Telehealth gets the nod for follow-up care

From the mHealthNews archive
By Eric Wicklund
08:23 am

People who undergo a routine surgical procedure would much rather go online for their follow-up appointment than visit their doctor's office.

That's the takeaway from a study done at Nashville's Vanderbilt University Medical Center, the results of which appear in the online version of the Journal of the American College of Surgeons.

[See also: Communicating with patients? Follow their preferences, not yours]

The study focused on 50 patients who'd had uncomplicated surgeries, ranging from hernia repairs to elective laparoscopic cholecystectomy, and included specific requirements. All patients were required to have Internet access in their homes and the ability to take and upload digital images of their surgery site using a smartphone, tablet or digital camera. The patient would then transmit those images through an online patient portal established by Vanderbilt, and both patient and doctor communicated used the portal to discuss follow-up care (though not necessarily at the same time).

By the end of the study, during which the patients met with their doctors both online and in person, organizers said 76 percent of patients preferred the online visits as the only form of follow-up care. The surgeons involved in the study, meanwhile, said they felt the online and in-person visits were equally as effective for 68 percent of the patients, while in-person visits were more effective for 24 percent of the patients and online visits worked best for the remaining 8 percent.

Among the biggest benefits of online follow-up care was the speed of the visit, a key factor for the typical clinician with a heavy workload. Online visits averaged about 15 minutes, while in-person visits averaged about 103 minutes. The study also noted that no complications were missed in the online consults.

[See also: Can an app help patients recover from surgery?]

Kristy Kummerow Broman, MD, MPH, lead study author and a resident physician in general surgery at Vanderbilt, said the study highlights the effectiveness of telehealth consults while also pointing out the limitations.

"Some operations simply require an in-person assessment," she said in a release accompanying the study. "We think the key is designing our tools for online care and developing appropriate standards for adequate online assessment so that providers can determine when online care is adequate and when in-person care may be needed."

The study also called attention to the fact that the patients were responsible for taking photos of their surgery site and sending them to their doctor.

"The data revealed potential advantages of online postoperative care, including convenient access for patients, decreased patient travel times and surgeon efficiency gains," the study reported. "However, these (benefits) must be carefully weighed against potential detriments of using patient-generated data to provide clinical assessment, including concerns about liability, provider work burden and modified patient-provider relationships."

Kummerow Broman said the physicians involved in the study may have been skeptical at first, but came around to the concept of online follow-up care when they realized their patients preferred that option. "By the end, all of our surgeons saw utility in the concept of online care," she said.

She also stressed that the study focused on patient attitudes, not the quality of care.

"We wanted to first establish whether this method is something that patients wanted, and now that we feel we have done so, we are continuing our research in this area trying to develop ways to measure safety and quality," she said.



[See also: Patients: telehealth tops the doctor's office]


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