 years were more likely to wait for an IPC. CONCLUSION The rate of satisfaction with the VC was high. Satisfaction was not significantly associated with the reason for the consultation (joint involved, degenerative or post-traumatic condition, first VC, first consultation, or follow-up before or after surgery). Although most patients who accepted the VC felt that this modality was equivalent to an IPC, many remained desirous of an in-person encounter with the surgeon, notably among the youngest individuals. Outside the setting of a pandemic, the IPC remains the consultation modality of choice for most of our patients. LEVEL OF EVIDENCE V, prospective study without a control group.
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Affiliation(s)
- Alexis Perrin
- Service de chirurgie orthopédique et traumatologique, hôpital Saint Philibert, rue du Grand But, 59160 Lille, France,Corresponding author
| | - Nicolas Mainard
- Service de chirurgie infantile, CHU Lille, hôpital Jeanne de Flandre, avenue Eugène Avinée, 59000 Lille, France,Université Lille-Hauts de France, 59000 Lille, France
| | - Marc Limousin
- Centre de chirurgie orthopédique, clinique de Saint-Omer, 71, rue Ambroise Paré, 62575 Blendecques, France
| | - Eric Meyer
- Centre de chirurgie orthopédique, clinique de Saint-Omer, 71, rue Ambroise Paré, 62575 Blendecques, France
| | - Franck Remy
- Centre de chirurgie orthopédique, clinique de Saint-Omer, 71, rue Ambroise Paré, 62575 Blendecques, France
| | - Guillaume Strouk
- Centre de chirurgie orthopédique, clinique de Saint-Omer, 71, rue Ambroise Paré, 62575 Blendecques, France
| | - Laurène Norberciak
- Délégation à la recherche clinique et à l’innovation, unité de biostatistiques, groupement des hôpitaux de l’institut catholique de Lille, 59160 Lille, France,Université catholique de Lille, 60, boulevard Vauban, 59800 Lille, France
| | - Pierre-Emmanuel Ridon
- Centre de chirurgie orthopédique, clinique de Saint-Omer, 71, rue Ambroise Paré, 62575 Blendecques, France
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Lambrey PJ, Mainard N, Graf S, Elegbe BA, Perrin A. Will videoteleconsultation have been just a stopgap in French orthopedics-traumatology? A national survey of 280 surgeons. Orthop Traumatol Surg Res 2023; 109:103469. [PMID: 36336295 DOI: 10.1016/j.otsr.2022.103469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION There have been no studies assessing French orthopedic surgeons' satisfaction with video and telephone consultations. These were encouraged during the coronavirus pandemic. We therefore performed a prospective study to assess (1) the profile of physicians using videoteleconsultation (VTC) during the pandemic and factors influencing use, (2) satisfaction with VTC, and (3) the pros, cons and prospects of VTC. HYPOTHESIS The study hypothesis was that VTC in orthopedics-traumatology is sufficiently satisfying to be used in everyday practice outside of pandemic contexts. MATERIAL AND METHOD A French nationwide survey was conducted in the form of an assessment of professional practices. Orthopedic and traumatology surgeons were sent a digital questionnaire, using the mailing lists of some of the French professional and scientific societies, with an estimate of 2000 practitioners who could be reached. The survey concerned use of VTC, modalities and satisfaction and the practitioner's profile. On the basis of the questionnaire responses, a Net Promoter Score (NPS) was calculated, evaluating the number (from -100 to +100) of respondents likely to recommend VTC. RESULTS In total 280 of the estimated 2000 practitioners who were contacted (14.0%) responded. Their mean age was 47.7±10.0years (range: 30-84years). The rate of use of VTC rose from 8.9% (n=25/280) before the pandemic to 55.3% (n=155/280) during it. In the 155 practitioners who had used VTC, NPS was -46.4. Only 51% (n=79/155) were in favor of continuing VTCs outside of pandemic settings. Likewise, 50.3% (n=78/155) reported that clinical examination was more time-consuming via VTC than in face-to-face consultation, and 57.4% (n=89/155) said the same about visualizing complementary examinations. Finally, 98.1% (n=152/155) found VTC less satisfying than face-to-face consultation for clinical examination, and only 18.1% (n=28/155) scheduled surgery after VTC alone. CONCLUSION To date in French orthopedics-traumatology, VTC does not satisfy surgeons, with its virtual rather than physical clinical examination; even so, it offers a solution in pandemic settings. LEVEL OF EVIDENCE IV; prospective study without control group.
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Affiliation(s)
- Pierre-Jean Lambrey
- Service de chirurgie orthopédique et traumatologique, CHU de Lille, 2, avenue Émile-Laine, 59000 Lille, France; Université Lille - Hauts-de-France, 59000 Lille, France.
| | - Nicolas Mainard
- Université Lille - Hauts-de-France, 59000 Lille, France; Service de chirurgie infantile, CHU Lille, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - Sahara Graf
- Délégation à la recherche clinique et à l'innovation, cellule de biostatistiques, groupement des hôpitaux de Lille, institut catholique de Lille, 59160 Lille, France
| | - Boni Armand Elegbe
- Délégation à la recherche clinique et à l'innovation, cellule de data-management, groupement des hôpitaux de Lille, institut catholique de Lille, 59160 Lille, France
| | - Alexis Perrin
- Service de chirurgie orthopédique et traumatologique, hôpital Saint-Philibert, rue du Grand-But, 59160 Lille, France; Université catholique de Lille, 60, boulevard Vauban, 59800 Lille, France
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[Satisfaction and feasibility of videoconsultation (VC) in orthopaedic and trauma surgery in the context of the COVID-19 pandemic: Prospective study of 783 patients]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET TRAUMATOLOGIQUE 2023; 109:65-72. [PMID: 35694128 PMCID: PMC9174351 DOI: 10.1016/j.rcot.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/25/2021] [Indexed: 02/08/2023]
Abstract
Contexte L’épidémie COVID-19 a contraint les spécialistes à recourir à la vidéo-téléconsultation (VTC) afin d’assurer un lien médical. Les consultations physiques (CP) et les interventions chirurgicales ayant été annulées, la VTC devait être privilégiée. Il n’existe aucune étude française récente portant sur la VTC comme principale solution de consultation. Aussi, nous avons mené une étude prospective afin d’évaluer : 1) la satisfaction des patients ; 2) l’accessibilité et l’avenir de la VTC ; 3) les motifs de refus à la VTC dans ce contexte. Hypothèse La VTC a été appréciée favorablement par les patients. Patients et méthode Nous avons mené une étude prospective monocentrique observationnelle d’une série continue de patients, contactés pendant la période du confinement du 16 mars au 11 mai 2020, leur proposant de modifier le format de la CP en VTC. L’ensemble des patients étaient considérés dans l’étude, qu’ils aient accepté ou non la VTC. Les motifs de refus étaient recueillis lors de la proposition. En cas d’acceptation, le chirurgien envoyait par mail au patient un questionnaire anonyme de satisfaction après la VTC. Résultats Sept cent quatre-vingt-trois CP étaient programmées, 291 VTC ont été réalisées (37,2 %), 408 patients (52,1 %) ont refusé la VTC, 84 (10,7 %) n’ont pu être contactés par téléphone et ont donc été exclus. Le taux d’acceptation à la VTC était de 37 % (291/783). Le taux de participation au questionnaire était de 80,1 % (233/291), dont 2 réponses très partielles non prises en compte dans le reste des analyses, laissant 231 patients en analyse. Il s’agissait d’une première consultation avec le chirurgien pour 28,6 % (66/231) des patients, alors que 71,4 % (165/231) avaient déjà rencontré le chirurgien et, parmi ces derniers, 51,6 % (85/165) consultaient pour un suivi après chirurgie. L’expérience globale de la VTC était cotée en moyenne à 4,3 ± 0,8 sur une échelle de 0 à 5. Au total, 69,7 % (161/231) évaluaient la VTC identique à une CP, mais pour 7,8 % (18/231), l’expérience était plus mauvaise, et pour 3 % (7/231), elle était meilleure ; 19,5 % (45/231) restaient sans avis. Si le choix entre CP et VTC avait été possible pendant ce premier confinement, 72,7 % (168/231) des patients auraient choisi une CP. En revanche, 85,7 % (198/231) choisiront une CP après le confinement. Le groupe ayant refusé la VTC était en moyenne significativement plus âgé (57,8 ± 16,4 ans vs 48 ± 14,4 ans (p < 0,0001)) et habitait à une distance moins importante de l’institution (p < 0,0001), mais il n’y avait pas différence selon le sexe avec 42,9 % d’hommes (175/408) en cas de refus de VTC vs 46,8 % d’hommes (108/231) (p = 0,39)). Le principal motif de refus était la volonté de rencontrer physiquement le praticien dans 65,7 % des cas (268/408). Les patients les plus âgés (≥ 65 ans) ont le plus largement évoqué des problèmes matériels (accès équipement et internet), les patients les plus jeunes (≤ 35 ans) préféraient attendre une CP. Conclusion Un taux élevé de satisfaction a été constaté. Les motifs (articulation, pathologie dégénérative ou traumatique, première VTC, première consultation ou suivi avant ou après chirurgie) n’avaient pas d’influence significative sur la satisfaction. Bien qu’une majorité évaluait la VTC identique à la CP, la population est encore attachée au lien physique lors de la consultation, d’autant plus parmi les plus jeunes. En dehors du contexte épidémique, la CP reste encore le mode de consultation souhaité par une large majorité de nos patients. Niveau de preuve IV ; étude prospective sans groupe contrôle.
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Fabrés Martín C, Ventura Parellada C, Herrero Antón de Vez H, Ordoñez Urgiles CE, Alonso-Rodríguez Piedra J, Mora Guix JM. Telemedicine approach for patient follow-up after total knee and reverse total shoulder arthroplasty: a pilot study. Int J Comput Assist Radiol Surg 2023; 18:595-602. [PMID: 36422767 PMCID: PMC9686457 DOI: 10.1007/s11548-022-02784-z] [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] [Received: 01/15/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The study aimed to demonstrate the reduction in postoperative follow-up visit time for patients receiving total knee arthroplasty (TKA) or reverse total shoulder arthroplasty (RTSA) by implementing a novel asynchronous telemedicine system compared to face-to-face visits. The range of motion interobserver agreement and patient satisfaction were evaluated in the telemedicine group. METHODS A randomized controlled trial was conducted with a total of 28 patients with a mean age of 71 years (range 13.3). Patients were distributed into two study groups, TKA (n = 14) and RTSA (n = 14), and each group was randomly allocated into a face-to-face or virtual follow-up visit group. For the virtual group, software was designed including patient-specific model items (X-ray, range of motion and functional scores) for each arthroplasty. Functional assessment was conducted using the International Knee Documentation Committee (IKDC) score for TKA and American Shoulder and Elbow score (ASES) and Simple Shoulder Test (SST) for RTSA. The range of motion interobserver concordance was conducted in the virtual follow-up groups via an intraclass correlation coefficient. Finally, a satisfaction survey was performed in the virtual follow-up groups. Mann-Whitney U test was used for statistical analysis. RESULTS Mean time differences between face-to-face and virtual follow-ups were 502.5 s (95% CI 387.8-617.1; p < 0.002) in the RTSA group and 710 s (95% CI 597.91-822; p < 0. 002) in the TKA group. The range of motion interobserver concordance in the virtual group was 0.974 for TKA and 0.804 for RTSA. Finally, virtual follow-up satisfaction using the telematic method was 8.9 out of 10. CONCLUSION The results of this study showed that a virtual follow-up using asynchronous telemedicine systems could reduce visit times, allow a correct articular range of motion evaluation and maintain satisfaction perception for patients. Asynchronous telemedicine could be an efficient method to conduct postoperative follow-up after knee and shoulder arthroplasty.
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Affiliation(s)
- Carles Fabrés Martín
- Department of Orthopedic Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain.
| | | | - Hugo Herrero Antón de Vez
- Clinic for Plastic, Reconstructive, Hand and Burn Surgery, München Klinik Bogenhausen, Munich, Germany
| | | | | | - José María Mora Guix
- Department of Orthopedic Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
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Glinkowski WM. Telemedicine Orthopedic Consultations Duration and Timing in Outpatient Clinical Practice During the COVID-19 Pandemic. Telemed J E Health 2022; 29:778-787. [PMID: 36251954 DOI: 10.1089/tmj.2022.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Orthopedic associations advocated telemedicine during the COVID-19 pandemic to prevent disease transmission without hindering providing services to orthopedic patients. The study aimed to evaluate outpatient orthopedic teleconsultations' timing, length, and organizational issues in the circumstances of the COVID-19 pandemic based on consecutive orthopedic teleconsultations during the period of the first lockdown. Methods: Orthopedic telemedical consultations (OTCs) were provided from March 23, 2020, to June 1, 2020, and analyzed retrospectively based on mobile smartphone billing and electronic health record. Teleconsultations were based on the legal regulations of telemedicine services in Poland. Results: One thousand seventy-one patients (514 women and 557 men) with a mean age of 41.7 were teleconsulted. The length of the OTC averagely lasted 13.36 min (standard deviation 8.63). Consulted patients suffered from orthopedic disorders 65.3%, musculoskeletal injuries 26.3%, and other diseases 8.4%. Most OTCs were delayed (74.22%) concerning the planned schedule, with a median delay time of 12 min. Only 7.3% of teleconsultations were held precisely on time. Conclusions: Televisit length may not be dependent on gender, older age, or more diagnoses. The services like e-prescriptions, e-Referrals, e-Orders for orthotics, and e-Sick-leaves influence OTC length. Any extension of the patient's OTC may create a "snowball effect" of further delay for each subsequent OTC. Orthopedic teleconsultation requires new understanding and skills by both the patient and specialist physicians. Future research directions should concern the practical aspects of orthopedic teleconsultations, like legal, organizational, and technological issues and their implementation.
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Affiliation(s)
- Wojciech, M. Glinkowski
- Center of Excellence “TeleOrto” for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
- Polish Telemedicine and eHealth Society, Warsaw, Poland
- Gabinet Lekarski, Warsaw, Poland
- Centrum Medyczne PZU Zdrowie, Warsaw, Poland
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Patient Preferences Regarding Telemedicine to In-person Consultation: A Questionnaire-Based Survey. Indian J Orthop 2022; 56:2202-2209. [PMID: 36189122 PMCID: PMC9510221 DOI: 10.1007/s43465-022-00750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Telemedicine has been evolving over the last two decades; however, with the advent of the COVID 19 pandemic, its utility and acceptance have drastically increased. Most studies report increasing acceptability and satisfaction rates. This study aimed to assess patient preferences regarding telemedicine to in-person consultations and to attempt to assess the factors driving these preferences. MATERIAL AND METHODS A questionnaire-based cross-sectional study was conducted for patients who had both teleconsultation and in-person consultation in the orthopedic outpatient. After obtaining consent to participate in the study, the patients were divided into broad clinical categories and responses were recorded regarding the treatment of illness by the doctor and opinions regarding telemedicine. Most questions were in yes/no or a Likert-based questionnaire. Mean, median, percentage and proportions were used for statistical analysis of the data. RESULTS The study group included 264 patients, with the majority with fractures and dislocations. Most patients (55.7%) were comfortable using the software for teleconsultation, and half the respondents found telemedicine convenient. A large percentage of the study group preferred in-person consultation to teleconsultation (58.7%), and the primary reasons for discontinuing teleconsultation were dissatisfaction during the interaction with the doctor and poor connectivity to telecommunication networks. CONCLUSION Telecommunication has high acceptance and satisfaction, but many factors limit its acceptance in developing countries.
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Ben-Ari E, Kirschenbaum J, Patel RG, Kwon YW, Rokito AS, Zuckerman JD, Virk MS. The future of health care service in orthopedic practice: telemedicine or in-person visits? J Shoulder Elbow Surg 2021; 30:e703-e712. [PMID: 34089879 DOI: 10.1016/j.jse.2021.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to assess patient satisfaction and preference for telemedicine vs. in-person visits for outpatient shoulder and elbow musculoskeletal consultation during the coronavirus disease 2019 (COVID-19) pandemic and in the future. METHODS Patients who had telemedicine visits for shoulder and elbow musculoskeletal complaints at a single institution from March through June 2020 were invited to respond to a post-visit survey. The survey included a standardized questionnaire that focused on the patient's satisfaction with the telemedicine visits during the pandemic and preference for using the telemedicine platform in the future, following the pandemic. Additional details regarding their virtual visits (severity of medical condition, as well as previous virtual or emergency department visits) were also obtained. Data regarding patient demographic characteristics and visit details (primary diagnosis, type of visit, length of visit, and treating physician) were extracted from the electronic medical records. RESULTS In total, 153 patients participated in the study. Overall, high satisfaction scores regarding the telemedicine visits were noted: 91% of patients reported that their concerns were adequately addressed, 89% would recommend telemedicine to a friend, and 94% stated that they would use the telemedicine platform again in the presence of a situation similar to the COVID-19 pandemic. However, the majority of patients (76%) reported a preference for in-person visits for the same musculoskeletal complaint if it were not for COVID-19. A telemedicine visit duration > 10 minutes and a first-time telemedicine visit correlated with higher satisfaction rates (P = .037 and P = .001, respectively). CONCLUSIONS COVID-19 has provided a boost to the use of our telemedicine platform, with a high satisfaction rate among patients with shoulder and elbow musculoskeletal complaints, largely owing to safety reasons and limited access to in-person doctor visits. However, a considerable number of patients would have preferred in-person visits for similar health complaints if there were no pandemic. Further research on optimizing the selection of patients for telemedicine visits and addressing their expectations and concerns regarding their visits will improve patients' preference for future telemedicine visits.
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Affiliation(s)
- Erel Ben-Ari
- Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA; Division of Orthopaedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Joshua Kirschenbaum
- Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Ruby G Patel
- Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Young W Kwon
- Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Andrew S Rokito
- Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA.
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Sandhu KS, Singh A, Singh A, Singh D, Sandhu A. Telemedicine Versus In-Person Visits in Postoperative Care in Orthopedic Patients: Follow-Up Study From North India. Cureus 2021; 13:e18399. [PMID: 34725627 PMCID: PMC8555917 DOI: 10.7759/cureus.18399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Telemedicine is improving healthcare delivery in orthopedic patients but the data regarding this are scarce from India, especially North India. Methodology: During this one-year prospective observational study, all patients with fractures of the upper end of tibia requiring surgical intervention and who consented to avail teleconsultation services were included. All these patients were assessed by patient satisfaction score pre-operatively. Patients were randomly assigned for post-operative care schedules of 5 and 14 days in telemedicine and inpatient visits during their follow-up period. Results: A total of 50 patients were included and the satisfaction rating among the two groups was identical. The average patient satisfaction score (on a 10-point scale) was found to be 9.77 in the inpatient visits based on the one-on-one follow-up group and 9.79 in the telemedicine consultation group. Conclusion: In orthopedics, the implementation of telemedicine can minimize the need for the patient to physically visit the outpatient department. The rates of response and overall patient satisfaction were high in the telemedicine group. However, more efforts should be made to address the limitations and problems of using telemedicine.
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Affiliation(s)
| | | | | | | | - Annie Sandhu
- Emergency Department, All India Institute of Medical Sciences, Rishikesh, IND
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Ajrawat P, Young Shin D, Dryan D, Khan M, Ravi B, Veillette C, Leroux T. The Use of Telehealth for Orthopedic Consultations and Assessments: A Systematic Review. Orthopedics 2021; 44:198-206. [PMID: 34292815 DOI: 10.3928/01477447-20210621-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) pandemic, tele-health for orthopedic care is expanding rapidly. The authors sought to identify the evidence describing the effectiveness, barriers, and clinical applications of telehealth for orthopedic assessments and consultations. MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched from inception to March 2020. Forty-seven studies were included, with the most common conditions evaluated being trauma related and the primary modality being videoconferencing. Available literature supports the use of telehealth for orthopedic consultations and assessments because it yields moderate-to-high patient and provider satisfaction, accurate examinations, cost-effectiveness, and reduced wait times. Most commonly reported concerns were professional liability, network security, and technical issues. Given the COVID-19 pandemic, rapid implementation and uptake of virtual assessment for patient care has occurred. The current evidence suggests that telehealth is capable of providing prompt access to quality, cost-efficient orthopedic consultations and assessments. [Orthopedics. 2021;44(4):198--206.].
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Fahey E, Elsheikh MFH, Davey MS, Rowan F, Cassidy JT, Cleary MS. Telemedicine in Orthopedic Surgery: A Systematic Review of Current Evidence. Telemed J E Health 2021; 28:613-635. [PMID: 34375150 DOI: 10.1089/tmj.2021.0221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has triggered transformative changes in how clinicians interact with patients. There has been a shift toward virtual consultations. The evidence to support this change in practice is unclear. The aim of this study was to systematically review the evidence base for virtual consultations for orthopedics. Materials and Methods: Two independent reviewers performed a literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing the MEDLINE, EMBASE, and Scopus databases. Only studies reporting outcomes following the use of telemedicine for diagnosis, consultation, rehabilitation, and follow-up were included. Outcomes analyzed were: (1) patient and clinician satisfaction, (2) clinical outcome measures, and (3) cost analysis of traditional versus teleconsultation. Results: A total of 41 studies were included. Fifteen studies compared clinical outcomes of telemedicine against a matched traditional cohort. Of these 15 studies, 2 demonstrated noninferiority, 9 showed no statistically significant difference, and 4 found telemedicine to be superior. Eleven studies recorded patient reported outcomes, which demonstrated high patient satisfaction. Nine studies reported decreased costs when telemedicine was compared to traditional care. The remaining six studies had varied aims and methodologies that didn't fit well with any of these subheadings. Discussion: While the available evidence is limited, the studies assessed here show that telemedicine can deliver high quality health care with good clinical outcomes and high patient satisfaction in a cost-effective manner. Our team thinks what this has highlighted is that communication technology is advancing rapidly and that we as a community of surgeons need to be able to adapt rapidly and adopt innovative technology to continue to improve patient experience and outcomes.
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Affiliation(s)
- Eoin Fahey
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mohamed F H Elsheikh
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Martin S Davey
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiachra Rowan
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Tristan Cassidy
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - May S Cleary
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland.,College of Medicine, University College Cork, Cork, Ireland
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11
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Wickman J, Ferlotti C, Ferrell J, Hutyra C, Phinney D, Wahl M, Mather RC. Implementing video visits into an orthopedic hip arthroscopy practice: a case study. J Hip Preserv Surg 2021; 7:655-659. [PMID: 34377509 PMCID: PMC8349574 DOI: 10.1093/jhps/hnab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Telehealth videoconferencing has been shown to be feasible, cost-effective and safe in numerous fields of medicine. In an effort to increase access and improve the quality of care offered to patients we implemented a telehealth initiative allowing for remote orthopedic clinic visits at a major academic medical center. Here we report on our experience and early outcomes. A telehealth platform was launched for a single fellowship trained orthopedic surgeon at a major academic hospital in August 2018. New patients residing outside the metro area, all return patients and patients with an uncomplicated post-operative course were offered the option to complete patient encounters remotely via a telehealth platform. Each patient was offered a Patient Satisfaction Survey following video visit. Patient zip codes were used to estimate patient commutes. Ninety-six percent of patients agreed/strongly agreed with the statement 'I was satisfied with my Telehealth experience' while 51% agreed/strongly agreed with the statement 'This visit was just as good as a face to face visit'. In all, 94% of patients agreed/strongly agreed with the statement 'Having a telehealth visit made receiving care more accessible for me'. The median miles saved on commutes were 123.3 miles. The no show rate for telehealth visits was 8.2% versus 3.2% for in-person (P < 0.001). Telehealth video visits provided patients with a modality for completing orthopedic clinic visits while maintaining a high-quality care and patient satisfaction. Patient convenience was optimized with video visits with elimination of long commutes. Level of evidence: IV.
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Affiliation(s)
- John Wickman
- Orthopaedic Surgery Department, Duke University Medical Center, 311 Trent Drive, Suite 2214, Box 104002, Durham, NC 27710, USA
| | - Colleen Ferlotti
- Orthopaedic Surgery Department, Duke University Medical Center, 311 Trent Drive, Suite 2214, Box 104002, Durham, NC 27710, USA
| | - Justin Ferrell
- Orthopaedic Surgery Department, Duke University Medical Center, 311 Trent Drive, Suite 2214, Box 104002, Durham, NC 27710, USA
| | - Carolyn Hutyra
- Orthopaedic Surgery Department, Duke University Medical Center, 311 Trent Drive, Suite 2214, Box 104002, Durham, NC 27710, USA
| | - Donna Phinney
- Orthopaedic Surgery Department, Duke University Medical Center, 311 Trent Drive, Suite 2214, Box 104002, Durham, NC 27710, USA
| | - Megan Wahl
- Orthopaedic Surgery Department, Duke University Medical Center, 311 Trent Drive, Suite 2214, Box 104002, Durham, NC 27710, USA
| | - Richard C Mather
- Orthopaedic Surgery Department, Duke University Medical Center, 311 Trent Drive, Suite 2214, Box 104002, Durham, NC 27710, USA
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12
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Kwok M, Hunn S, Tan H, Borschmann M. Diagnostic concordance of telemedicine for otolaryngology, head and neck surgery in regional Australia. ANZ J Surg 2021; 91:1668-1672. [PMID: 33890722 DOI: 10.1111/ans.16881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The use of telehealth during the COVID-19 pandemic has emerged as both a necessary and significant tool in the provision of safe and timely healthcare in the field of otolaryngology. Increased access to specialist care in a regional setting is an additional benefit. Variation in diagnostic accuracy of telehealth consultations may affect diagnosis and management. Therefore, our aim is to determine the diagnostic concordance of telemedicine for otolaryngology in an Australian regional setting with physical consultations. METHODS Retrospective review was conducted for all patients who received an initial telemedicine appointment over a 7-month period during the COVID-19 pandemic in regional Victoria, Australia. Data were collected regarding initial diagnosis and management from telemedicine consultations, subsequent physical appointment findings and management and intraoperative findings. Statistical analysis was performed using Prism (version 8.0, GraphPad). RESULTS Two hundred and fifty-nine patients were included. The most common conditions referred were for consideration of tonsillectomy with or without adenoidectomy (44.0%). Overall diagnostic concordance of the initial referrer was 63.3% and for telephone appointments, it was 81.9%. Concordance of recommended treatment plans between telephone and physical appointments was 96.9%. CONCLUSION Although physical appointments are an essential aspect of practice in OHNS, there are significant benefits of phone only telemedicine within the context of a global pandemic which were compounded by a regional setting. Paediatric patients were found to have the highest concordance of diagnosis and treatment plans.
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Affiliation(s)
- Matthew Kwok
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Samuel Hunn
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Hannah Tan
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Michael Borschmann
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
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13
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Singh AK, Kasle DA, Jiang R, Sukys J, Savoca EL, Z Lerner M, Kohli N. A Review of Telemedicine Applications in Otorhinolaryngology: Considerations During the Coronavirus Disease of 2019 Pandemic. Laryngoscope 2020; 131:744-759. [PMID: 32942340 PMCID: PMC7537247 DOI: 10.1002/lary.29131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/HYPOTHESIS Review the published literature of telemedicine's use within otorhinolaryngology (ORL), highlight its successful implementation, and document areas with need of future research. STUDY DESIGN State of the Art Review. METHODS Three independent, comprehensive searches for articles published on the subject of telemedicine in ORL were conducted of literature available from January 2000 to April 2020. Search terms were designed to identify studies which examined telemedicine use within ORL. Consensus among authors was used to include all relevant articles. RESULTS While several, small reports document clinical outcomes, patient satisfaction, and the cost of telemedicine, much of the literature on telemedicine in ORL is comprised of preliminary, proof-of-concept reports. Further research will be necessary to establish its strengths and limitations. CONCLUSIONS Particularly during the coronavirus disease of 2019 pandemic, telemedicine can, and should, be used within ORL practice. This review can assist in guiding providers in implementing telemedicine that has been demonstrated to be successful, and direct future research. Laryngoscope, 131:744-759, 2021.
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Affiliation(s)
- Amrita K Singh
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - David A Kasle
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Roy Jiang
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Jordan Sukys
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Emily L Savoca
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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14
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Kumar S, Kumar A, Kumar M, Kumar A, Arora R, Sehrawat R. Feasibility of telemedicine in maintaining follow-up of orthopaedic patients and their satisfaction: A preliminary study. J Clin Orthop Trauma 2020; 11:S704-S710. [PMID: 32837105 PMCID: PMC7395587 DOI: 10.1016/j.jcot.2020.07.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The current COVID-19 pandemic has implications on the morbidities of orthopedic patients due to lack of routine follow-ups, and inpatient and outpatient-based interventions. Telemedicine has recently emerged as an alternative for healthcare delivery to the patients and providing them with important information about orthopedic self-care and medications that can be followed without a hospital visit. However, due to lack of physical assessment, telemedicine is bound to have some limitations as well. The aim of this study is to analyze the effectiveness of proactive telemedicine in maintaining follow-up of orthopedic patients, and their satisfaction with telemedicine as an alternative mode of treatment delivery. METHODS This one-month cross-sectional study enrolled the follow-up patients that visited the orthopedic outpatient-department in February 2020. The patients were sequentially called according to the order of their registration, on a daily basis. Consenting patients were provided with telemedicine-based consultations, and those requiring physical evaluation were called for outpatient visits after documenting the valid reasons. The response-rates and the volume of patients requiring physical visits were measured for different diagnosis-based groups. Patients were asked to complete a questionnaire that included overall patient satisfaction with telemedicine, its effectiveness, and ease in following the telemedicine-based treatment. RESULTS The response rate to telemedicine was 88.67%. Among the patients availing telemedicine, 71.43% were managed without needing physical visits to the outpatient-department. The need for physical examination and failed patient-doctor communication were the most common reasons for advising physical outpatient visits. The overall satisfaction-rate to telemedicine was 92%, and only 7.2% of patients had difficulty in understanding or following telemedicine-based advice. CONCLUSIONS Telemedicine can effectively reduce the need for physical visits to outpatient-departments for follow up of orthopedic patients. The response-rate and overall patient-satisfaction rates to telemedicine are high. Further efforts in expanding the use of telemedicine and addressing its limitations, especially those related to the failed communications, are needed to develop it as an alternative to physical orthopedic consultations in the current situation.
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Affiliation(s)
| | - Arvind Kumar
- Department of Orthopaedics, HIMSR, New Delhi, India,Corresponding author. Department of Orthopaedics, HIMSR, New Delhi, India.
| | - Mukesh Kumar
- Department of Orthopaedics, HIMSR, New Delhi, India
| | - Ashok Kumar
- Gastroenterology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Rajesh Arora
- Department of Orthopaedics, HIMSR, New Delhi, India
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15
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Teleassistance for frail elderly people: A usability and customer satisfaction study. Geriatr Nurs 2020; 41:463-467. [DOI: 10.1016/j.gerinurse.2020.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/31/2022]
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16
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Makhni MC, Riew GJ, Sumathipala MG. Telemedicine in Orthopaedic Surgery: Challenges and Opportunities. J Bone Joint Surg Am 2020; 102:1109-1115. [PMID: 32618908 DOI: 10.2106/jbjs.20.00452] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Improvements in technology and a push toward value-based health care have poised the telemedicine industry for growth; however, despite the benefits of virtual care, widespread implementation had not occurred until the coronavirus 2019 (COVID-19) pandemic. Powerful barriers have hindered the widespread adoption of telemedicine, including lack of awareness, implementation costs, inefficiencies introduced, difficulty performing physical examinations, overall lack of perceived benefit of virtual care, negative financial implications, concern for medicolegal liability, and regulatory restrictions. Some of these challenges have been addressed with temporary state and federal mandates in response to the COVID-19 pandemic; however, continued investment in systems and technology as well as refinement of regulations around telemedicine are needed to sustain widespread adoption by patients and providers.
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Affiliation(s)
- Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grant J Riew
- Department of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
| | - Marissa G Sumathipala
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts
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17
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Behmanesh A, Sadoughi F, Mazhar FN, Joghataei MT, Yazdani S. Tele-orthopaedics: A systematic mapping study. J Telemed Telecare 2020; 28:3-23. [PMID: 32393139 DOI: 10.1177/1357633x20919308] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services and provide an overview of the trends in the field. METHODS In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria. RESULTS We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician-patient relationship was more common than other interactions, such as physician-physician and physician-robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland. DISCUSSION Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future.
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Affiliation(s)
- Ali Behmanesh
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Najd Mazhar
- Bone and Joint Reconstruction Research Centre, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahram Yazdani
- School of Management and Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Buvik A, Bergmo TS, Bugge E, Smaabrekke A, Wilsgaard T, Olsen JA. Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial. J Med Internet Res 2019; 21:e11330. [PMID: 30777845 PMCID: PMC6399572 DOI: 10.2196/11330] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/22/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Telemedicine consultations using real-time videoconferencing has the potential to improve access and quality of care, avoid patient travels, and reduce health care costs. OBJECTIVE The aim of this study was to examine the cost-effectiveness of an orthopedic videoconferencing service between the University Hospital of North Norway and a regional medical center in a remote community located 148 km away. METHODS An economic evaluation based on a randomized controlled trial of 389 patients (559 consultations) referred to the hospital for an orthopedic outpatient consultation was conducted. The intervention group (199 patients) was randomized to receive video-assisted remote orthopedic consultations (302 consultations), while the control group (190 patients) received standard care in outpatient consultation at the hospital (257 consultations). A societal perspective was adopted for calculating costs. Health outcomes were measured as quality-adjusted life years (QALYs) gained. Resource use and health outcomes were collected alongside the trial at baseline and at 12 months follow-up using questionnaires, patient charts, and consultation records. These were valued using externally collected data on unit costs and QALY weights. An extended sensitivity analysis was conducted to address the robustness of the results. RESULTS This study showed that using videoconferencing for orthopedic consultations in the remote clinic costs less than standard outpatient consultations at the specialist hospital, as long as the total number of patient consultations exceeds 151 per year. For a total workload of 300 consultations per year, the annual cost savings amounted to €18,616. If costs were calculated from a health sector perspective, rather than a societal perspective, the number of consultations needed to break even was 183. CONCLUSIONS This study showed that providing video-assisted orthopedic consultations to a remote clinic in Northern Norway, rather than having patients travel to the specialist hospital for consultations, is cost-effective from both a societal and health sector perspective. This conclusion holds as long as the activity exceeds 151 and 183 patient consultations per year, respectively. TRIAL REGISTRATION ClinicalTrials.gov NCT00616837; https://clinicaltrials.gov/ct2/show/NCT00616837 (Archived by WebCite at http://www.webcitation.org/762dZPoKX).
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Affiliation(s)
- Astrid Buvik
- Department of Orthopaedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Trine S Bergmo
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Einar Bugge
- Centre for Quality Improvement and Development, University Hospital of North Norway, Tromsø, Norway
| | - Arvid Smaabrekke
- Department of Orthopaedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Centre for Quality Improvement and Development, University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Jan Abel Olsen
- Department of Community Medicine, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
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19
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Goedeke J, Ertl A, Zöller D, Rohleder S, Muensterer OJ. Telemedicine for pediatric surgical outpatient follow-up: A prospective, randomized single-center trial. J Pediatr Surg 2019; 54:200-207. [PMID: 30343977 DOI: 10.1016/j.jpedsurg.2018.10.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Telemedicine is gaining popularity for a variety of indications. We performed a randomized controlled trial comparing telemedical versus conventional clinic follow-up in terms of feasibility and quality. METHODS Patients discharged from pediatric surgery were randomized to telemedical or onsite follow-up. In the telemedical group, video telephony was used to obtain interim history and physical findings. Onsite patients were personally seen in the outpatient clinic. Caregivers completed a postvisit survey on satisfaction and efficiency. Providers scored data transmission quality and clinical interpretability. RESULTS From March 2015 until January 2017, 224 patients were randomized equally to the study groups. Telemedicine was highly accepted by caregivers, and data transmission quality was sufficient for comprehensive follow-up. No important clinical findings were missed. Quality of interaction scored higher in the telemedical versus the onsite group (77.8% vs. 48%, p < 0.001) as did caregiver satisfaction (5.4 vs. 5.1, p < 0.03). Travel investment, time required, loss of earnings, and days off from work/school were all significantly lower in the telemedical group (p < 0.001). CONCLUSIONS Telemedical posthospitalization follow-up in pediatric surgery provides a cost-effective, time-saving alternative for patients and caregivers that is well received and accepted. The quality of clinical data transmission is sufficient to provide safe care and uncompromised clinical judgment. TYPE OF STUDY Prospective and randomized controlled study. LEVEL OF EVIDENCE Level 1b.
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Affiliation(s)
- Jan Goedeke
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Alexandra Ertl
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniela Zöller
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Institute for Medical Biometry and Statistics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stephan Rohleder
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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20
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Buvik A, Bugge E, Knutsen G, Småbrekke A, Wilsgaard T. Patient reported outcomes with remote orthopaedic consultations by telemedicine: A randomised controlled trial. J Telemed Telecare 2018; 25:451-459. [PMID: 29973130 DOI: 10.1177/1357633x18783921] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Decentralised services through outreach clinics or modern technology reduce patient travel time and cost to society. Telemedicine consultation through videoconference is one such modality. Here, we compared patient-reported health outcomes and satisfaction between video-assisted remote and standard face-to-face orthopaedic consultations. Methods This randomised controlled trial included two parallel groups: (1) patients receiving video-assisted remote consultation at a regional medical centre (RMC); and (2) patients receiving standard consultation at the orthopaedic outpatient clinic of the University Hospital of North Norway (UNN). This study included patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. After each consultation, patient satisfaction was determined using patient-completed questionnaires containing questions on patient-reported health (three-level European quality of life five-dimension index (EQ-5D-3L)/European quality of life visual analogue scale (EQ-VAS)) and questions from a validated OutPatient Experiences Questionnaire (OPEQ). Results This study included 389 patients, of which 199 received remote consultation and 190 received standard consultation (total of 559 consultations). In all, 99% RMC-randomised patients and 99% UNN-randomised patients evaluated the consultation as very satisfactory or satisfactory. Moreover, 86% RMC-randomised patients preferred video-assisted consultation as the next consultation. No difference was observed in patient-reported health after 12 months between the two groups. EQ-5D index scores were 0.77 and 0.75 for RMC- and UNN-randomised patients, respectively ( p = 0.42). Discussion We did not observe any difference in patient-reported satisfaction and health (EQ-5D/EQ-VAS) between video-assisted and standard consultations, suggesting that video-assisted remote consultation can be safely offered to some orthopaedic patients. Moreover, a significantly high proportion of patients selected video-assisted remote consultation as their next consultation, thus strengthening the findings of this study. However, economic aspects should be assessed before widely recommending video-assisted consultation.
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Affiliation(s)
- Astrid Buvik
- Department of Orthopaedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Einar Bugge
- Centre for Quality Improvement and Development, University Hospital of North Norway, Tromsø, Norway
| | - Gunnar Knutsen
- Department of Orthopaedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Arvid Småbrekke
- Department of Orthopaedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Centre for Quality Improvement and Development, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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21
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Pozza ED, D'Souza GF, DeLeonibus A, Fabiani B, Gharb BB, Zins JE. Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up. Aesthet Surg J 2017; 38:101-109. [PMID: 29117293 DOI: 10.1093/asj/sjx079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/05/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. OBJECTIVES The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? METHODS From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. RESULTS A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. CONCLUSIONS The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Gehaan F D'Souza
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Anthony DeLeonibus
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Brianna Fabiani
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Facial Surgery Section Editor for Aesthetic Surgery Journal
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Narasimha S, Madathil KC, Agnisarman S, Rogers H, Welch B, Ashok A, Nair A, McElligott J. Designing Telemedicine Systems for Geriatric Patients: A Review of the Usability Studies. Telemed J E Health 2016; 23:459-472. [PMID: 27875667 DOI: 10.1089/tmj.2016.0178] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One area where telemedicine may prove to be highly effective is in providing medical care to the geriatric population, an age group predicted to account for 20% of the population in the near future. However, even though telemedicine has certain advantages, the usability of these systems with this population merits investigation. MATERIALS AND METHODS This article reviews the literature published from 2000 to 2016 with the goal of analyzing the characteristics of usability-related studies conducted using geriatric participants and the subsequent usability challenges identified. Articles were found using Web of Knowledge and PubMed citation indexing portals using the keywords (1) Telemedicine* AND Geriatrics* (2) Telemedicine* AND Usability* (3) Telemedicine* AND Usability* AND Older Adults*. RESULTS A total of 297 articles were obtained from the initial search. After further detailed screening, 16 articles were selected for review based on the inclusion criteria. Of these, 60% of the studies focused on the overall usability of telemedicine systems; 6.25% focused on the usability of a telepresence robot; 12.5% compared a face-to-face medical consultation with the use of telemedicine systems, and 25% focused on the study of other aspects of telemedicine in addition to its usability. Findings reported in the studies included high patient satisfaction with telemedicine in 31.25%, whereas another 31.25% indicated a high acceptance of this method of medical consultation. Care coordination in 6.25% of the studies; confidence in telemedicine in 6.25%; trust, privacy, and reliability in 6.25%; and increased convenience when compared to personal visits in 18.75% were also reported. CONCLUSIONS This review suggests limited research providing scientifically valid and reproducible usability evaluation at various stages of telemedicine system development. Telemedicine system designers need to consider the age-related issues in cognition, perception, and behavior of geriatric patients while designing telemedicine applications. Future directions for research were developed based on the limitations as well as other results found in this systematic review.
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Affiliation(s)
- Shraddhaa Narasimha
- 1 Department of Industrial and Civil Engineering, Clemson University , Clemson, South Carolina
| | - Kapil Chalil Madathil
- 1 Department of Industrial and Civil Engineering, Clemson University , Clemson, South Carolina
| | - Sruthy Agnisarman
- 1 Department of Industrial and Civil Engineering, Clemson University , Clemson, South Carolina
| | - Hunter Rogers
- 1 Department of Industrial and Civil Engineering, Clemson University , Clemson, South Carolina
| | - Brandon Welch
- 2 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Aparna Ashok
- 1 Department of Industrial and Civil Engineering, Clemson University , Clemson, South Carolina
| | - Aswathi Nair
- 1 Department of Industrial and Civil Engineering, Clemson University , Clemson, South Carolina
| | - James McElligott
- 3 Department of Pediatrics, Medical University of South Carolina , Charleston, South Carolina
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Buvik A, Bugge E, Knutsen G, Småbrekke A, Wilsgaard T. Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial. BMC Health Serv Res 2016; 16:483. [PMID: 27608768 PMCID: PMC5017045 DOI: 10.1186/s12913-016-1717-7] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 08/26/2016] [Indexed: 11/30/2022] Open
Abstract
Background Decentralised services using outreach clinics or modern technology are methods to reduce both patient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such modality. Before new technologies are implemented, it is important to investigate both the quality of care given and the economic impact from the use of this new technology. The aim of this clinical trial was to study the quality of planned remote orthopaedic consultations by help of videoconference. Method We performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote consultations at a regional medical centre (RMC) as an intervention versus standard consultation in the orthopaedic outpatient clinic at the University Hospital of North Norway (UNN) as a control. The participants were patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons evaluated each consultation they performed by completing a questionnaire. The primary outcome measurement was the difference in the sum score calculated from this questionnaire, which was evaluated by the non-inferiority of the intervention group. The study design was based on the intention to treat principle. Ancillary analyses regarding complications, the number of consultations per patient, operations, patients who were referred again and the duration of consultations were performed. Results Four-hundred patients were web-based randomised. Of these, 199 (98 %) underwent remote consultation and 190 (95 %) underwent standard consultation. The primary outcome, the sum score of the specialist evaluation, was significantly lower (i.e. ‘better’) at UNN compared to RMC (1.72 versus 1.82, p = 0.0030). The 90 % confidence interval (CI) for the difference in score (0.05, 0.17) was within the non-inferiority margin. The orthopaedic surgeons involved evaluated 98 % of the video-assisted consultations as ‘good’ or ‘very good’. In the ancillary analyses, there was no significant difference between the two groups. Conclusions This study supports the argument that it is safe to offer video-assisted consultations for selected orthopaedic patients. We did not find any serious events related to the mode of consultation. Further assessments of the economic aspects and patient satisfaction are needed before we can recommend its wider application. Trial registration ClinicalTrials.gov identifier: NCT00616837 Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1717-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Astrid Buvik
- Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway.
| | - Einar Bugge
- Centre for Clinical Research and Education, University Hospital of North Norway, P.O. Box 20, N-9038, Tromsø, Norway
| | - Gunnar Knutsen
- Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway
| | - Arvid Småbrekke
- Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway
| | - Tom Wilsgaard
- Centre for Clinical Research and Education, University Hospital of North Norway, P.O. Box 20, N-9038, Tromsø, Norway.,Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
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24
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Buvik A, Bugge E, Knutsen G, Småbrekke A, Wilsgaard T. Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial. BMC Health Serv Res 2016. [PMID: 27608768 DOI: 10.1186/s12913-016-1717-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decentralised services using outreach clinics or modern technology are methods to reduce both patient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such modality. Before new technologies are implemented, it is important to investigate both the quality of care given and the economic impact from the use of this new technology. The aim of this clinical trial was to study the quality of planned remote orthopaedic consultations by help of videoconference. METHOD We performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote consultations at a regional medical centre (RMC) as an intervention versus standard consultation in the orthopaedic outpatient clinic at the University Hospital of North Norway (UNN) as a control. The participants were patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons evaluated each consultation they performed by completing a questionnaire. The primary outcome measurement was the difference in the sum score calculated from this questionnaire, which was evaluated by the non-inferiority of the intervention group. The study design was based on the intention to treat principle. Ancillary analyses regarding complications, the number of consultations per patient, operations, patients who were referred again and the duration of consultations were performed. RESULTS Four-hundred patients were web-based randomised. Of these, 199 (98 %) underwent remote consultation and 190 (95 %) underwent standard consultation. The primary outcome, the sum score of the specialist evaluation, was significantly lower (i.e. 'better') at UNN compared to RMC (1.72 versus 1.82, p = 0.0030). The 90 % confidence interval (CI) for the difference in score (0.05, 0.17) was within the non-inferiority margin. The orthopaedic surgeons involved evaluated 98 % of the video-assisted consultations as 'good' or 'very good'. In the ancillary analyses, there was no significant difference between the two groups. CONCLUSIONS This study supports the argument that it is safe to offer video-assisted consultations for selected orthopaedic patients. We did not find any serious events related to the mode of consultation. Further assessments of the economic aspects and patient satisfaction are needed before we can recommend its wider application. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00616837.
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Affiliation(s)
- Astrid Buvik
- Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway.
| | - Einar Bugge
- Centre for Clinical Research and Education, University Hospital of North Norway, P.O. Box 20, N-9038, Tromsø, Norway
| | - Gunnar Knutsen
- Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway
| | - Arvid Småbrekke
- Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway
| | - Tom Wilsgaard
- Centre for Clinical Research and Education, University Hospital of North Norway, P.O. Box 20, N-9038, Tromsø, Norway.,Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
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Abstract
Recent improvements in technology and telecommunications have resulted in renewed interest in telemedicine [1]. The UK’s National Health Service (NHS) Executive has recently published an ‘Information for Health’ strategy which states that ‘telemedicine and telecare will undoubtedly come to the fore as a way of providing services in the future. They have a key role to play in the Government’s plans to modernize the NHS’ [2]. Within the current climate, the future success of telemedicine will depend on patient and provider acceptance of such technologies. It is, therefore, imperative that the views and experiences of the users and providers of healthcare services are sought to enable problems to be resolved and issues addressed before telemedicine is fully implemented: ‘Information about the patients’ experiences can be an important lever for change, both highlighting where, and what sort of quality improvements are needed’ [3]. This paper provides an overview of telemedicine and patient satisfaction and considers the satisfaction studies to date. It finally discusses some of the problems in assessing patient satisfaction within telemedicine and how future studies may be improved in light of the findings. It is based upon work that is presently being carried out at the School of Health and Related Research (ScHARR) at the University of Sheffield as part of a Randomized Controlled Trial of telemedicine in dermatology, funded by the NHS Executive Research and Development Programme.
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Affiliation(s)
- K. Collins
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA,
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26
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Telemedicine in Cleft Care: Reliability and Predictability in Regional and International Practice Settings. J Craniofac Surg 2016; 26:1116-20. [PMID: 26010103 DOI: 10.1097/scs.0000000000001560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Regional and international cleft care providers are challenged in their ability to deliver reliable, comprehensive care. Our institution utilizes video teleconferencing to facilitate initial evaluation and postoperative cleft care. This study describes our experience using telemedicine, generates a perioperative treatment algorithm using this technology, and compares cost-utility of telemedicine to in-person ambulatory visits when regional practices are involved. METHODS A 5-year retrospective review of all cleft patients evaluated in an ambulatory setting was conducted. Patient demographics and location, number, and type of telemedicine visits were recorded. Specific treatment algorithms utilizing telemedicine for perioperative care for primary and secondary cleft lip and nasal repair, palatoplasty, and operation for velopharyngeal insufficiency are described. A cost-utility analysis was performed comparing distances between patient homes and primary hub versus telemedicine clinic sites. RESULTS Five hundred nineteen patients were identified; 18.1% attended at least 1 teleconferencing visit. Postoperative follow-up was 100%. The majority of screening, preoperative, and postoperative care was provided using telemedicine. In-person evaluations were performed when intraoral assessments were necessary. Telemedicine visits were associated with an average savings of 239 miles per visit in the United States and 578 miles per visit in Mexico. CONCLUSIONS Video teleconferencing can be used to provide comprehensive regional and international cleft care to facilitate initial evaluations and consistent follow-up. This technology can alleviate the travel burden on families and cleft care providers practicing over a large geographic radius.
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27
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Bashiri M, Greenfield LJ, Oliveto A. Telemedicine Interest for Routine Follow-Up Care Among Neurology Patients in Arkansas. Telemed J E Health 2015; 22:514-8. [PMID: 26684500 DOI: 10.1089/tmj.2015.0112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Teleneurology in Arkansas has been used primarily for management of acute stroke with a state-funded hub-and-spoke model allowing physicians at rural hospitals to access vascular neurologists in time to facilitate tissue plasminogen activator administration. Routine neurologic care has been provided only in small pilot studies. We wished to determine patient interest in participating in teleneurology for routine follow-up visits as well as demographic and medical factors associated with interest. MATERIALS AND METHODS New and established patients of the Neurology Outpatient Clinic at the University of Arkansas for Medical Sciences (UAMS) were surveyed between March 2011 and December 2012 to assess their interest in participating in teleneurology as well as potential factors associated with their interest. RESULTS Of 1,441 respondents, 52.4% were interested in telemedicine. Of those interested versus uninterested in telemedicine, respectively, 68.9% versus 36.32% traveled more than 1 h to the clinic, 64.7% versus 35.3% had difficulty secondary to neurological conditions, 22.6% versus 6.8% had missed medical appointments due to travel problems, and 43.1% versus 9.4% had travel-imposed financial hardship. CONCLUSIONS Telemedicine interest for routine follow-up visits was strong among patients at the UAMS Neurology Outpatient Clinic. Factors positively associated with interest included long travel distances, travel expenses, and transportation difficulties. These results suggest that implementing a telemedicine program for follow-up visits would be acceptable to neurology patients for routine ongoing care.
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Affiliation(s)
- Maryam Bashiri
- 1 Interdisciplinary Biomedical Sciences Graduate Program, Clinical and Translational Sciences Track, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - L John Greenfield
- 2 Department of Neurology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Alison Oliveto
- 3 Department of Psychiatry, University of Arkansas for Medical Sciences , Little Rock, Arkansas
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Marsh JD, Bryant DM, MacDonald SJ, Naudie DDR, McCalden RW, Howard JL, Bourne RB, McAuley JP. Feasibility, effectiveness and costs associated with a web-based follow-up assessment following total joint arthroplasty. J Arthroplasty 2014; 29:1723-8. [PMID: 24881023 DOI: 10.1016/j.arth.2014.04.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/24/2014] [Accepted: 04/02/2014] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to assess the feasibility, effectiveness and costs of a web-based follow-up compared to in-person assessment following primary total hip or total knee arthroplasty. Patients who were at least 12 months postoperative were randomized to follow-up method. We excluded patients who had revision surgery, osteolysis, complications or identified radiographic issues. 229 patients (118 Web, 111 in-person) completed the study. There were no patients who had an issue missed by the web-based follow-up. Patients in the web-based group travelled less (28.2km vs 103.7km, (P<0.01)), had lower associated costs ($10.45 vs $21.36, (P<0.01)) and took less time to complete (121.7min web vs 228.7min usual). Web-based follow-up is a feasible, clinically effective alternative with lower associated costs than in-person clinic assessment.
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Affiliation(s)
- Jacquelyn D Marsh
- Faculty of Health Sciences, Elborn College, Room 1423 The University of Western Ontario, London, ON
| | - Dianne M Bryant
- Faculty of Health Sciences, Elborn College, Room 1423 The University of Western Ontario, London, ON
| | | | | | | | - James L Howard
- London Health Sciences Centre University Hospital, London, ON
| | - Robert B Bourne
- London Health Sciences Centre University Hospital, London, ON
| | - James P McAuley
- London Health Sciences Centre University Hospital, London, ON
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Marsh J, Bryant D, MacDonald SJ, Naudie D, Remtulla A, McCalden R, Howard J, Bourne R, McAuley J. Are patients satisfied with a web-based followup after total joint arthroplasty? Clin Orthop Relat Res 2014; 472:1972-81. [PMID: 24562873 PMCID: PMC4016458 DOI: 10.1007/s11999-014-3514-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/05/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND A web-based followup assessment may be a feasible, cost-saving alternative of tracking patient outcomes after total joint arthroplasty. However, before implementing a web-based program, it is important to determine patient satisfaction levels with the new followup method. Satisfaction with the care received is becoming an increasingly important metric, and we do not know to what degree patients are satisfied with an approach to followup that does not involve an in-person visit with their surgeons. QUESTIONS/PURPOSES We determined (1) patient satisfaction and (2) patients' preferences for followup method (web-based or in-person) after total joint arthroplasty. METHODS We randomized patients who were at least 12 months after primary THA or TKA to complete a web-based followup or to have their appointment at the clinic. There were 410 eligible patients contacted for the study during the recruitment period. Of these, 256 agreed to participate, and a total of 229 patients completed the study (89% of those enrolled, 56% of those potentially eligible; 111 in the usual-care group, 118 in the web-based group). Their mean age was 69 years (range, 38-86 years). There was no crossover between groups. All 229 patients completed a satisfaction questionnaire at the time of their followup appointments. Patients in the web-based group also completed a satisfaction and preference questionnaire 1 year later. Only patients from the web-based group were asked to indicate preference as they had experienced the web-based and in-person followup methods. We used descriptive statistics to summarize the satisfaction questionnaires and compared results using Pearson's chi-square test. RESULTS Ninety-one patients (82.0%) in the usual-care group indicated that they were either extremely or very satisfied with the followup process compared with 90 patients (75.6%) who were in the web-based group (p < 0.01; odds ratio [OR] = 3.95; 95% CI, 1.79-8.76). Similarly, patients in the usual care group were more satisfied with the care they received from their surgeon, compared with patients in the web-based group (92.8% versus 73.9%; p < 0.01, OR = 1.37; 95% CI, 0.73-2.57). Forty-four percent of patients preferred the web-based method, 36% preferred the usual method, and 16% had no preference (p = 0.01). CONCLUSIONS Our results show moderate to high satisfaction levels with a web-based followup assessment. Patients who completed the usual method of in-person followup assessment reported greater satisfaction; however, the difference was small and may not outweigh the additional cost and time-saving benefits of the web-based followup method. LEVEL OF EVIDENCE Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jacquelyn Marsh
- Faculty of Health Sciences, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1 Canada
| | - Dianne Bryant
- Faculty of Health Sciences, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1 Canada
| | | | - Douglas Naudie
- London Health Sciences Centre, University Hospital, London, ON Canada
| | - Alliya Remtulla
- Faculty of Health Sciences, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1 Canada
| | - Richard McCalden
- London Health Sciences Centre, University Hospital, London, ON Canada
| | - James Howard
- London Health Sciences Centre, University Hospital, London, ON Canada
| | - Robert Bourne
- London Health Sciences Centre, University Hospital, London, ON Canada
| | - James McAuley
- London Health Sciences Centre, University Hospital, London, ON Canada
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30
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Eriksson L, Lindström B, Ekenberg L. Patients' experiences of telerehabilitation at home after shoulder joint replacement. J Telemed Telecare 2011; 17:25-30. [DOI: 10.1258/jtt.2010.100317] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the experience of ten patients who received video-based physiotherapy at home for two months after a shoulder joint replacement. Videoconferencing took place via the patient's home broadband connection at a bandwidth of 256–768 kbit/s. Qualitative interviews were carried out, transcribed and analysed. Through qualitative content analysis six categories were identified: (1) a different reinforced communication; (2) pain-free exercising as an effective routine; (3) from a dependent patient to a strengthened person at home; (4) closeness at a distance; (5) facilitated daily living; and (6) continuous physiotherapy chain. The access to bodily knowledge, continuity, collaboration and being at home were all aspects that contributed to the patients' recovery. The patients described experiences of safety, and strengthening during their daily exercise routine at home. The frequent interplay with the patient during telerehabilitation made it possible for the physiotherapist to make an individual judgement about each patient; this could be one reason for the positive findings. Home video-based physiotherapy may be useful in other kinds of physiotherapy.
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Affiliation(s)
- Lisbeth Eriksson
- Division of Health and Rehabilitation, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
- Department of Physiotherapy, Sunderby Hospital, Luleå, Sweden
| | - Britta Lindström
- Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Lilly Ekenberg
- Department of Research and Development, County Council of Norrbotten, Luleå, Sweden
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Noury N, Barralon P, Couturier P, Favre-Reguillon F, Guillemaud R, Mestais C, Caritu Y, David D, Moine S, Franco A, Guiraud-By F, Berenguer M, Provost H. ACTIDOM--a microsystem based on MEMS for activity monitoring of the frail elderly in their daily life. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:3305-8. [PMID: 17270988 DOI: 10.1109/iembs.2004.1403929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A "ambulatory activity recorder" was developed, with 3 accelerometers and 3 magnetometers, to detect and qualify the elementary activities of a person, such as walking and transfers. The signal processing is explained, along with the preliminary results obtained on young and older healthy subjects. This work open the way to continuous and automatic monitoring of the level of mobility.
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Affiliation(s)
- N Noury
- TIMC-IMAG Laboratory, Grenoble, France.
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32
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Tangtrakulwanich B, Kwunpiroj W, Chongsuvivatwong V, Geater AF, Kiatsiriroj N. Teleconsultation with digital camera images is useful for fracture care. Clin Orthop Relat Res 2006; 449:308-12. [PMID: 16691138 DOI: 10.1097/01.blo.0000218737.31129.6c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Teleconsultation using digital camera images has not yet been proven useful in orthopaedic practice. We ascertained the validity and reliability of teleconsultation using digital camera images of 100 patients with nondisplaced or minimally displaced fractures and 50 healthy age-matched subjects. We used three sets of images from each patient: a digitized radiograph, digital clinical photographs of the injured site, and conventional analog radiographs. Assessments were made independently by three groups of assessors: four orthopaedic staff members, four senior residents, and four junior residents all of whom evaluated the digitized information via E-mail. Digitized radiographs, digitized radiographs supplemented with a clinical photograph, and conventional radiographs were assessed consecutively at 1-week intervals. We used clinical and radiographic followup data as a gold standard. The overall reliability (kappa), sensitivity, and specificity of digitized radiographs were 0.57, 83.2%, and 80.7%, respectively. Reliability, sensitivity, and specificity of the digitized radiographs were not decreased after transmitting via E-mail. The level of experience in radiographic interpretation was associated independently with fracture misdiagnosis. Teleconsultation using digital camera images was valid and reliable. We recommend sending clinical photographs with the digitized radiograph. LEVEL OF EVIDENCE Diagnostic study, level II. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Boonsin Tangtrakulwanich
- Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Songkhla, Thailand.
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33
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Nicolas L, Franco A, Provost H, Amico L, Berenguer M, Lombard F, Tyrrell J, Couturier P, Bosson JL, Wernert S, Schnee D, Basset D, Chemarin A, Frossard M. Téléassistance en hospitalisation à domicile. Presse Med 2005; 34:1059-64. [PMID: 16334880 DOI: 10.1016/s0755-4982(05)84116-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose of this project was to study the clinical feasibility of videophone-based communication between patients in their homes, and the care teams who work in the Home Hospitalization department (HH). METHODS This pilot study of videophone users compared them with a group of control patients also in HH. They came from either the adult, maternity or pediatric departments. Patients who met the inclusion criteria and consented to participate in the study were randomly assigned to one of two groups: those who had a videophone installed in their homes (telemedicine group), and those who received the standard HH care (control group). Sixteen patients in the telemedicine group were matched with 16 from the control group, according to age, Karnofsky Index score, and the reason for HH admission. RESULTS The mean videophone call lasted six minutes, and patients averaged 23 calls each over the study period (0.7 calls per patient per working day). The videophone enabled better follow-up of wounds: for example, the nurse could transmit photos from the patient's home for real-time coordination. It was also useful for following patients suffering from pain, for technical nursing care, and for educating patients and their caregivers. Anxiety (measured with the Hospital Anxiety and Depression Scale) diminished during the study period for the telemedicine patients, compared with the control group (p=0.048). Within the telemedicine group, all patients and their families were very satisfied or satisfied with their care and with the communication (15/15), although the staff's level of satisfaction was slightly lower (14/16); there were no significant differences between groups. CONCLUSION The ViSaDom program indicates that videophone communication is feasible and acceptable and could be a useful tool for improving the quality, efficiency and effectiveness of care.
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Affiliation(s)
- L Nicolas
- Réseau d'Hospitalisation Domicile, Département de Médecine Gériatrique, CHU, Grenoble (38).
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Abboud JA, Bozentka DJ, Beredjiklian PK. Telemedicine consultation for patients with upper extremity disorders is reliable. Clin Orthop Relat Res 2005:250-7. [PMID: 15930947 DOI: 10.1097/01.blo.0000155009.77961.5c] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Telemedicine is a valuable resource for the delivery of health care to patients in underserved areas. The purpose of this study was to assess the reliability of asynchronous teleconsultation in the diagnosis and establishment of treatment plans for patients with disorders of the upper extremity. One hundred patients with disorders of the upper extremity were prospectively evaluated. Initial patient evaluations, done by an independent evaluator, involved a medical history, physical examination, digital images of the patient, and digitized radiographic studies. This patient information was presented electronically to two hand surgeons 6 months after one surgeon independently evaluated the patients in the outpatient clinic. The physicians formulated diagnosis and treatment plans for the patients based on the blinded electronic information. These findings then were compared with the treatment plans made by the physicians at the time of the patients' visits. Telemedicine consultation resulted in excellent agreement within observers (kappa = .92) and between observers (kappa = .86). Telemedicine consultation seems to be a reliable method for diagnosis and establishment of treatment plans in the management of upper extremity disorders. LEVEL OF EVIDENCE Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients--with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph A Abboud
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 39th and Market Streets, Philadelphia, PA 19104, USA.
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Ohinmaa A, Vuolio S, Haukipuro K, Winblad I. A cost-minimization analysis of orthopaedic consultations using videoconferencing in comparison with conventional consulting. J Telemed Telecare 2002; 8:283-9. [PMID: 12396857 DOI: 10.1177/1357633x0200800507] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared the costs of conventional outpatient visits to the surgical department of the University Hospital of Oulu with those of videoconferencing between the primary care centre in Pyhäjärvi and the University Hospital (separated by 160 km). The cost data were obtained from a randomized controlled trial that included 145 first-admission and follow-up orthopaedic patients. In the telemedicine group the annual fixed costs were 6074 in the hospital and 3910 in the primary care centre. The additional variable costs were 2 in the hospital and 19 in primary care. At a workload of 100 patients, the total cost, including travel and indirect costs, was 87.8 per patient in the telemedicine group and 114.0 per patient in the conventional group (i.e. a total cost saving from the use of teleconsultation of 2620). A cost-minimization analysis showed that telemedicine was less costly for society than conventional care at a workload of more than 80 patients per year. If the distance to specialist care were reduced from 160 km to 80 km, the break-even point increased to about 200 patients per year. Wider utilization of the videoconferencing equipment for other purposes, or the use of less expensive videoconferencing equipment, would make services cost saving even at relatively short distances. The study showed that orthopaedic outpatient telecare can be cost minimizing.
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Affiliation(s)
- Arto Ohinmaa
- Department of Economics, University of Oulu, Finland.
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Baruffaldi F, Gualdrini G, Toni A. Comparison of asynchronous and realtime teleconsulting for orthopaedic second opinions. J Telemed Telecare 2002; 8:297-301. [PMID: 12396859 DOI: 10.1177/1357633x0200800509] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied a teleconsulting service for second opinions in orthopaedics. Three units of the national insurance organization for accidents at work were connected to a large orthopaedic hospital in Bologna. During a 20-month study, 65 consultations were provided: 51 (78%) by asynchronous (store-and-forward) consulting and 14 (22%) by realtime videoconferencing. All the consultations made use of radiology images (radiographs, computerized tomography scans, magnetic resonance imaging scans and ultrasound scans). Video-messages and still images were commonly used to support the asynchronous consultations. More data were transmitted on average for an asynchronous teleconsultation (8 MByte) than in a videoconference (5 MByte). The average time spent by orthopaedic specialists was slightly longer in videoconferences (21 min, SD 8) than in asynchronous teleconsultations (19 min, SD 8). The clinicians confidence in their diagnosis was generally good but was lower in asynchronous consultations. The main problem affecting the telemedicine service was the lack or the low quality of the information received from the referring sites. The clinical complexity of the case and the organizational requirements were declared to be the main factors affecting the choice of consulting procedure. The study showed that the asynchronous method was preferred in the majority of cases and could be easily integrated into clinical practice, although there were some concerns about the diagnostic quality of the information transmitted.
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Affiliation(s)
- F Baruffaldi
- Laboratorio di Tecnologia Medica, Istituti Ortopedici Rizzoli, Bologna, Italy.
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Krupinski E, Nypaver M, Poropatich R, Ellis D, Safwat R, Sapci H. Telemedicine/telehealth: an international perspective. Clinical applications in telemedicine/telehealth. Telemed J E Health 2002; 8:13-34. [PMID: 12020403 DOI: 10.1089/15305620252933374] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Demongeot J, Virone G, Duchêne F, Benchetrit G, Hervé T, Noury N, Rialle V. Multi-sensors acquisition, data fusion, knowledge mining and alarm triggering in health smart homes for elderly people. C R Biol 2002; 325:673-82. [PMID: 12360854 DOI: 10.1016/s1631-0691(02)01480-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We deal in this paper with the concept of health smart home (HSH) designed to follow dependent people at home in order to avoid the hospitalisation, limiting hospital sojourns to short acute care or fast specific diagnostic investigations. For elderly people the project of such a HSH has been called AISLE (Apartment with Intelligent Sensors for Longevity Effectiveness). For this purpose, system having three levels of automatic measuring (1) the circadian activity, (2) the vegetative state, and (3) some state variables specific of certain organs involved in precise diseases, has been developed within the framework of a 'Health Integrated Smart Home Information System' (HIS2). HIS2 is an experimental platform for technologic development and clinical evaluation, in order to ensure the medical security and quality of life for patients who need home based medical monitoring. Location sensors are placed in each room of the HIS2, allowing the monitoring of patient's successive daily activity phases within the patient's home environment. We proceed with a sampling in an hourly schedule to detect weak variations of the nycthemeral rhythms. Based on numerous measurements, we establish a mean value with confidence limits of activity variables in normal behaviour permitting to detect for example a sudden abnormal event (like a fall) as well as a chronic pathologic activity (like a pollakiuria), allowing us to define a canonical domain within which the patient's activity is qualified to be 'predictable'. Alerts are set off if the patient's activity deviates from a predictable canonical domain. Moreover, we can follow the cardio-respiratory state by measuring the intensity of the respiratory sinusal arrhythmia in order to quantify the integrity of the bulbar vegetative system, and we finally propose to carefully watch abnormal symptoms like arterial pressure or presence of plasma proteins in the expired air flow for early detecting respectively hypertension or pulmonary oedema.
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Affiliation(s)
- Jacques Demongeot
- Laboratoire TIMC-IMAG, UMR CNRS 5525, faculté de médecine, université Joseph-Fourier de Grenoble, 38700 La Tronche, France.
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Williams TL, May CR, Esmail A. Limitations of patient satisfaction studies in telehealthcare: a systematic review of the literature. Telemed J E Health 2002; 7:293-316. [PMID: 11886667 DOI: 10.1089/15305620152814700] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.
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Affiliation(s)
- T L Williams
- School of Primary Care, University of Manchester, United Kingdom.
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Sezeur A, Degramont A, Touboul E, Mosnier H. Teleconsultation before chemotherapy for recently operated on patients. Am J Surg 2001; 182:49-51. [PMID: 11532415 DOI: 10.1016/s0002-9610(01)00662-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some operated on cancer patients require specialized complementary chemotherapy. Often, this takes place in another institution, where the patient consults the medical oncologist before hospitalization. The aim of this study was to analyze the potential benefit of a videoconference consultation within this framework. METHODS Sixteen operated on cancer patients hospitalized in the Surgical Unit received a teleconsultation in the presence of their surgeon and with the chemotherapist at some distance. During this period, the modalities of chemotherapy proposed, the duration of the teleconsultation, the economy of transport, and so on were noted. Twenty-four hours later each patient filled in a questionnaire aimed at, one, evaluating the quality of the image on an visual analogue scale (VAS) and the potential inconvenience involved; and two, evaluating the index of patient satisfaction on VAS. Furthermore, the last 12 patients filled in a questionnaire adapted to each of them, according to the information they had received. Each correct answer was noted 1, and each incorrect answer was noted 0. A memorization percentage was deduced. RESULTS The average age of the 16 patients was 63.4 years (range 46 to 78). The average duration of the teleconsultation was 27 minutes (12 to 40). The index of image satisfaction was 61.3%. As for the last 12 patients, 9.8 questions (7 to 12) enabled the calculation at 24 hours of the percentage of data retained by the patient (memorization index) based on the modalities and consequences of the chemotherapy. The percentage of correct answers was 80.5%. Fourteen of the 16 patients considered that teleconsultation had its advantages. Two patients would have preferred a classic consultation. The global satisfaction index was 79.9%. The average cost of functioning per patient was 187.76 FF A saving in transport of 509.92 FF was recorded per patient. CONCLUSIONS In the context of this original study, teleconsultation neither altered the doctor-patient relationship nor the quality of the message transmitted. Furthermore, it encourages closer links between complementary teams working at a distance and multidisciplinarity in cancerology.
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Affiliation(s)
- A Sezeur
- Service de Chirurgie Générale et Digestive, Hôpital Rothschild, 33 bd de Picpus, 75012, Paris, France.
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Lamminen H, Ruohonen K, Uusitalo H. Visual tests for measuring the picture quality of teleconsultations for medical purposes. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2001; 65:95-110. [PMID: 11275330 DOI: 10.1016/s0169-2607(00)00120-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Telemedicine provides a new way of delivering medical services. The good quality of the picture is, however, essential for a proper and reliable teleconsultation, especially in the cases when visual information about the patient's physical condition is of great importance as in ophthalmology and dermatology. Therefore real-time telemedical applications need standards for these procedures, e.g. minimum requirements for resolution, as well as contrast and color discrimination. The present study was carried out to test these parameters in a real environment. A panel of different resolution, contrast sensitivity and color discrimination tests was carried out for five test persons via PictureTel videoconference system by ISDN 128 kbit/s line speed and in a normal way. The good color discrimination of the teleconsultation system makes it possible to use the system in the evaluation of different skin lesions and exemas. However, the poor resolution and especially poor contrast sensitivity makes the use of the equipment valueless in the evaluation of diseases where the diagnoses are based on the discrimination of small details, like the biomicroscopical analysis of inflammatory cells in the aqua's humor in cases of intraocular inflammation. The authors are suggesting a simple panel of tests to optimize and standardize these parameters.
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Affiliation(s)
- H Lamminen
- Department of Ophthalmology, Tampere University Hospital, P.O. Box 2000, FIN-33501, Tampere, Finland.
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Whitten PS, Mair F. Telemedicine and patient satisfaction: current status and future directions. Telemed J E Health 2001; 6:417-23. [PMID: 11242550 DOI: 10.1089/15305620050503898] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
One of the most researched areas in telemedicine concerns the issue of satisfaction. However, most of this research lacks any consistent methodological approach. As a result, it is difficult to conclude whether patients and providers are satisfied with telemedicine. However, this paper postulates that there is a bigger problem within the satisfaction literature than the quality of the research to date. Instead, the bigger question is whether the results from a specific telemedicine project can actually be generalized across all telemedicine contexts. This paper argues that research should focus on specific questions of interest rather than continue the tradition of generic satisfaction research if we hope to gain specific knowledge that will inform the field of telemedicine as a whole.
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Affiliation(s)
- P S Whitten
- Department of Telecommunication, Michigan State University, East Lansing 48824-1212, USA.
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Stroetmann KA, Gruetzmacher P, Stroetmann VN. Improving quality of life for dialysis patients through telecare. J Telemed Telecare 2000; 6 Suppl 1:S80-3. [PMID: 10793981 DOI: 10.1258/1357633001934249] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Home dialysis can improve the care and quality of life for patients with renal failure. We have explored the possibility of extending home care to more patients needing continuous ambulatory peritoneal dialysis (CAPD) using telemedicine. We tested videoconferencing support for five CAPD patients using low-cost ISDN equipment (128 kbit/s). Initial results indicated that it was possible to integrate videocommunication into the daily routine of the clinic and the response from patients was surprisingly positive. Selection of appropriate, affordable technology and the ISDN service support by the telecommunications provider proved to be considerably more difficult than anticipated. The first indications also suggest medical advantages for home teledialysis.
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Affiliation(s)
- K A Stroetmann
- Empirica Gesellschaft fuer Kommunikations- und Technologieforschung mbH, Bonn, Germany.
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Mair F, Whitten P. Systematic review of studies of patient satisfaction with telemedicine. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1517-20. [PMID: 10834899 PMCID: PMC27397 DOI: 10.1136/bmj.320.7248.1517] [Citation(s) in RCA: 448] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To review research into patient satisfaction with teleconsultation, specifically clinical consultations between healthcare providers and patients involving real time interactive video. DESIGN Systematic review of telemedicine satisfaction studies. Electronic databases searched include Medline, Embase, Science Citation Index, Social Sciences Citation Index, Arts and Humanities Citation Index, and the TIE (Telemedicine Information Exchange) database. SUBJECTS Studies conducted worldwide and published between 1966 and 1998. MAIN OUTCOME MEASURES Quality of evidence about patient satisfaction. RESULTS 32 studies were identified. Study methods used were simple survey instruments (26 studies), exact methods not specified (5), and qualitative methods (1). Study designs were randomised controlled trial (1 trial); random patient selection (2); case-control (1); and selection criteria not specified or participants represented consecutive referrals, convenience samples, or volunteers (28). Sample sizes were </=20 (10 trials), </=100 (14), >100 (7), and not specified (1). All studies reported good levels of patient satisfaction. Qualitative analysis revealed methodological problems with all the published work. Even so, important issues were highlighted that merit further investigation. There is a paucity of data examining patients' perceptions or the effects of this mode of healthcare delivery on the interaction between providers and clients. CONCLUSIONS Methodological deficiencies (low sample sizes, context, and study designs) of the published research limit the generalisability of the findings. The studies suggest that teleconsultation is acceptable to patients in a variety of circumstances, but issues relating to patient satisfaction require further exploration from the perspective of both clients and providers.
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Affiliation(s)
- F Mair
- Department of Primary Care, Whelan Building, Quadrangle, University of Liverpool, Liverpool L69 3GB.
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Nesbitt TS, Ellis JC, Kuenneth CA. A proposed model for telemedicine to supplement the physician workforce in the USA. J Telemed Telecare 2000; 5 Suppl 2:S20-6. [PMID: 10628014 DOI: 10.1258/1357633991933486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Maldistribution of physicians is the norm in much of the USA. This paper explores the effect that the integration of telemedicine into the health system could have on physician workforce requirements in the USA. The analysis is based on preliminary evidence suggesting that telemedicine is an effective and efficient means of delivering a broad spectrum of health services to medically under-served rural and inner-city communities. While the emphasis here is on interactive, video-based telemedicine services, other telemedicine modalities, such as store-and-forward techniques and remote monitoring, are likely to have a parallel effect. As these new technologies become a normal part of health care, they will reshape the medical workforce and exert a profound influence on physician workforce requirements in the USA. This paper presents a potential model for this reshaped workforce that emphasizes an expanded role for mid-level health-care providers.
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Affiliation(s)
- T S Nesbitt
- UC Davis Health System, Sacramento, California 95817, USA
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