Feasibility and safety of surgical wound remote follow-up by smart phone in appendectomy: A pilot study.
ABSTRACT: The objective of the present study is to assess the safety and feasibility of the use of telemedicine-based services for surgical wound care and to measure patient satisfaction with telemedicine-based follow-up.24 patients were included, they were provided with a corporate mail address. On day 7 after surgery patients sent, via email, an image of their surgical wound together with a completed questionnaire in order to obtain an early diagnosis. Two independent physicians studied this information and the histologic analysis of the specimen. On day 8, all patients underwent face-to-face office examination by a third physician and all of them completed a satisfaction questionnaire at the end of the study.The use of telemedicine-based services showed a sensitivity of 100%, a specificity of 91.6%, a positive predictive value of 75% and a negative predictive value of 100%. Degree of concordance between the two physicians, as regards the necessity of face-to-face follow-up yielded a kappa coefficient of 0.42 (standard error 0.25 and confidence interval 95% (0.92-0.08), which means a moderate agreement between the two evaluations. 94% of patients were satisfied with telemedicine-based follow-up and 93% showed their preference for this procedure over conventional methods.The telemedicine-based follow-up, has proven to be feasible and safe for the evaluation of early postoperative complications. Patients reported high levels of satisfaction with the procedure. Telemedicine-based follow-up could become standard practice with the development of a specific mobile application.
Project description:<h4>Objective</h4>To compare patient and physician satisfaction between home-based telemedicine visits and office visits for follow-up care within a movement disorders program.<h4>Methods</h4>Patients were offered telemedicine visits as follow-up care. After telemedicine visits, a questionnaire of items along a 10-point Likert Scale (10?=?most satisfied) assessed patient and overall physician satisfaction, comparing the experience to past in-office visits.<h4>Results</h4>Patients and physicians were highly satisfied with the telemedicine experience, both groups having median endorsement scores of 9.25 and 10.0, respectively (response range 6-10), and furthermore, favoring future telemedicine visits when feasible. Although some assessments could not be performed (postural stability, rigidity), physicians likewise favored having future telemedicine visits (median score 10, range 5.0-10).<h4>Conclusions</h4>This direct comparison of patient satisfaction with telemedicine visits to previously experienced office visits strongly supports telemedicine care, with patients highlighting convenience, time, and expense. Despite some limitations with telemedicine, physicians expressed highly rated quality-of-service provided.
Project description:OBJECTIVE:To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS:A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act (PDSA) method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data was prospectively collected over three years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS:53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n=34) and unplanned reattendance rate was 3.2% (n=32). 93.1% of patients reported satisfaction with the service. CONCLUSION:The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.
Project description:Telemedicine may transform health care by overcoming geographical and travel-associated barriers to patient care. This study assesses patient satisfaction with telemedicine for fracture care. Methods:Two groups of patients were compared from suburban/rural Pennsylvania. One group reported to a regional medical center for real-time video consultation with a pediatric orthopaedic surgeon facilitated by a physician's assistant. The other group underwent conventional outpatient clinic visits at a tertiary care hospital. The distance between the tertiary care hospital and the regional medical center was 69 miles. New or follow-up fracture patients not living in the vicinity of either medical center were included. A satisfaction survey and questionnaire were administered to both groups at the end of their visit. Results:One hundred sixty-seven patients returned the questionnaires (66 conventional and 101 telemedicine). Telemedicine visits decreased indirect and direct costs (P = 0.032). Travel costs and travel times were lower (P < 0.001) in the telemedicine group. Patient satisfaction was similar. Only 8 of 101 patients in the telemedicine cohort preferred their next visit to be a conventional follow-up. Discussion:Utilization of video consultation and trained physician assistants to provide pediatric orthopaedic care across suburban/rural areas can increase pediatric orthopaedic surgeon access and decrease travel costs while maintaining patient satisfaction.
Project description:<h4>Background</h4>Smoking is a major public health concern. In Japan, a 12-week standard smoking cessation support program is available, however, its required face-to-face visits are a key obstacle in completing the program. Telemedicine is a useful way to provide medical treatment at a distance. Although telemedicine for smoking cessation using an internet-based video system has the potential for ensuring better clinical outcomes for patients with nicotine dependence, its efficacy is unclear.<h4>Objective</h4>The aim of this study is to determine the efficacy and feasibility of a smoking cessation support program using an internet-based video system compared with a face-to-face program among patients with nicotine dependence.<h4>Methods</h4>This study will be a randomized, controlled, open-label, multicenter trial. Participants randomized to the intervention arm will undergo an internet-based smoking cessation program, whereas control participants will undergo a standard face-to-face program. We will use the CureApp Smoking Cessation (CASC) for both arms, which consists of the CASC smartphone app for patients and a Web-based patient information management system for clinicians with a mobile carbon monoxide checking device. The primary endpoint will be the continuous abstinence rate (CAR) from weeks 9 to 12. Secondary endpoints will be: (1) the smoking cessation success rate at 4, 8, 12, and 24 weeks; (2) CAR from weeks 9 to 24; (3) changes in scores on the mood and physical symptoms scale and 12-Item French Version Of The Tobacco Craving Questionnaire; (4) Kano Test for Social Nicotine Dependence scores at 8, 12, and 24 weeks; (5) time to first lapse after the first visit; (6) nicotine dependence and cognition scale scores at 12 and 24 weeks; (7) usage rate of the CASC; (8) qualitative questionnaire about the usability and acceptability of telemedicine; and (9) presence of product problems or adverse events.<h4>Results</h4>We will recruit 114 participants who are nicotine-dependent but otherwise healthy adults from March to July 2018 and follow up with them until January 2019 (24 weeks). We expect all study results to be available by the end of March 2019.<h4>Conclusions</h4>This will be the first randomized controlled trial to evaluate the efficacy and feasibility of an internet-based (telemedicine) smoking cessation support program relative to a face-to-face program among patients with nicotine dependence. We expect that the efficacy of the telemedicine smoking cessation support program will not be clinically worse than the face-to-face program. If this trial demonstrates that telemedicine does not have clinically worse efficacy and feasibility than a conventional face-to-face program, physicians can begin to offer a more flexible smoking cessation program to patients who may otherwise give up on trying such programs.<h4>Trial registration</h4>University Hospital Medical Information Network Clinical Trials Registry: UMIN000031620; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035975.<h4>International registered report identifier (irrid)</h4>DERR1-10.2196/12701.
Project description:<h4>Introduction</h4>When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services.<h4>Methods</h4>Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives.<h4>Results</h4>Telephone contacts for 272 patients (mean age: 38.7?years, range: 17-79?years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n?=?18), urgent (23.5%, n?=?64), less urgent (29.8%, n?=?81), or nonurgent (39.3%, n?=?107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n?=?26) or anger and aggression (2.9%, n?=?8) in a minority of patients, while 88.6% (n?=?241) reacted with understanding, or relief (3.3%, n?=?9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p?=?0.004), urgent or very urgent medical needs (p?=?0.004), and female gender (p?=?0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n?=?10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n?=?31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n?=?25).<h4>Conclusion</h4>Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.
Project description:BACKGROUND:Surgical site infections (SSI) represent a significant public health problem as the most common nosocomial infection and a leading cause of unplanned hospital readmissions among surgical patients. Many develop following hospital discharge and often go unrecognized by patients. Telemedicine offers the opportunity to leverage the mobile technology to remotely monitor wound recovery in the transitional period between hospital discharge and routine clinic follow-up. However, many existing telemedicine platforms are episodic, replacing routine follow-up, rather than equipped for continued monitoring; they include only low-risk patient populations and those who already have access to and comfort with the necessary technology; and transmit no visual information. OBJECTIVE:Drawing upon the Coleman model for care transitions and the Proctor model for implementation, we propose a protocol of postoperative wound monitoring using smartphone digital images. In this study, we will establish the feasibility of such a program, both for patients and for the clinical care team. METHODS:We will recruit 40 patients or patient/caregiver pairs from our inpatient vascular surgery service. Eligible patients will be English-speaking, 18 years of age or older, and have an incision at least 3 cm in length. Participants will receive a training session, during which they will learn to use the device and the wound monitoring smartphone app. Following hospital discharge, they will submit digital images of their wound and responses to a survey about their recovery for 14 days. Experienced health care providers on the vascular surgery inpatient service will review transmitted data daily and contact patients for any concerning findings. RESULTS:Primary outcomes will include participant adherence to the protocol, time required for providers to review submissions, time from submission to provider review, and participant satisfaction. Secondary outcomes will include SSI detection and hospital readmission. CONCLUSIONS:Health systems are increasingly dedicating efforts to transitional care improvement programs. This feasibility trial will confirm whether patients and their caregivers can learn to use a postdischarge wound monitoring smartphone app and will assess patient and provider satisfaction. This protocol will provide preliminary evidence for a shift in the delivery of postdischarge care in a patient-centered and cost-effective manner. TRIAL REGISTRATION:Clinicaltrials.gov NCT02735525; https://clinicaltrials.gov/ct2/show/NCT02735525 (Archived by WebCite at http://www.webcitation.org/6oIvN4Mab).
Project description:BACKGROUND:As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. OBJECTIVE:The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. METHODS:This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. RESULTS:A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). CONCLUSIONS:Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.
Project description:BACKGROUND:Research has shown that text-based communication via telemedicine will continue to be a mode of communication that patients and physicians use in the future. However, very few studies have examined patients' perspectives regarding the increased use of text-based communication versus face-to-face (FtF) communication. OBJECTIVE:This study aimed to understand and compare the potential differences in patients' perceptions of communication effectiveness with their physicians through different modes of communication. METHODS:We conducted a web-based survey of 345 patients to explore the impact of different channels on effective communication and perceived health behavior and outcomes. We tested the impact of patients' perceived communication and media effectiveness on their self-efficacy, communication satisfaction, and perceived health outcomes, separately for text-based information technology (IT)-mediated communication and FtF communication. Furthermore, we conducted a group comparison to identify significant differences across these 2 groups. RESULTS:We found no significant differences between patients' perceptions of effective communication using either IT-mediated communication or FtF communication with their physicians. However, we found significant differences in patients' perception of media effectiveness: patients perceived FtF communication to be a more favorable medium (P=.02). Interestingly, we found no significant difference in terms of benefits (P=.09) and success (P=.08) of IT-mediated communication versus FtF communication. CONCLUSIONS:The results of this study imply that patients can achieve the same level of communication effectiveness with their physicians using IT-mediated communication as they would in comparable FtF interactions, but patients view FtF communication to be a more favorable medium than IT-mediated communication.
Project description:<h4>Objective</h4>To assess if telemedicine can be used successfully for follow-up care of children with respiratory illnesses. The authors also assessed problems faced by the doctors and satisfaction of caregivers of these patients with telemedicine.<h4>Methods</h4>The authors conducted an ambispective observational study. Data related to demographic details and diagnoses of patients who had telemedicine consultation (teleconsultation) appointments between 2nd April 2020 to 15th May 2020 were reviewed retrospectively. They noted proportion of patients having successful prescription. To assess problems faced by doctors and satisfaction of caregiver of patients with teleconsultation, a prospective questionnaire was sent via Google Forms 6-10 wk after the initial appointment date. Those who did not respond to Google Forms were called by phone to assess the same.<h4>Results</h4>A total of 188 patients received teleconsultation during the study period. Team was able to prescribe treatment in 181 (96.3%) patients via teleconsultation and other seven (3.7%) required physical evaluation. Mean (SD) age of patients was 9.7 (4.9) y, range 3 mo to 18 y. There were 117 (62.2%) boys and 71 (37.8%) girls. Majority (58%) of the patients were asthmatics. The team advised refill prescription in 83% patients as symptoms were controlled. Three out of five residents faced minor problems while providing teleconsultation. In satisfaction assessment, 78% of caregivers rated teleconsultation 8 or more, out of 10 points, suggesting that most of them were satisfied with telemedicine.<h4>Conclusion</h4>In majority of children with respiratory illnesses, successful follow-up care can be provided by telemedicine.
Project description:Since the outbreak of the coronavirus epidemic, the "virtual" telemedicine has become a critical substitute for patient-provider interactions. However, virtual encounters often face challenges in the care of patients in high-risk categories such as chronic kidney disease (CKD) patients. In this study, we explore the patient's satisfaction and the practical effects of a newly established telemedicine program on CKD patients' care during the COVID-19 pandemic. Based on a prior version of an online patient care platform established in 2017, we developed a customized and improved online telemedicine program designed to specifically address the challenges emerging from the pandemic. This included an online, smart phone-based strategy for triage and medical care delivery and psychological support. We invited a total of 278 CKD patients to join the new platform during the pandemic. The subjects in group A were patients utilizing our old online CKD system and were historical users registered at least 3 months before the pandemic. A pilot survey interrogating medical and psychological conditions was conducted. Feedback on the program as well as a psychological assessment were collected after 1 month. In total, 181 patients showed active responses to the program, with 289 person-time medical consultations occurring during the study. The virtual care program provided a rapid triage for 17% (30 out of 181) patients, with timely referral to in-patient medical encounters for their worsening medical conditions or severe psychological problems. Nearly all patients (97.4%) believed the program was helpful. The number of symptoms (OR 1.309, 95%CI 1.113-1.541; P = 0.001) and being enrolled during the pandemic (OR 3.939, 95% CI 1.174-13.221; P = 0.026) were associated with high stress. During the follow-up, the high-stress CKD group at baseline showed a significant decrease in avoidance score (6.9 ± 4.7 vs. 9.8 ± 1.9, P = 0.015). In conclusion, during the pandemic, we established an online telemedicine care program for CKD patients that provides a rapid triage function, effective CKD disease management, and potentially essential psychological support.