Study: App-based visits seem viable for post-surgical follow-ups

By Heather Mack
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Women recovering from breast reconstruction surgery following a mastectomy may be just fine checking in with their doctors via their smartphone rather than having to visit in person, a small study published in JAMA Surgery suggested.  

Surgeons at the Women’s College Hospital in Toronto randomly assigned 65 post-operative women to either attend planned follow-up visits with their doctor at one and four weeks after surgery, or do that follow-up via a mobile app made by QoC Health Inc, which uses patient-provided photos and a questionnaire to track recovery.  Using the app resulted in a reduction of in-clinic visits – with no adverse impact on complication rates –and also made for a more engaged and satisfied patient.

“Patients using the mobile app attended 0.40 times fewer in-person visits for follow-up care and sent more emails to their healthcare professionals during the first 30 days after surgery than did patients in the in-person follow-up group,” the authors write. “The mobile app group was more likely than the in-person group to agree or strongly agree that their type of follow-up care was convenient … These are important findings given the current demands on the healthcare system and the push toward patient-centric care.”

Since breast reconstruction surgery comes with low complication rates and is performed on an ambulatory basis – with all patients going home the day of the surgery – most follow-up visits are “perfunctory”, the researchers write. However, as the researchers note, “surgical care programs have become regionalized to ensure higher volumes in specific centers of excellence, which means that more patients travel to receive that care.”

That means cutting down things like time and car-induced jostling can make for a more comfortable recovery, and the app’s encouragement for patients to email their doctors resulted in a more communication overall.

"This finding is important because a common criticism of telemedicine or virtual communication between patients and healthcare professionals is whether it truly replaces in-person care,” the researchers write. “Improving patient convenience without compromising satisfaction is another critical finding as we look for ways to build a patient-centric healthcare system that supports quicker recovery and resumption of normal daily living.”

The researchers also indicated they would be reporting on the cost impact of their app program, which is the consideration for many health systems and employers before they fully embrace telemedicine. But studies looking at the convenience and cost-saving factor of telehealth approaches from the patient perspective are important too, as was the case with a recent UC Davis study that found telemedicine saved patients time and money, with a bonus of less pollution from cars.

The post-op mobile app study isn’t necessarily one that can be scaled up immediately. For one, it’s a low-risk group, and the researchers did not do an analysis of the impact in the workload for nurses and clinicians (who could follow their patients’ progress on a remote web portal). But it still gave some interesting insights, Tark Sammour and Andrew Hill noted in a a commentary piece in JAMA
 
“It is clear that this modality of patient follow-up is currently limited to patients undergoing low-risk surgery who are adept at using mobile devices such as smartphones, but nevertheless, the findings suggest that there is value to be gained by delegating postoperative follow-up to the remote telemedicine space,” they wrote.