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Alashek WA, Ali SA. Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review. Libyan J Med 2024; 19:2301829. [PMID: 38197179 PMCID: PMC10783830 DOI: 10.1080/19932820.2024.2301829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024] Open
Abstract
Background: Telemedicine became a fundamental part of healthcare provision during COVID-19 pandemic. An evaluation of telemedicine-associated satisfaction helps the service develop more viable applications. This review evaluated the satisfaction of healthcare users and providers and their willingness to use this modality in future.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search on empirical articles published between March 2020 and December 2022 was performed on 'PubMed' and 'Scopus' databases. Findings that reported on satisfaction of patients, families and caregivers as well as clinicians were extracted and analysed. Quality of included studies was assessed. After applying inclusion and exclusion criteria, the review included 27 eligible studies.Results: Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare. Almost all studies were undertaken within the NHS. There were many tools that measured satisfaction. Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%. Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information. Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people. In general, willingness to use telemedicine in future was high in the recipients as well as the providers of healthcare.Conclusion: COVID-19 pandemic has transformed healthcare in the UK and promoted a revolution in telemedicine applications. Satisfaction was high among both recipient and provider of healthcare. Telemedicine managed to provide a continued care throughout the pandemic while maintaining social distance. The current review presented commendable evidence to encourage different specialities to engage in telemedicine application.
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Affiliation(s)
- WA. Alashek
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - SA. Ali
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Karasik D, Cabrera CI, Shammassian B, Wright JM, Bambakidis N, D'Anza B. Benefits of Neurosurgical Teleconsults in the Management of Intracerebral Hemorrhage: Transfers and Transportation Cost Reduction. World Neurosurg 2024:S1878-8750(24)01058-1. [PMID: 38936617 DOI: 10.1016/j.wneu.2024.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Our study explores the efficacy and economic benefits of neurosurgical teleconsultations in managing intracerebral hemorrhage (ICH), focusing on reducing unnecessary patient transfers and associated costs. METHODS We conducted a cost-savings analysis at our institution of a previously published pilot study involving a cohort of patients with ICH who were potential candidates for airlift to our tertiary care center but instead received neurosurgical consultation via teleconsultation to avoid the transfer. Data on patient demographics, distances, and costs were collected and analyzed to assess the economic impact of teleconsultations. RESULTS The cohort comprised 14 patients; we noted significant cost savings from avoiding interhospital transfers, ranging from $84,346.52 to $120,495.03 per patient. Teleconsultations facilitated immediate, collaborative decision-making between healthcare providers at community hospitals and a tertiary care center, reducing the need for expensive air transportation and unnecessary hospital transfers. CONCLUSIONS Neurosurgical teleconsultations offer a cost-effective alternative to traditional patient transfer methods for ICH management, providing substantial economic benefits while maintaining high physician and patient-family satisfaction levels. This study underscores the potential of our teleneurosurgery program to significantly reduce costs by reducing unnecessary financial burdens on patients' families and healthcare systems.
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Affiliation(s)
- Daniel Karasik
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Berje Shammassian
- Department of Neurological Surgery, Louisiana State University Health Sciences New Orleans, Louisiana, USA
| | - James M Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas Bambakidis
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brian D'Anza
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Brian.D'
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Agaoglu FO, Karagoz N. Investigation of Health Professionals' Intention to Use Telemedicine in Turkey. Telemed J E Health 2024; 30:e1187-e1191. [PMID: 37930746 DOI: 10.1089/tmj.2023.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Introduction: The aim of this study is to determine the usage intention levels by health professionals of telemedicine applications whose legal infrastructure is recently completed by the Ministry of Health in Turkey and whose use is desired to be expanded. Methods: In addition to the questions posed to determine the demographic characteristics of the health professional, their relationship with technology, and their level of knowledge about the word telemedicine; survey data, which included statements to determine factors such as telemedicine use intentions, perceived usefulness, perceived ease, and attitude, were analyzed. Results: Survey questions were answered by 337 health professionals. It has been determined that 83.4% of health professionals have a medium and high level of relationship with technology, 26.4% have never heard of telemedicine, and the rest have various interactions with medicine. According to the results of the research, it is clearly stated that the intention of health professionals to use telemedicine applications is shaped by factors such as perceived usefulness, perceived ease, and attitude. Conclusion: It has been clearly determined that the intention of health professionals to use telemedicine applications is shaped by factors such as perceived usefulness, perceived ease, and attitude. In parallel with this information, it is seen that the possibility of affecting the intentions of using telemedicine by managing the perceptions of health professionals is possible within the obtained results.
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Affiliation(s)
- Ferhat Onur Agaoglu
- Department of Health Management, Erzincan Binali Yildirim University, Erzincan, Turkiye
| | - Naim Karagoz
- Department of Medical Education, Sivas Cumhuriyet University, Sivas, Turkiye
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Bardwell A, Crowe CS, Rhee PC. Limb spasticity and telemedicine consultation for reconstructive surgery: patient perspectives of surgical assessment. J Osteopath Med 2024; 0:jom-2023-0235. [PMID: 38501736 DOI: 10.1515/jom-2023-0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024]
Abstract
CONTEXT Spasticity is characterized by increased muscle tone and stretch reflexes, often caused by an upper motor neuron (UMN) syndrome. Many patients live with their dysfunction of their upper or lower limbs for many years and are managed by a multidisciplinary team including physical medicine and rehabilitation specialists, neurologists, and/or physical therapists in an attempt to decrease their spasticity and enhance their quality of life. Reconstructive surgery is a treatment option for many patients living with spasticity. The goal of surgery is to permanently decrease their spastic tone and improve their quality of life. Spastic hemiplegia or hemiparesis is an area of orthopedic surgery that is uniquely suited to telemedicine evaluation. Telemedicine visits can lower the threshold for patients to obtain consultation, receive second opinions, and determine whether traveling for an in-person assessment might be worthwhile, particular to larger medical centers. OBJECTIVES The objective of our study was to characterize patient perceptions of telemedicine consultation for spasticity surgery and to determine its effectiveness for indicating reconstructive procedures. METHODS An electronic survey consisting of 16 questions was distributed to all patients after the virtual consultation from April 2020 to September 2022 as part of a neuro-orthopedic evaluation. Domains of inquiry included patient demographic and diagnosis information, satisfaction with provider assessment, ease of use, appointment preference, and whether surgery was eventually performed. Identifying information was voluntarily provided by patients and allowed for survey data to be linked to the medical record. Patients were included in the study if they were diagnosed with upper and/or lower extremity spasticity, were evaluated by telemedicine visit, and were over the age of 18. They were excluded from the study if they were evaluated for any condition aside from spasticity or returned an incomplete survey. Patients who completed the survey were prospectively followed through December 2022 to determine whether a subsequent in-person visit was pursued and/or reconstructive surgery was performed. RESULTS A total of 19 of 36 patients completed surveys, for a response rate of 52.7 %. Nearly all (94.7 %, n=18) patients felt that the provider expressed maximal concern for patient questions/worries, included them in decisions regarding care, and appropriately discussed treatment strategies. Similarly, the majority (89.5 %, n=17) were maximally satisfied with explanations about their condition and would recommend the care provider to others. Most patients (84.2 %, n=16) also felt that the ease of communication via the virtual platform was very good. All patients were eventually indicated for and subsequently underwent reconstructive surgery for spasticity. CONCLUSIONS Spasticity patients were overwhelmingly satisfied with their initial virtual consultation as an alternative to face-to-face visits. Telemedicine provides a clinical opportunity for seeking information about spasticity surgery and offers a cost-effective and convenient option for patients who find travel to specialty centers prohibitive.
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Affiliation(s)
- Abigail Bardwell
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christopher S Crowe
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter C Rhee
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Clinical Investigation Facility, Department of Orthopedic Surgery, Travis Air Force Base, CA, USA
- 200 1st Street SW, Rochester, MN 55905, USA
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Hailu BY, Berhe E, Yemane A, Atsbha Abera M, Berhane S, Berhe F, Belay SA, Gebreegziabher Hailu A, Berhe Abreha B, Gebrearegay Haileeyesus H, Gidey K. Patient Satisfaction with the Implementation of Telehealth in Ambulatory Care during the COVID-19 Pandemic: A Single Institution Experience. BIOMED RESEARCH INTERNATIONAL 2024; 2024:6800057. [PMID: 38405427 PMCID: PMC10890901 DOI: 10.1155/2024/6800057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/16/2023] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
Background COVID-19 has reduced the capacity for delivering essential health services due to lockdown restrictions. Telehealth is an effective alternative option to improve healthcare access. However, there remain implementation challenges to patient adoption in resource-limited settings such as Ethiopia. Therefore, the purpose of this study was to assess patient satisfaction following the implementation of telehealth in ambulatory settings during the COVID-19 pandemic. Methods A cross-sectional study was conducted at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia. Patients who used the telehealth service were invited to participate in a patient satisfaction survey. All statistical analyses were performed using STATA Version 14.1. Result A total of 149 patients have participated in the survey. Out of the total participants, 129 (86.6%) found that telehealth is easy to understand and overall satisfaction for telehealth was 87.9%. About two-thirds of the patients (97, 65.1%) reported that the telehealth visit is just as good as a traditional visit. The vast majority of participants (148, 98.6%) stated that they would definitely or probably use telehealth again and would recommend it to others. The majority of respondents (137, 91.9%) followed the recommendations provided. Conclusion Patients have a high level of satisfaction with the use of telehealth during the COVID-19 pandemic. About two-thirds of patients said the telehealth visit was just as good as a traditional visit. The majority of patients followed the recommendations given to them by the healthcare providers and stated that they would definitely or probably use telehealth in the future and would recommend it to others. This high level of patient satisfaction with telehealth implementation suggests that the service could be considered in low-income countries as well.
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Affiliation(s)
- Berhane Yohannes Hailu
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, Ayder Comprehensive Specialized Hospital, Mekelle University-College of Health Sciences, Mekelle, Ethiopia
| | - Awol Yemane
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Merhawit Atsbha Abera
- Department of Internal Medicine, Ayder Comprehensive Specialized Hospital, Mekelle University-College of Health Sciences, Mekelle, Ethiopia
| | - Samuel Berhane
- Department of Internal Medicine, Ayder Comprehensive Specialized Hospital, Mekelle University-College of Health Sciences, Mekelle, Ethiopia
| | - Fikaden Berhe
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Saba Abraham Belay
- Career and Professional Development Center, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abraha Gebreegziabher Hailu
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Bereket Berhe Abreha
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hailemariam Gebrearegay Haileeyesus
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Algarni SA, Alrashid MH, Aldayel MS, Allowaihiq LH, Almuqbil AA, Albarrak AM, Almobarak S. Satisfaction of adult and pediatric neurologists and neurosurgeons using telehealth during the COVID-19 pandemic in Saudi Arabia: a cross-sectional study. Front Digit Health 2024; 6:1195697. [PMID: 38419806 PMCID: PMC10899518 DOI: 10.3389/fdgth.2024.1195697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives Telehealth has become increasingly important in achieving universal health coverage. It offers doctors and their patients' convenience, including providing quality care at reduced costs. During the coronavirus disease (COVID)-19 pandemic, telehealth has been a vital tool for remote healthcare services. This study aimed to assess the satisfaction of adult and pediatric neurologists and neurosurgeons using telehealth, during the COVID-19 pandemic in Saudi Arabia. Methods This study had 348 participants. It was conducted among adult and pediatric neurologists and neurosurgeons using telehealth technology at their clinics between February and June 2021. The self-administered questionnaire included sociodemographic data, behavior in using telehealth, and an assessment of satisfaction with telehealth; the SPSS Windows software version 26 was used to analyze the data. Results The most common age group was 25-34 years (42.8%), with men dominating (68.4%). The mean satisfaction score was 25.9 (SD 3.91) out of 33 points, with 90.2% of respondents satisfied with telehealth and 9.8% dissatisfied. Working in an academic center or private hospital, being a first-time telehealth user, using messages as a telehealth method, and using telehealth daily were associated with increased satisfaction with telehealth use. Conclusion The satisfaction of adult and pediatric neurologists and neurosurgeons with telehealth was high. Although physicians still preferred face-to-face interviews, they recognized the benefits of telehealth in strengthening the patient-provider relationship, improving productivity, and integrating into daily workflows. The satisfaction levels align with past studies, but physical examination needs should be considered. Telehealth is suitable for follow-up visits and varies across subspecialties.
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Affiliation(s)
- Saleh Ayed Algarni
- Department of Neuroscience, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Maha Hamoud Alrashid
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | | | | | - Anas Mohammad Albarrak
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Sulaiman Almobarak
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Pediatric Neurology Department, King Saud Medical City, Riyadh, Saudi Arabia
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Sharma P, Kamath C, Brockman TA, Roche A, Sinicrope P, Jiang R, Decker PA, Pazdernik V, Patten C. Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study. JMIR Form Res 2024; 8:e50572. [PMID: 38265855 PMCID: PMC10851122 DOI: 10.2196/50572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. OBJECTIVE This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. METHODS We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ≥18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, "Have you ever had a video appointment with a healthcare provider?" "Yes" respondents were defined as "users" (adapted to video appointments), and "no" respondents were defined as "persistent nonusers" of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. RESULTS Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. CONCLUSIONS Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients' decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients' negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a "digital health coordinator" could be assigned to assist with various digital health solutions.
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Affiliation(s)
- Pravesh Sharma
- Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, WI, United States
| | - Celia Kamath
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Tabetha A Brockman
- Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States
| | - Anne Roche
- Psychology, Mayo Clinic, Rochester, MN, United States
| | - Pamela Sinicrope
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ruoxiang Jiang
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Paul A Decker
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Vanessa Pazdernik
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Christi Patten
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Barasch JG, Tang W, Khalili L, Askanase A. The Evolving Role of Telemedicine in the Care of Patients With Connective Tissue Diseases. Arthritis Care Res (Hoboken) 2024; 76:19-21. [PMID: 37842736 DOI: 10.1002/acr.25259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Julia G Barasch
- Columbia University Vagelos College of Physicians and Surgeons, New York City
| | - Wei Tang
- Columbia University Irving Medical Center, New York City
| | - Leila Khalili
- Columbia University Irving Medical Center, New York City
| | - Anca Askanase
- Columbia University Irving Medical Center, New York City
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Zachrison KS, Yan Z, White BA, Park L, Schwamm LH. Factors Associated with the Digital Patient Experience of Virtual Care Across Specialties. TELEMEDICINE REPORTS 2023; 4:227-235. [PMID: 37637376 PMCID: PMC10457601 DOI: 10.1089/tmr.2023.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/29/2023]
Abstract
Background We aimed to characterize patient experience with virtual care across medical specialties using validated survey data. Primary objective: to determine whether experience varied by visit modality (virtual vs. in-person) and whether relationships persisted after adjusting for patient and provider characteristics. Secondarily, among physicians with sufficient data, we compared virtual versus in-person patient experience scores at the physician level and identified characteristics associated with better experience scores for virtual care. Methods This was a retrospective analysis of administrative databases from a large New England health care system, including all ambulatory visits from October 1, 2020 to September 30, 2021 with patient experience scores recorded. We compared experience between virtual and in-person at the visit level (score: 0-10) and the physician level for likelihood of recommending the physician to friends or family. We used a series of cross-classified hierarchical models with visits grouped by patient and by physician to decompose sources of variation. Among physicians with sufficient data, we compared physicians with higher virtual versus higher in-person net promoter score (NPS). Results Of 378,472 visits performed by 3368 physicians, 86,878 (23%) were conducted virtually. Most scored ≥9 for either modality, with a small preference for virtual versus in-person care (9.6 vs. 9.5, p < 0.001). We found that more variation in scores was explained by patient than by physician (22.9% vs. 3%). Visit modality was of minimal explanatory value. Most physicians' virtual and in-person NPS were similar, and virtual visit volume was not associated. Conclusions We found robust evidence for the parity of patient experience between virtual and in-person modalities across specialties.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zhiyu Yan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin A. White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee Park
- Department of Internal Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
- Mass General Brigham, Boston, Massachusetts, USA
| | - Lee H. Schwamm
- Mass General Brigham, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Agbali RA, Balas EA, Beltrame F, Heboyan V, De Leo G. A review of questionnaires used for the assessment of telemedicine. J Telemed Telecare 2023:1357633X231166161. [PMID: 37032470 DOI: 10.1177/1357633x231166161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.
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Affiliation(s)
- Raphael A Agbali
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - E Andrew Balas
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - Francesco Beltrame
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genova, Italy
| | - Vahe Heboyan
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
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Nie JZ, Karras CL, Texakalidis P, Trybula SJ, Dahdaleh NS. A Systematic Review of Outpatient Telemedicine Use in Neurosurgery Since the Start of Coronavirus Disease 2019. World Neurosurg 2022; 167:e1090-e1102. [PMID: 36115568 DOI: 10.1016/j.wneu.2022.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has sparked interest in telemedicine, resulting in an increase in neurosurgical publications focused on it. We summarize this new literature to evaluate telemedicine applications to neurosurgery. METHODS A systematic literature review was performed in accordance with the PRISMA guidelines by searching PubMed, Embase, and Scopus for journal articles published after January 1, 2020. All journal articles that included data after the start of COVID-19 and evaluated any aspect of telemedicine relevant to outpatient neurosurgical visits were included. The premise and key findings of each included study were extracted, as well as patient and provider satisfaction with and preference for telemedicine. RESULTS Thirty-seven articles met the inclusion criteria. Four studies proposed and evaluated a remote neurologic examination. Two studies reported similar postvisit outcomes between remote and in-person visits. Twenty-four studies reported a combination of patient and provider opinions toward telemedicine. Of 9834 patients and 116 providers, 82.4% and 65.2% were satisfied overall with telemedicine, respectively. Of 3526 patients and 168 providers, 57.0% and 66.5% preferred telemedicine to in-person visits, respectively. CONCLUSIONS Overall, most patients and providers have a high opinion of telemedicine for outpatient visits, and increasing evidence suggests that remote visits yield favorable clinical outcomes. The high rates of patient and provider satisfaction and preference may be considered for further adoption of remote neurosurgical visits beyond the COVID-19 era.
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Affiliation(s)
- Jeffrey Z Nie
- Southern Illinois University School of Medicine, Springfield, Illinois, USA.
| | - Constantine L Karras
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pavlos Texakalidis
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - S Joy Trybula
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Castaño-Leon AM, Paredes I, Lagares A, Gomez PA, González-Leon P, Perez-Nuñez A, Jiménez-Roldán L, Delgado-Fernández J, Eiriz Fernández C, García-Pérez D, Moreno-Gómez LM, Esteban-Sinovas O, Delgado-López PD, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez-Carmona M, Arteaga-Romero F, González-Pombo M, F Alén J, Gil-Simoes R, Torres CV, Navas-García M, Blasco García de Andoain G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-González M, Menéndez-Cortezón B, Rodríguez-Botana B, Pérez-Alfayate R, Fernández-García C, Ferrández-Pujante B, Vargas-Jiménez AC, Cotúa C, de la Lama A, Calero Félix L, Ruiz-Juretschke F, García-Leal R, Valera-Melé M, Casitas Hernando V, Rivero B, Orduna-Martínez J, Casado Pellejero J, Fustero De Miguel D, Díaz Molina J, Moles Herbera J, Castelló-Ruiz MJ, Gomar-Alba M, García-Pérez F, Hernández-García BJ, Villaseñor-Ledezma JJ, Otero-Rodríguez Á, Ailagas de Las Heras JJ, Gonçalves-Estella J, Sousa-Casasnovas P, Pascual-Argente D, Ruiz Martín L, Roa Montes de Oca JC, Arandia Guzmán D, García Martín A, Torres Carretero L, Garrido Ruiz A, Calvo M, Miranda-Lloret P, Rodríguez-Cadarso M, Antón J, Roca Barber A, Quiroz-Tejada A, Carbayo-Lozano G, Bermúdez G, Paternain Martin C, De la Fuente Villa P, Fidalgo De la Rosa M, Sistiaga-Gracia ÍL, Zabalo G. Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study. BMJ Open 2022; 12:e061208. [PMID: 35977759 PMCID: PMC9388715 DOI: 10.1136/bmjopen-2022-061208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. DESIGN This was an observational retrospective study. SETTINGS A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. PARTICIPANTS A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. RESULTS More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic. CONCLUSIONS Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.
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Affiliation(s)
- Ana M Castaño-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Igor Paredes
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gomez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pedro González-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Jiménez-Roldán
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Daniel García-Pérez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M Moreno-Gómez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ariel Kaen
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | | | | | - Marta González-Pombo
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - José F Alén
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas-García
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Natalia Frade-Porto
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Miguel Gelabert-González
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Beatriz Menéndez-Cortezón
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Brais Rodríguez-Botana
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Carlos Cotúa
- Neurosurgery Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Adolfo de la Lama
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | - Lourdes Calero Félix
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | | | - Roberto García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Marc Valera-Melé
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - Belén Rivero
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Jorge Díaz Molina
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Moles Herbera
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria J Castelló-Ruiz
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Mario Gomar-Alba
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Fernando García-Pérez
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | | | | | - Álvaro Otero-Rodríguez
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Pablo Sousa-Casasnovas
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Daniel Pascual-Argente
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Laura Ruiz Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Daniel Arandia Guzmán
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Andoni García Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Luis Torres Carretero
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Alejandra Garrido Ruiz
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Marta Calvo
- Neurosurgery Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Miranda-Lloret
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Joan Antón
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Amparo Roca Barber
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Arnold Quiroz-Tejada
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Garazi Bermúdez
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | | | | | - Gorka Zabalo
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
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Lassarén P, Tewarie IA, Gerstl JVE, Florman JE, Smith TR, Broekman MLD. Telemedicine and the right to health: A neurosurgical perspective. J Clin Neurosci 2022; 102:71-74. [PMID: 35738183 DOI: 10.1016/j.jocn.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022]
Abstract
Neurosurgical task force is limited and unevenly distributed. Telemedicine has become increasingly popular, and could help neurosurgical centers meet patient right to care. This scoping review aims to evaluate the impact and feasibility of telemedicine on the right to neurosurgical care, using the AAAQ toolbox. The AAAQ toolbox consists of Availability, Accessibility, Acceptability and Quality. Neurosurgical availability is limited by the number of neurosurgeons, but by using task shifting and -sharing via telemedicine, the number of patients receiving neurosurgical care could increase without increasing the number of neurosurgeons. Telemedicine can improve geographic accessibility to neurosurgical care, but may also introduce technological literacy barriers. Acceptability of telemedicine is a double-edged sword; while a useful service, telemedicine also creates ethical concerns regarding privacy and confidentiality. Regulations and adaptations for vulnerable patient groups are key considerations for deploying telemedicine. Finally, there is emerging evidence that the quality of remote neurosurgical diagnostics and care can keep high standards. Overall, telemedicine has the potential of taking neurosurgery one step closer to meeting patient right to health, globally.
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Affiliation(s)
- Philipp Lassarén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Ishaan A Tewarie
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; Faculty of Medicine, Erasmus University Rotterdam/Erasmus Medical Center Rotterdam, The Netherlands
| | - Jakob V E Gerstl
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Maine Medical Center, Portland, ME, United States
| | - Jeffrey E Florman
- Department of Neurosurgery, Maine Medical Center, Portland, ME, United States
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Marike L D Broekman
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Paro MR, Lambert WA, Leclair NK, Chakraborty AR, Angelo S, Pesante B, Stoltz P, Martin JE, Bookland MJ, Hersh DS. Family-acquired photographs for the evaluation of pediatric head shape via telemedicine: an analysis of photograph quality. Neurosurg Focus 2022; 52:E11. [DOI: 10.3171/2022.3.focus2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Telemedicine can be an effective tool for the evaluation of the pediatric patient with a cranial deformity, but it increases the reliance of neurosurgical providers on data provided by patients and families. Family-acquired photographs, in particular, can be used to augment the evaluation of pediatric head shape abnormalities via telemedicine, but photographs of sufficient quality are necessary. Here, the authors systematically reviewed the quality and utility of family-acquired photographs for patients referred to their pediatric neurosurgery clinic for telemedicine-based head shape evaluations.
METHODS
All telemedicine encounters that were completed for head shape abnormalities at the authors’ institution between May 2020 and December 2021 were retrospectively reviewed. Instructions were sent to families prior to each visit with examples of ideal photographs. Three orthogonal views of the patient’s head—frontal, lateral, and vertex—were requested. Data were collected regarding demographics, diagnosis, follow-up, and photograph quality. Quality variables included orthogonality of each requested view, appropriate distance, appropriate lighting, presence of distracting elements, and whether hair obscured the head shape.
RESULTS
Overall, 565 patients had 892 visits during the study period. A total of 1846 photograph requests were made, and 3335 photographs were received for 829 visits. Of 2676 requested orthogonal views, 1875 (70%) were received. Of these, 1826 (97%) had adequate lighting, 1801 (96%) had appropriate distance, and 1826 (97%) had no distracting features. Hair did not obscure the head shape on the vertex view in 557 visits with orthogonal vertex views (82%). In-person follow-up was requested for further medical evaluation in 40 visits (5%).
CONCLUSIONS
The family-acquired photographs in this series demonstrated high rates of adequate lighting and distance, without distracting features. Lack of orthogonality and obscuration of the head shape by hair, however, were more common issues. Family education prior to the visit may improve the quality of family-acquired photographs but requires an investment of time by medical staff. Efforts to further improve photographic quality will facilitate efforts to perform craniometric evaluations through telemedicine visits.
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Affiliation(s)
| | | | | | | | | | | | - Petronella Stoltz
- Division of Neurosurgery, Connecticut Children’s, Hartford, Connecticut; and
| | - Jonathan E. Martin
- Division of Neurosurgery, Connecticut Children’s, Hartford, Connecticut; and
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut
| | - Markus J. Bookland
- Division of Neurosurgery, Connecticut Children’s, Hartford, Connecticut; and
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut
| | - David S. Hersh
- Division of Neurosurgery, Connecticut Children’s, Hartford, Connecticut; and
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut
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15
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Mora C, Sampedro I, Rodríguez-Caballero A, Martín-Láez R, Ortega-Roldán M, Venkatraghavan L, Fernández-Miera M, Varea M, Pajaron-Guerrero M, Esteban J, Moreno B, Manzano A, Ruiz I, Martino J, Zadeh G, Bernstein M, Velásquez C. Barriers and facilitators in the implementation of a telemedicine-based outpatient brain tumor surgery program. Neurosurg Focus 2022; 52:E8. [DOI: 10.3171/2022.3.focus2242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Despite growing evidence on the benefits of outpatient oncological neurosurgery (OON), it is only performed in a few specialized centers and there are no previous descriptions of established OON programs in Europe. Moreover, increasing application of telemedicine strategies, especially after the start of the coronavirus disease 2019 (COVID-19) pandemic, is drastically changing neurosurgical management, particularly in the case of vulnerable populations such as neuro-oncological patients. In this context, the authors implemented an OON program in their hospital with telematic follow-up. Herein, they describe the protocol and qualitatively analyze the barriers and facilitators of the development process.
METHODS
An OON program was developed through the following steps: assessment of hospital needs, specific OON training, multidisciplinary team organization, and OON protocol design. In addition, the implementation phase included training sessions, a pilot study, and continuous improvement sessions. Finally, barriers and facilitators of the protocol’s implementation were identified from the feedback of all participants.
RESULTS
An OON protocol was successfully designed and implemented for resection or biopsy of supratentorial lesions up to 3 cm in diameter. The protocol included the patient’s admission to the day surgery unit, noninvasive anesthetic monitoring, same-day discharge, and admission to the hospital-at-home (HaH) unit for telematic and on-site postoperative care. After a pilot study including 10 procedures in 9 patients, the main barriers identified were healthcare provider resistance to change, lack of experience in outpatient neurosurgery, patient reluctance, and limitations in the recruitment of patients. Key facilitators of the process were the patient education program, the multidisciplinary team approach, and the HaH-based telematic postoperative care.
CONCLUSIONS
Initiating an OON program with telematic follow-up in a European clinical setting is feasible. Nevertheless, it poses several barriers that can be overcome by identifying and maximizing key facilitators of the process. Among them, patient education, a multidisciplinary team approach, and HaH-based postoperative care were crucial to the success of the program. Future studies should investigate the cost-effectiveness of telemedicine to assess potential cost savings, from reduced travel and wait times, and the impact on patient satisfaction.
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Affiliation(s)
- Carla Mora
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
| | - Isabel Sampedro
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | | | - Rubén Martín-Láez
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria
| | - Marta Ortega-Roldán
- Ciencias Jurídicas y Empresariales, Universidad de Cantabria, Santander, Cantabria, Spain
- Medtronic Ibérica, Madrid, Spain
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto
| | | | - Mar Varea
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | | | - Jesus Esteban
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
| | - Blanca Moreno
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | - Asunción Manzano
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | - Isabel Ruiz
- Department of Anesthesiology, Hospital Universitario Marqués de Valdecilla
| | - Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Carlos Velásquez
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria
- Department of Anatomy and Cell Biology, Universidad de Cantabria, Santander, Cantabria; and
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Pennington Z, Michalopoulos GD, Biedermann AJ, Ziegler JR, Durst SL, Spinner RJ, Meyer FB, Daniels DJ, Bydon M. Positive impact of the pandemic: the effect of post-COVID-19 virtual visit implementation on departmental efficiency and patient satisfaction in a quaternary care center. Neurosurg Focus 2022; 52:E10. [PMID: 35921181 DOI: 10.3171/2022.3.focus2243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has significantly changed clinical practice across US healthcare. Increased adoption of telemedicine has emerged as an alternative to in-person contact for patient-physician interactions. The aim of this study was to analyze the impact of telemedicine on workflow and care delivery from January 2019 to December 2021 in a neurosurgical department at a quaternary care center. METHODS Prospectively captured data on clinic appointment utilization, duration, and outcomes were queried. Visits were divided into in-person visits and telemedicine appointments, categorized as follow-up visits of previously surgically treated patients, internal consultations, new patient visits, and early postoperative returns after surgery. Appointment volume was compared pre- and postpandemic using March 2020 as the pandemic onset. Clinical efficiency was measured by time to appointment, rate of on-time appointments, proportion of appointments resulting in surgical intervention (surgical yield), and patient-reported satisfaction, the latter measured as the proportion of patients indicating "high likelihood to recommend practice." RESULTS A total of 54,562 visits occurred, most commonly for follow-up for previously operated patients (51.8%), internal new patient referrals (24.5%), and external new patient referrals (19.8%). Total visit volume was stable pre- to postpandemic (1521.3 vs 1512, p = 0.917). However, in-person visits significantly decreased (1517/month vs 1220/month, p < 0.001), with a nadir in April 2020, while telemedicine appointment utilization increased significantly (0.3% vs 19.1% of all visits). Telemedicine utilization remained stable throughout the 1st calendar year following the pandemic. Telemedicine appointments were associated with shorter time to appointment than in-person visits both before and after the pandemic onset (0-5 days from appointment request: 60% vs 33% vs 29.8%, p < 0.001). Patients had on-time appointments in 87% of telemedicine encounters. Notably, telemedicine appointments resulted in surgery in 31.8% of internal consultations or new patient visits, a significantly lower rate than that for in-person visits (51.8%). After the widespread integration of telemedicine, patient satisfaction for all visits was higher than before the pandemic onset (85.9% vs 88.5%, p = 0.027). CONCLUSIONS Telemedicine use significantly increased following the pandemic onset, compensating for observed decreases in face-to-face visits. Utilization rates have remained stable, suggesting effective integration, and delays between referrals and appointments were lower than for in-person visits. Importantly, telemedicine integration was not associated with a decrease in overall patient satisfaction, although telemedicine appointments had a lower surgical yield. These data suggest that telemedicine smoothened the impact of the pandemic on clinical workflow and helped to maintain continuity and quality of outpatient care.
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Affiliation(s)
- Zach Pennington
- 1Department of Neurologic Surgery and.,2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Giorgos D Michalopoulos
- 1Department of Neurologic Surgery and.,2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | | | - Mohamad Bydon
- 1Department of Neurologic Surgery and.,2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
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17
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Pogorzelska K, Chlabicz S. Patient Satisfaction with Telemedicine during the COVID-19 Pandemic-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106113. [PMID: 35627650 PMCID: PMC9140408 DOI: 10.3390/ijerph19106113] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/26/2022]
Abstract
Telemedicine is a convenient tool for providing medical care remotely. It is routinely offered as an alternative to face-to-face consultations in healthcare settings all over the world. Due to the COVID-19 pandemic and increased use of telemedicine in everyday clinical practice, the effectiveness of this modality and patient satisfaction with telemedicine is a subject of growing concern. PubMed and Google Scholar databases were searched. Papers published between January 2020 and August 2021 which met inclusion and exclusion criteria were analyzed. During the COVID-19 pandemic patients have found telemedicine a beneficial tool for consulting healthcare providers. A high level of satisfaction with telehealth was observed in each study across every medical specialty. Telemedicine is undoubtedly a convenient tool that has helped ensure continuity of medical care during the COVID-19 pandemic thanks to its considerable potential. In particular situations, telehealth may adequately replace face-to-face consultation. Regular patients’ feedback is necessary to improve the use of telemedicine in the future.
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18
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Meng G, McAiney C, Perlman CM, McKillop I, Tisseverasinghe T, Chen HH. Service process factors affecting patients' and clinicians' experiences on rapid teleconsultation implementation in out-patient neurology services during COVID-19 pandemic: a scoping review. BMC Health Serv Res 2022; 22:534. [PMID: 35459134 PMCID: PMC9026006 DOI: 10.1186/s12913-022-07908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background The adoption of teleconsultation for outpatient neurology services was limited until the onset of the COVID-19 pandemic which forced many outpatient neurology services to rapidly switch to virtual models. However, it remains unclear how this change has impacted patients’ and clinicians’ perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients’ and clinicians’ experiences of outpatient teleconsultation services during COVID-19. Methods Arksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health Organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’ perception of teleconsultation services. Results A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients’ and clinicians’ experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support. Conclusions Our findings identified six key service process factors affecting the patients’ and clinicians’ teleconsultation experiences in outpatient neurology services. The need for improvement of triage process and standardizing administrative virtual care pathway are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID era. More research is needed to assess outpatient neurology teleconsultation service quality from patients’ and clinicians’ perspectives. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07908-4.
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Affiliation(s)
- Guangxia Meng
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Christopher M Perlman
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Ian McKillop
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | | | - Helen H Chen
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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19
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Telemedicine in Neurosurgery and Artificial Intelligence Applications. World Neurosurg 2022; 163:83-84. [PMID: 35588640 PMCID: PMC9084592 DOI: 10.1016/j.wneu.2022.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Mouchtouris N, Yu S, Prashant G, Nelson N, Reyes M, Gonzalez G, Smit R, Collopy S, Jabbour P, Sharan A, Harrop J, Rosenwasser R, Evans JJ. Telemedicine in Neurosurgery during the COVID-19 Outbreak: Where We Are One Year Later. World Neurosurg 2022; 163:e83-e88. [PMID: 35306198 PMCID: PMC8925084 DOI: 10.1016/j.wneu.2022.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/27/2022]
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Omer M, Al-Afif S, Machetanz K, Bettag C, Tatagiba M, Rohde V, Krauss JK. Impact of COVID-19 on the Neurosurgical Resident Training Program: an Early Experience. J Neurol Surg A Cent Eur Neurosurg 2022; 83:321-329. [PMID: 35189640 DOI: 10.1055/s-0042-1743108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The present study evaluates the impact of COVID-19 pandemic restrictions during the first lockdown period in spring 2020 on the neurosurgical resident training program, and provides constructive approaches to deal with such situations. METHODS A concurrent embedded mixed methods design was used. Qualitative data were collected through in-depth interviews from all neurosurgical residents at three university hospitals in Germany. Concurrently, quantitative data of the number of performed surgeries, outpatient visits, and the usage of telemedicine in the period from October 2019 to July 2020 were collected and analyzed accordingly. RESULTS During the period of COVID-19 pandemic restrictions in spring 2020, there was a marked reduction in the number of surgeries performed by neurosurgical residents, from an average of 41.26 (median 41) surgeries per month to 25.66 (median 24) per month, representing a decrease of 37.80%. The decrease in the operations was concerning mainly spinal and functional surgery. Outpatient visits were reduced significantly, with a concurrent fivefold increase in the usage of telemedicine. General and pediatric neurosurgery outpatient clinics were the most affected. However, although surgical exposure was reduced during the lockdown phase, neurosurgical residents focused on conducting research and improving theoretical knowledge. Nevertheless, the global uncertainties caused by COVID-19 generated notable psychological stress among some residents. CONCLUSIONS The COVID-19 pandemic restrictions significantly affected the neurosurgical training program. Innovative solutions need to be developed to increase teaching and research capacities of neurosurgical residents as well as to improve surgical skills by installing surgical skill laboratories or similar constructs.
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Affiliation(s)
- Mazin Omer
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Kathrin Machetanz
- Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christoph Bettag
- Department of Neurosurgery, Georg August University Göttingen, Göttingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg August University Göttingen, Göttingen, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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22
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Kilipiris EG, Horn F, Kolnikova M, Ochoa JV, Matuskova O, Jelovac D, Stebel A. Parental Satisfaction from Telemedicine in the Follow-up of Children Operated for Craniosynostosis during COVID-19 Pandemic. Cleft Palate Craniofac J 2022; 60:562-568. [PMID: 35043707 PMCID: PMC10102827 DOI: 10.1177/10556656221074214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The current study aimed to evaluate the satisfaction level of parents from telemedicine use in the long-term follow-up of children operated for craniosynostosis during the COVID-19 pandemic. DESIGN A cross-sectional 9-question survey analysis using Qualtrics survey software. SETTING An institutional study carried out at a national, tertiary level academic center in the Slovak Republic. PATIENTS All patients operated for non-syndromic and syndromic craniosynostosis in our department, who participated in the virtual postoperative follow-up consultations from March 23, 2020, through July 2, 2021, were included in our series. They were enrolled 498 patients, with the parents of 256 children being responding to the survey. INTERVENTIONS The survey remained open until July 16, 2021, two weeks after the last virtual consultations. It was delivered to the parents by e-mail to generate closed 5-point Likert scale responses. RESULTS Overall, 72.3% of parents were satisfied with the telemedicine program, and 67.2% found it convenient. Collectively, 89.1% reported that the received instructions were helpful to them. However, only 18.7% of them answered that they would prefer telemedicine consultations in the future. CONCLUSION The results of this study showed a high satisfaction from the parents during the virtual follow-up of children operated for craniosynostosis. However, despite their positive experience with telemedicine, the vast majority of parents stated that they would prefer in-person visits in the future.
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Affiliation(s)
- Evangelos G Kilipiris
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | - Frantisek Horn
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | - Miroslava Kolnikova
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | | | - Olga Matuskova
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | - Drago Jelovac
- Clinic for Maxillofacial Surgery, School of Dentistry, 119082University of Belgrade, Belgrade, Serbia
| | - Adam Stebel
- 112816University Hospital with Polyclinic at F. D. Roosevelt, Banska Bystrica and Comenius University, Bratislava, Slovak Republic
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23
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Meese KA, Hall AG, Feldman SS, Colón-López A, Rogers DA, Singh JA. Physician, Nurse, and Advanced Practice Provider Perspectives on the Rapid Transition to Inpatient and Outpatient Telemedicine. TELEMEDICINE REPORTS 2022; 3:7-14. [PMID: 35720449 PMCID: PMC8989090 DOI: 10.1089/tmr.2021.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 06/15/2023]
Abstract
Background: Many health systems transitioned rapidly to using inpatient and outpatient telemedicine during the COVID-19 pandemic. Prior research has examined clinician satisfaction and experiences with telemedicine in a siloed approach for specific provider types. Less is known about how experiences with the rapid transition to telemedicine affected the entire clinical team, and how this contributed to their overall distress. Methods: A survey was conducted within a large academic medical center in the Southeastern United States during June of 2020. The survey asked about experiences with inpatient and outpatient telemedicine and overall distress. Analysis of variance was calculated to examine differences in experiences among physicians, nurses, and advanced practice providers (APPs) with both inpatient and outpatient telemedicine. Multivariate regression analysis was conducted to determine whether reported telemedicine stressors were associated with changes in overall distress scores. Qualitative comments provided during the survey were included to illustrate the quantitative findings. Results: Of the 1130 survey respondents, 237 indicated that they used telemedicine. Telemedicine use was not statistically significantly associated with overall distress scores. The APPs indicated the greatest satisfaction with telemedicine, followed by physicians and then nurses. Team members differed on their perceptions of quality of care and safety for inpatient and outpatient telemedicine. Physicians (70%) and APPs (64%) felt safer having the option to use inpatient telemedicine, whereas only 26% of nurses reported the same. Overall, >70% of physicians and APPs would like to continue having the option to use inpatient and outpatient telemedicine in the future, whereas <50% of nurses reported the same. Discussion: These results suggest that telemedicine holds promise for providing care beyond the pandemic, and it may be a mechanism to improve flexibility, autonomy, and expand patient access. Implementation of new technologies must consider the experiences of the entire team, rather than a siloed approach to determining satisfaction with the changes.
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Affiliation(s)
- Katherine A. Meese
- Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- UAB Medicine Office of Wellness, Birmingham, Alabama, USA
| | - Allyson G. Hall
- Healthcare Quality and Safety Programs, Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Outcomes and Effectiveness Research and Education, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sue S. Feldman
- Department of Health Services Administration, School of Health Professions, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alejandra Colón-López
- Department of Sociology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David A. Rogers
- UAB Medicine Chief Wellness Officer, Birmingham, Alabama, USA
- Department of Surgery, ProAssurance Chair of Physician Wellness, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder A. Singh
- Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, The UAB School of Public Health, Birmingham, Alabama, USA
- Medicine Service, VA Medical Center, Birmingham, Alabama, USA
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24
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Callaghan T, McCord C, Washburn D, Goidel K, Schmit C, Nuzhath T, Spiegelman A, Scobee J. The Changing Nature of Telehealth Use by Primary Care Physicians in the United States. J Prim Care Community Health 2022; 13:21501319221110418. [PMID: 35795898 PMCID: PMC9274427 DOI: 10.1177/21501319221110418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. METHODS Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. RESULTS The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. DISCUSSION The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term.
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25
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Rodrigues A, Li G, Zhang M, Jin MC, Hayden-Gephart M. High-quality neurosurgeon communication and visualization during telemedicine encounters improves patient satisfaction. J Clin Neurosci 2021; 94:18-23. [PMID: 34863435 DOI: 10.1016/j.jocn.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While recent studies have focused on confirming satisfaction with telemedicine during the coronavirus disease 2019 (COVID-19) era, we leveraged a novel survey instrument to identify associations between patient experience and telemedicine-specific factors such as device selection, audio/visual resolution, and connection stability. METHODS Telemedicine visit data were gathered from our institution between June 22, 2020 and February 14, 2021. Each patient indicated their overall visit score, likelihood-to-recommend (LTR) score, and device used for the encounter. Remaining questions were randomly distributed to patients to ensure equal distribution across respondents. RESULTS Over 34 weeks, there were 901 unique neurosurgical telemedicine visits linked to a post-visit survey at our institution. The LTR top box score percentage showed no significant change across 34 weeks (p = 0.218). After adjusting across available covariates, patients who experienced wait times exceeding 20 min were significantly less likely to report high overall scores (aOR: 0.12; 95% CI: 0.03-0.41; p = 0.001). Patients who indicated they were less able to understand the provider (aOR: 0.22; 95% CI: 0.07-0.66; p = 0.007), or who indicated the provider was not able to properly see them (aOR: 0.11; 95% CI: 0.03-0.43; p = 0.002) were associated with substantially lower overall scores. Visits with interrupted connectivity or those forced to move to a regular phone call were not important predictors of overall score. CONCLUSIONS In the largest description of patient satisfaction with telemedicine in the neurosurgical setting during the COVID-19 era, we identified timely and high-quality physician-patient visualization and communication as among the most important predictors of patient satisfaction in virtual settings.
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Affiliation(s)
- Adrian Rodrigues
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Guan Li
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Michael Zhang
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Michael C Jin
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
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26
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Villegas MA, Okenfuss E, Savarirayan R, White K, Hoover-Fong J, Bober MB, Duker A, Legare JM. Multidisciplinary Care of Neurosurgical Patients with Genetic Syndromes. Neurosurg Clin N Am 2021; 33:7-15. [PMID: 34801144 DOI: 10.1016/j.nec.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neurosurgical patients with genetic syndromes often receive care from multidisciplinary teams. Successful models range from multiple providers in one clinic space seeing a patient together to specialists located at different institutions working together. Collaboration and bidirectional communication are key. Multidisciplinary care improves outcomes and patient satisfaction. Choosing the goal of the clinic, using ancillary staff, and obtaining institutional buy-in are important initial first steps to establishing a multidisciplinary team clinic. Multidisciplinary teams can leverage technology to expand care via telehealth in multidisciplinary clinics and more vitally communication between providers on the team.
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Affiliation(s)
- Melissa A Villegas
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Ericka Okenfuss
- Department of Genetics, Kaiser Permanente of Northern California, 1650 Response Road Kaiser, Sacramento, CA 95815, USA
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute and University of Melbourne, Parkville, Victoria 3052, Australia
| | - Klane White
- Seattle Children's, 4800 Sand Point Way, OA.9.120, Seattle, WA 98105, USA
| | - Julie Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, McKusick Nathans Department of Genetic Medicine, Johns Hopkins University, 600 N. Wolfe Street, Blalock 1008, Baltimore, MD 21287, USA
| | - Michael B Bober
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Angela Duker
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Janet M Legare
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA.
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27
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Gachabayov M, Latifi LA, Parsikia A, Latifi R. The Role of Telemedicine in Surgical Specialties During the COVID-19 Pandemic: A Scoping Review. World J Surg 2021; 46:10-18. [PMID: 34743242 PMCID: PMC8572066 DOI: 10.1007/s00268-021-06348-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 12/27/2022]
Abstract
Background The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic. Methods This was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020–August 8, 2020) and second 6-month period (August 9–March 4, 2021) of the COVID-19 pandemic. Results Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty. Conclusion Telemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06348-1.
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Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Lulejeta A Latifi
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,University of Arizona, Tucson, AZ, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Afshin Parsikia
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA. .,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
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Patel S, Shlobin NA, Rosenow JM. Letter to the Editor Regarding "Application of Remote Deep Brain Stimulation Programming for Parkinson Disease Patients". World Neurosurg 2021; 155:199. [PMID: 34724736 DOI: 10.1016/j.wneu.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Saarang Patel
- Seton Hall University, South Orange, New Jersey, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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The Utility of Remote Video Technology in Continuing Neurosurgical Care in the COVID-19 Era: Reflections from the Past Year. World Neurosurg 2021; 156:43-52. [PMID: 34509681 PMCID: PMC8428034 DOI: 10.1016/j.wneu.2021.08.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
Abstract
Objective In 2020, the coronavirus disease 2019 (COVID-19) pandemic exposed existing stressors in the neurosurgical care infrastructure in the United States. We aimed to detail innovative technologic solutions inspired by the pandemic-related restrictions that augmented neurosurgical education and care delivery. Methods Several digital health and audiovisual innovations were implemented, including use of remote video technology to facilitate inpatient consultations and outpatient ambulatory virtual visits, optimize regional hospital neurosurgical coverage, expand interdisciplinary patient management conferences (i.e., tumor board), and further enhance the neurosurgical resident education program. Enterprise patient experience data were queried to evaluate patient satisfaction following the switch to virtual visits. Results Between January 2020 and April 2021, use of virtual visits more than doubled in the Department of Neurosurgery. A survey of 10,772 patients following ambulatory visits showed that virtual visits were equal if not better in providing satisfactory patient care than in-person visits. After switching our interdisciplinary spine tumor board to a virtual meeting, we increased surgeon participation and attendance by 49.29%. Integration of remote audiovisual technology in resident didactics and clinical training improved our ability to provide comprehensive and personalized educational experiences our trainees. Conclusions Digital health technology has improved neurosurgical care and comprehensive training at our institution. Investment in the technologic infrastructure required for these remote audiovisual services during the COVID-19 pandemic will facilitate the expansion of neurosurgical care provision for patients across the United States in the future. Governing bodies within organized neurosurgery should advocate for the continued financial and licensing support of these service on a national fiscal and policy level.
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30
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Brown NJ, Wilson CM, Detchou DKE. Letter to the Editor. Social media in neurosurgery recruitment during COVID-19 and beyond. Neurosurg Focus 2021; 51:E25. [PMID: 34333467 DOI: 10.3171/2021.5.focus21296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nolan J Brown
- 1University of California Irvine School of Medicine, Irvine, Orange, CA
| | - Chidinma M Wilson
- 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Donald K E Detchou
- 3Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA and.,4Hospital of the University of Pennsylvania, Philadelphia, PA
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Lambert WA, Leclair NK, Knopf J, Mosha MH, Bookland MJ, Martin JE, Hersh DS. Predictors of Telemedicine Utilization in a Pediatric Neurosurgical Population During the COVID-19 Pandemic. World Neurosurg 2021; 153:e308-e314. [PMID: 34224882 DOI: 10.1016/j.wneu.2021.06.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In the wake of the COVID-19 pandemic, telemedicine has become rapidly adopted by the neurosurgical community; however, few studies have examined predictors of telemedicine utilization. Here, we analyze patient variables associated with the acceptance of a telemedicine encounter by a pediatric neurosurgical population during the early phases of the COVID-19 pandemic. METHODS All patients seen in a single institution's outpatient pediatric neurosurgery clinic between April 1, 2020 and July 31, 2020 were retrospectively reviewed. Demographic variables were collected for each patient's first completed encounter. Patients participating in telemedicine were compared with those seen in person. Univariate analysis was performed using the Wilcoxon rank sum test for continuous variables and Fischer exact test for categorical variables. A logistic regression multivariable analysis was then performed. RESULTS We included 682 patients (374 telemedicine and 308 in person). Univariate analysis demonstrated that telemedicine visits were more likely to occur at earlier study dates (P < 0.001) and that patients participating in telemedicine visits were more likely to be established rather than new patients (P < 0.001), White or Caucasian (P < 0.001), not Hispanic or Latino (P < 0.001), English-speaking (P < 0.001), non-Medicare/Medicaid recipients (P < 0.001), have lower no-show rates (P = 0.006), and live farther from the hospital (P = 0.005). Multivariable analysis demonstrated older age (P = 0.031), earlier appointment date (P < 0.01), established patient status (P < 0.001), English-speaking (P < 0.02), and non-Medicare/Medicaid insurance (P < 0.05) were significant predictors of telemedicine utilization. CONCLUSIONS Significant demographic differences exist among pediatric patients who participated in telemedicine versus those who requested an in-person visit at our institution. Addressing barriers to access will be crucial for promoting health equity in continued utilization of telemedicine.
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Affiliation(s)
| | | | - Joshua Knopf
- UConn School of Medicine, Farmington, Connecticut, USA
| | - Maua H Mosha
- Department of Research, Connecticut Children's, Hartford, Connecticut, USA
| | - Markus J Bookland
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Department of Pediatrics, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - Jonathan E Martin
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - David S Hersh
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Department of Pediatrics, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA.
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32
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Chau MJ, Quintero JE, Guiliani A, Hines T, Samaan C, Seybold K, Stowe M, Hanlon D, Gerhardth GA, van Horne CG. Telehealth Sustainability in a Neurosurgery Department During the COVID-19 Pandemic. World Neurosurg 2021; 152:e617-e624. [PMID: 34129978 PMCID: PMC8220867 DOI: 10.1016/j.wneu.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The COVID-19 pandemic has shifted the dynamics of health care and neurosurgical practice. Elective surgeries were suspended for 8 weeks in Kentucky. Our objective was to determine if telehealth (TH) visits could be sustained as an alternative to in-person visits. METHODS Deidentified data on TH usage, in-person clinic visits, and inpatient and neurosurgical case volumes from March 2, 2020 to June 26, 2020 were obtained for retrospective analysis. RESULTS TH use increased soon after the case suspension started and then decreased to little usage. The number of in-person visits were significantly lower during elective case suspension compared with when cases were resumed. Twenty-five percent of all visits during the suspension were conducted using TH. Thirty-nine percent of TH-visit patients were new patients, 11% were preoperative, 10% were postoperative, and 39% were other existing patients. Forty-eight percent of TH visits resulted in a later in-person clinic visit. After the suspension, in-person visits rebounded to 98% of the prepandemic numbers and TH visits were low. CONCLUSIONS TH visits were challenging due to the need for in-person physical examinations in neurosurgery. TH temporarily accommodated patient needs during the pandemic but could not totally replace in-person visits and was not sustained after 3.5 months of use. Video TH visits worked well for nonurgent issues, such as minor visual examinations. Our findings could help guide the implementation of TH should similar circumstances arise again.
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Affiliation(s)
- Monica J Chau
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | - Jorge E Quintero
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA; Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Ashley Guiliani
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | - Tripp Hines
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | | | - Katie Seybold
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew Stowe
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Dean Hanlon
- Clinical Operations, University of Kentucky, Lexington, Kentucky, USA
| | - Greg A Gerhardth
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA; Neuroscience, University of Kentucky, Lexington, Kentucky, USA; Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Craig G van Horne
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA; Neuroscience, University of Kentucky, Lexington, Kentucky, USA.
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The Research on Patient Satisfaction with Remote Healthcare Prior to and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105338. [PMID: 34067818 PMCID: PMC8156025 DOI: 10.3390/ijerph18105338] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 02/08/2023]
Abstract
The issue of research on patient satisfaction with healthcare services took on a completely new dimension due to the COVID-19 pandemic and the developing telehealth services. This results from the fact that during the pandemic, remote healthcare was often the only possible form of care provision to the patient. The COVID-19 pandemic has substantially accelerated the implementation of remote healthcare in healthcare institutions and made it an essential tool for providing healthcare services. The objective of the literature review was to study the research on patient satisfaction with remote healthcare services prior to and during the pandemic. The study featured a literature review of electronic databases, such as: Medline, ProQuest, PubMED, Ebsco, Google Scholar, WoS. The identified empirical papers were classified in two groups concerning the research on patient satisfaction prior to and during the COVID-19 pandemic, and were divided and descriptively synthesised. Certain limitations to the methodical quality of the research were demonstrated as result of the conducted analyses. It was also ascertained that researchers lack clarity on the method of defining and measuring satisfaction prior to and during the COVID-19 pandemic.
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Zhang M, Zhou J, Dirlikov B, Cage T, Lee M, Singh H. Impact on neurosurgical management in Level 1 trauma centers during COVID-19 shelter-in-place restrictions: The Santa Clara County experience. J Clin Neurosci 2021; 88:128-134. [PMID: 33992171 DOI: 10.1016/j.jocn.2021.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Early COVID-19-targeted legislations reduced public activity and elective surgery such that local neurosurgical care greatly focused on emergent needs. This study examines neurosurgical trauma patients' dispositions through two neighboring trauma centers to inform resource allocation. We conducted a retrospective review of the trauma registries for two Level 1 Trauma Centers in Santa Clara County, one academic and one community center, between February 1st and April 15th, 2018-2020. Events before a quarantine, implemented on March 16th, 2020, and events from 2018 to 19 were used for reference. Encounters were characterized by injuries, services, procedures, and disposition. Categorical variables were analyzed by the χ2 test, proportions of variables by z-score test, and non-parametric variables by Fisher's exact test. A total of 1,336 traumas were identified, with 31% from the academic center and 69% from the community center. During the post-policy period, relative to matching periods in years prior, there was a decrease in number of TBI and spinal fractures (24% versus 41%, p < 0.001) and neurosurgical consults (27% versus 39%, p < 0.003), but not in number of neurosurgical admissions or procedures. There were no changes in frequency of neurosurgery consults among total traumas, patients triaged to critical care services, or patients discharged to temporary rehabilitation services. Neurosurgical services were similarly rendered between the academic and community hospitals. This study describes neurosurgical trauma management in a suburban healthcare network immediately following restrictive quarantine during a moderate COVID-19 outbreak. Our data shows that neurosurgery remains a resource-intensive subspeciality, even during restrictive periods when overall trauma volume is decreased.
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Affiliation(s)
- Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA
| | - James Zhou
- California Northstate University College of Medicine, 9700 W Taron Drive, Elk Grove, CA 95757, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Ben Dirlikov
- Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Tene Cage
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Marco Lee
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Harminder Singh
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA.
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Leung C, Wadhwa H, Sklar M, Sheth K, Loo S, Ratliff J, Zygourakis CC. Telehealth Adoption Across Neurosurgical Subspecialties at a Single Academic Institution During the COVID-19 Pandemic. World Neurosurg 2021; 150:e539-e549. [PMID: 33746106 PMCID: PMC7972829 DOI: 10.1016/j.wneu.2021.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/04/2022]
Abstract
Objective The COVID-19 pandemic has dramatically changed health care, forcing providers to adopt and implement telehealth technology to provide continuous care for their patients. Amid this rapid transition from in-person to remote visits, differences in telehealth utilization have arisen among neurosurgical subspecialties. In this study, we analyze the impact of telehealth on neurosurgical healthcare delivery during the COVID-19 pandemic at our institution and highlight differences in telehealth utilization across different neurosurgical subspecialties. Methods To quantify differences in telehealth utilization, we analyzed all outpatient neurosurgery visits at a single academic institution. Internal surveys were administered to neurosurgeons and to patients to determine both physician and patient satisfaction with telehealth visits. Patient Likelihood-to-Recommend Press-Ganey scores were also evaluated. Results There was a decrease in outpatient visits during the COVID-19 pandemic in all neurosurgical subspecialties. Telehealth adoption was higher in spine, tumor, and interventional pain than in functional, peripheral nerve, or vascular neurosurgery. Neurosurgeons agreed that telehealth was an efficient (92%) and effective (85%) methodology; however, they noted it was more difficult to evaluate and bond with patients. The majority of patients were satisfied with their video visits and would recommend video visits over in-person visits. Conclusions During the COVID-19 pandemic, neurosurgical subspecialties varied in adoption of telehealth, which may be due to the specific nature of each subspecialty and their necessity to perform in-person evaluations. Telehealth visits will likely continue after the pandemic as they can improve clinical efficiency; overall, both patients and physicians are satisfied with health care delivery over video.
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Affiliation(s)
- Christopher Leung
- Department of Neurological Surgery, Stanford University, Palo Alto, California, USA
| | - Harsh Wadhwa
- Department of Neurological Surgery, Stanford University, Palo Alto, California, USA
| | - Matthew Sklar
- Department of Neurological Surgery, Stanford University, Palo Alto, California, USA
| | - Kunj Sheth
- Department of Neurological Surgery, Stanford University, Palo Alto, California, USA
| | - Sophia Loo
- Department of Neurological Surgery, Stanford University, Palo Alto, California, USA
| | - John Ratliff
- Department of Neurological Surgery, Stanford University, Palo Alto, California, USA
| | - Corinna C Zygourakis
- Department of Neurological Surgery, Stanford University, Palo Alto, California, USA.
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Effect of the COVID-19 Pandemic on Patient Presentation and Perception to a Neurosurgical Outpatient Clinic. World Neurosurg 2021; 149:e274-e280. [PMID: 33610862 PMCID: PMC7891092 DOI: 10.1016/j.wneu.2021.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022]
Abstract
Background The world currently faces the novel COVID-19 pandemic, with cutbacks in patient care. Little is known about the effects of a pandemic on the presentation and admission to an outpatient clinic. Our aim was to gain a better understanding of the effects of reduced neurosurgical care access from the patient perspective, especially in terms of anxiety and urgency of treatment, and to improve outpatient management in case of a potential second wave and potential restrictions on health care. Methods We performed a questionnaire study over a period of 4 weeks following the COVID-19 lockdown at our academic neurosurgical department. A 15-item questionnaire was distributed to the patients with 3 additional questions to be answered by the treating neurosurgeon. Results A total of 437 questionnaires were analyzed. Overall anxiety to visit a general practitioner or the outpatient facility within the hospital was very low among patients. A quarter of all appointments had to be postponed due to COVID-19, in 0.6% postponement was perceived as incorrect by the treating neurosurgeon. We noted that 43% did not get an appointment due to the restrictions, 20% did not want to bother the medical system, and only 4% were afraid to get infected in the hospital. Conclusions Despite COVID-19, patients in need of neurosurgical service were hardly afraid to visit doctors and/or hospitals. Nonetheless, because legal requirements, access has been restricted, causing potential collateral damage in a small subset of neurosurgical patients.
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Gadjradj PS, Matawlie RH, Harhangi BS. Telemedicine use by neurosurgeons due to the COVID-19 related lockdown. BRAIN AND SPINE 2021; 1:100851. [PMID: 36247391 PMCID: PMC8641973 DOI: 10.1016/j.bas.2021.100851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
Abstract
Introduction Due to COVID-19 related restriction, the use of telemedicine has increased tremendously. With this increase, an evaluation in the neurosurgical field seems appropriate. Research question To what extent has telemedicine made its way in neurosurgical practice during the COVID-19 pandemic? Material and methods A 29-question survey was distributed among members of the congress of neurological surgeons regarding the respondents demographics the current level of COVID-19 restrictions, the current use of telemedicine and potential difficulties and consequences of telemedicine for patient care. Results The average number of weekly outpatient visits decreased with 31 visits to a mean of 15 visits per week, while the average number of surgeries performed decreased with 5 to a mean of 2 procedures per week. On average 60% of the normal consultations have been converted to telehealth consults. Telemedicine was expected to increase the ability to quickly meet patients for urgent appointments (70%) but was also expected to decrease the quality of the relationship (56%) between practitioners and patients. The biggest difficulties due to use of telemedicine were the inability to perform physical examination (42%) followed by the inability of patients to use technology (24%) and working with elderly patients (20%). Discussion and conclusion Telemedicine, however, comes with concerns regarding the quality of the relationship between patients and practitioners and regarding accessibility among certain patient groups. With these concerns, areas of improvement and further research are indicated. Due to the COVID-19 pandemic, telemedicine has become an integral part of the neurosurgical healthcare. Due to COVID-19 related restriction, the use of telemedicine among medical specialties has increased tremendously. With this increase, an evaluation in the neurosurgical field seems appropriate. On average 60% of the normal consultations have been converted to telehealth consults. Telemedicine was expected to increase the ability to quickly meet patients for urgent appointments (70%) but was also expected to decrease the quality of the relationship (56%) between practitioners and patients. The biggest difficulties due to use of telemedicine were the inability to perform physical examination (42%) followed by the inability of patients to use technology (24%) and working with elderly patients (20%). Due to the COVID-19 pandemic, telemedicine has become an integral part of the neurosurgical healthcare.
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Affiliation(s)
- Pravesh S. Gadjradj
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY, USA
- Corresponding author. Neurological Surgery, Weill Cornell Brain and Spine Center, 1300 York Avenue, New York, NY, USA.
| | - Roshni H.S. Matawlie
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY, USA
| | - Biswadjiet S. Harhangi
- Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, the Netherlands
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