Video consultation during follow up care: effect on quality of care and patient- and provider attitude in patients with colorectal cancer

Remote Follow-Up After Colorectal Cancer Surgery: A Systematic Review

BACKGROUND

Remote consultations are increasingly being utilized in colorectal cancer follow-up, especially since the COVID-19 pandemic, with benefits continuing beyond the pandemic. It is not clear how remote modalities affect patient satisfaction, quality of life (QoL) and safety of colorectal cancer follow-up.

OBJECTIVES

To investigate the impact of remote follow-up on patient satisfaction, QoL, clinician satisfaction, adherence to investigations, readmission rates, recurrence rates, and mortality rates for colorectal cancer.

METHODS

A systematic review was performed using three electronic databases: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, along with grey literature. Eligible studies included remote techniques such as telephone, video, or patient-initiated follow-up (PIFU) compared with standard face-to-face follow-up in patients who have undergone colorectal cancer resection. Two independent reviewers screened studies and assessed the risk of bias.

RESULTS

A total of 4417 records were identified with seven studies included. Six studies showed high levels of patient satisfaction in remote follow-up, with two studies showing significantly better satisfaction than standard follow-up. Two studies evaluated QoL, with one showing significantly better QoL in the remote follow-up group than the standard, and the other study showing comparable levels. Safety outcomes were minimally reported, but there were no adverse outcomes. There was at least moderate risk of bias in the four nonrandomized interventions due to confounding from patient selection into intervention groups.

CONCLUSIONS

Remote follow-up in colorectal cancer appears to be comparable to face-to-face follow-up with high levels of patient satisfaction and QoL. While adherence to follow-up investigations was not compromised, the evidence on oncological impact is limited, and further studies on mortality and recurrence rates are required to ensure overall safety.

Patients' and Clinicians' Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study

BACKGROUND

Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention-Advanced Symptom Management System (ASyMS)-after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries.

OBJECTIVE

In this qualitative study, both patients' and clinicians' experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients' experiences, clinical practice, and supportive care delivery.

METHODS

For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients' and clinicians' experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways.

RESULTS

Thematic analysis identified several themes that describe patients' and clinicians' experiences using ASyMS. One central orienting theme-ASyMS as a facilitator of change-was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is "normal" and what is to be expected, enhancing cancer care experiences, and informing future cancer care.

CONCLUSIONS

This study is the first to evaluate both patients' and clinicians' experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients' and clinicians' perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2016-015016.

A review of questionnaires used for the assessment of telemedicine

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.

Online video versus face-to-face patient-surgeon consultation: a systematic review

BACKGROUND

Online video consultation (OVC) is increasingly used in patient-surgeon pre-surgical and follow-up consultation but a comprehensive review assessing its benefits and downsides as compared to face-to-face (F2F) consultation is currently lacking. This systematic review evaluated the effectiveness of OVC as compared to F2F consultation.

METHODS

A literature search (Ovid/Medline, Embase, and Clarivate Analytics/Web of Science Core Collection) was conducted including studies comparing efficacy, patient and surgeon satisfaction, and information recall between OVC and F2F patient-surgeon consultation (inception-December 4, 2023).

RESULTS

Out of 1021 studies, 14 studies with 13,564 patients met the eligibility criteria, consisting of seven RCTs, three prospective, and four retrospective studies. Various types of surgical consultations were evaluated, including new referrals, routine follow-ups, postoperative follow-ups, and mixed consultations (both pre- and postoperative). None of the randomized trials exclusively compared OVC with F2F consultations in the high-demand preoperative setting, or assessed patient information recall. Efficacy outcomes were reported by seven studies. Among these, three RCTs showed that OVC improved efficacy in terms of waiting time (8.2 vs. 20.7 min, P = 0.01) and total appointment time (24 vs 71 min, P = 0.001, and 21.9 vs. 154.8 min, P = 0.001). Patient satisfaction was reported by 10 studies. Regarding patient satisfaction, one "mixed design" study favoured OVC (92% vs. 63%, P = 0.04), while eight studies reported similar outcomes.

CONCLUSIONS

This systematic review identified some benefits of OVC such as shorter waiting and total appointment times as compared to F2F patient-surgeon consultation, although the true value of OVC remains unknown due to the limited available evidence. Future pragmatic RCTs are needed, which should include the pre-surgical consultation and assess patient information recall.

Mothers prefer a hybrid model of postpartum care: a pilot mixed method study

BACKGROUND

Telehealth, including video consultation (VC), has become prevalent during the COVID-19 pandemic. However, the experience and concern of women using VC for postpartum care has yet to be adequately studied but is crucial for their adoption. The study aimed to assess the experience and attitude of postpartum mothers (PPM) towards using VC as a novel model of care delivery and the factors that could potentially affect their adoption.

METHOD

Data were gathered from PPM participating in VC using Zoom platform for postpartum care using mixed method. In-depth interviews (IDI) of twenty-five PPM were audio-recorded, transcribed verbatim and audited for accuracy. Thematic analysis was conducted to identify themes relating to perceived threat, usefulness, ease of use, and attitudes toward using VC in postpartum care. The themes are reported based on the "Health Information Technology Acceptance Model" framework. Preliminary quantitative data on the acceptability of VC were collected using structured surveys.

RESULTS

PPMs valued convenience, accessibility, and personalised care VC offered to address their immediate postpartum concerns. They perceived VC as suitable for seeking medical opinions, improving confidence in parent crafting, and providing better care access. They recognised the lack of physical examination as a major limitation in VC and proposed a hybrid postpartum care model, combining VC and in-person consultation to cater to individual needs and preferences. PPMs alluded to trust in the care providers, flexibility in VC appointment timings and enhanced interface of remote platforms as enablers for VC adoption. Preliminary quantitative data shows that PPMs found VC saved time (100%), energy (98%), and money (90%) and was appropriate (94%), easy to use (96%), acceptable (96%) for postpartum care.

CONCLUSION

PPMs favoured combining VC and in-person consultation to mitigate their concerns and personalise their care needs.

Preferences for Neurodevelopmental Follow-Up Care for Children: A Discrete Choice Experiment

INTRODUCTION

Identifying and addressing neurodevelopmental delays in children can be challenging for families and the healthcare system. Delays in accessing services and early interventions are common. The design and delivery of these services, and associated outcomes for children, may be improved if service provision aligns with families' needs and preferences for receiving care. The aim of this study is to identify families' preferences for neurodevelopmental follow-up care for children using an established methodology.

METHODS

We used a discrete choice experiment (DCE) to elicit families' preferences. We collected data from families and caregivers of children with neurodevelopmental needs. The DCE process included four stages. In stage 1, we identified attributes and levels to be included in the DCE using literature review, interviews, and expert advice. The finalised attributes were location, mode of follow-up, out-of-pocket cost per visit, mental health counselling for parents, receiving educational information, managing appointments, and waiting time. In stage 2, we generated choice tasks that contained two alternatives and a 'neither' option for respondents to choose from, using a Bayesian d-efficient design. These choice tasks were compiled in a survey that also included demographic questions. We conducted pre- and pilot tests to ensure the functionality of the survey and obtain priors. In stage 3, the DCE survey was administered online. We received 301 responses. In stage 4, the analysis was conducted using a latent class model. Additionally, we estimated the relative importance of attributes and performed a scenario analysis.

RESULTS

Two latent classes were observed. More families with full-time employees, higher incomes, postgraduate degrees, and those living in metropolitan areas were in class 1 compared with class 2. Class 1 families preferred accessing local public health clinics, face-to-face follow-up, paying AUD100 to AUD500, mental health support, group educational activities, health service-initiated appointments, and waiting < 3 months. Class 2 families disliked city hospitals when compared with private, preferred paying AUD100 or no cost, and had similar preferences regarding mental health support and wait times as class 1. However, no significant differences were noted in follow-up modality, receiving educational information, and appointment management. The relative importance estimation suggested that location was most important for class 1 (28%), whereas for class 2, cost accounted for nearly half of the importance when selecting an alternative. The expected uptake of follow-up care, estimated under three different hypothetical scenarios, may increase by approximately 24% for class 2 if an 'ideal' scenario taking into account preferences was implemented.

CONCLUSION

This study offers insights into aspects that may be prioritised by health services and policymakers to improve the design and delivery of neurodevelopmental follow-up care for children. The findings may enhance the organisation and functioning of existing care programmes; and therefore, improve the long-term outcomes of children with neurodevelopmental needs and their families.

The impact of patient experience dimensions on hospitals reputation and electronic word-of-mouth

Our objective was to identify the dimensions of the patient experience that directly influence a hospital's reputation and indirectly impact electronic word-of-mouth communication carried out by patients. We collected data from 484 hospital users and analyzed the data using PLS-SEM. Our results show that paying attention to patient preferences and physical comfort, providing information and education, and treating patients' families and friends well tend to have a significant impact on the hospital's reputation. In turn, a hospital's reputation may influence patients to perform electronic word-of-mouth about their experiences.

Experiences of healthcare professionals, patients and families with video calls to stimulate patient- and family-centred care during hospitalization: A scoping review

AIM

To synthesize the literature on the experiences of patients, families and healthcare professionals with video calls during hospital admission. Second, to investigate facilitators and barriers of implementation of video calls in hospital wards.

DESIGN

Scoping review.

METHODS

PubMed, CINAHL and Google Scholar were searched for relevant publications in the period between 2011 and 2023. Publications were selected if they focused on experiences of patients, families or healthcare professionals with video calls between patients and their families; or between families of hospitalized patients and healthcare professionals. Quantitative and qualitative data were summarized in data charting forms.

RESULTS

Forty-three studies were included. Patients and families were satisfied with video calls as it facilitated daily communication. Family members felt more engaged and felt they could provide support to their loved ones during admission. Healthcare professionals experienced video calls as an effective way to communicate when in-person visits were not allowed. However, they felt that video calls were emotionally difficult as it was hard to provide support at distance and to use communication skills effectively. Assigning local champions and training of healthcare professionals were identified as facilitators for implementation. Technical issues and increased workload were mentioned as main barriers.

CONCLUSION

Patients, families and healthcare professionals consider video calls as a good alternative when in-person visits are not allowed. Healthcare professionals experience more hesitation towards video calls during admission, as it increases perceived workload. In addition, they are uncertain whether video calls are as effective as in-person conservations.

IMPLICATIONS FOR THE CLINICAL PRACTICE

When implementing video calls in hospital wards, policymakers and healthcare professionals should select strategies that address the positive aspects of family involvement at distance and the use of digital communication skills.

PATIENT CONTRIBUTION

No patient or public contribution.

Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis

Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.

Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis

Objective

The aim of this study is to identify risk factors for readmission after elective esophagogastric cancer surgery and characterize the impact of readmission on long-term survival. The study will also identify whether the location of readmission to either the hospital that performed the primary surgery (index hospital) or another institution (nonindex hospital) has an impact on postoperative mortality.

Background

Over the past decade, the center-volume relationship has driven the centralization of major cancer surgery, which has led to improvements in perioperative mortality. However, the impact of readmission, especially to nonindex centers, on long-term mortality remains unclear.

Methods

This was a national population-based cohort study using Hospital Episode Statistics of adult patients undergoing esophagectomy and gastrectomy in England between January 2008 and December 2019.

Results

This study included 27,592 patients, of which overall readmission rates were 25.1% (index 15.3% and nonindex 9.8%). The primary cause of readmission to an index hospital was surgical in 45.2% and 23.7% in nonindex readmissions. Patients with no readmissions had significantly longer survival than those with readmissions (median: 4.5 vs 3.8 years; P < 0.001). Patients readmitted to their index hospital had significantly improved survival as compared to nonindex readmissions (median: 3.3 vs 4.7 years; P < 0.001). Minimally invasive surgery and surgery performed in high-volume centers had improved 90-day mortality (odds ratio, 0.75; P < 0.001; odds ratio, 0.60; P < 0.001).

Conclusion

Patients requiring readmission to the hospital after surgery have an increased risk of mortality, which is worsened by readmission to a nonindex institution. Patients requiring readmission to the hospital should be assessed and admitted, if required, to their index institution.

Citizens' perspectives on relocating care: a scoping review

BACKGROUND

Healthcare systems around the world are facing large challenges. There are increasing demands and costs while at the same time a diminishing health workforce. Without reform, healthcare systems are unsustainable. Relocating care, for example, from hospitals to sites closer to patients' homes, is expected to make a key contribution to keeping healthcare sustainable. Given the significant impact of this initiative on citizens, we conducted a scoping review to provide insight into the factors that influence citizens' attitudes towards relocating care.

METHOD

A scoping review was conducted. The search was performed in the following databases: Pubmed, Embase, Cinahl, and Scopus. Articles had to include relocating healthcare and citizens' perspectives on this topic and the articles had to be about a European country with a strong primary care system. After applying the inclusion and exclusion criteria, 70 articles remained.

RESULTS

Factors positively influencing citizens' attitudes towards relocating care included: convenience, familiarity, accessibility, patients having more control over their disease, and privacy. Factors influencing negative attitudes included: concerns about the quality of care, familiarity, the lack of physical examination, contact with others, convenience, and privacy. Furthermore, in general, most citizens preferred to relocate care in the studies we found, especially from the hospital to care provided at home.

CONCLUSION

Several factors influencing the attitude of citizens towards relocating care were found. These factors are very important when determining citizens' preferences for the location of their healthcare. The majority of studies in this review reported that citizens are in favour of relocating care. In general citizens' perspectives on relocating care are very often missing in articles. It was significant that very few studies on relocation from the hospital to the general practitioner were identified.

Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries

INTRODUCTION

Telemedicine is being adopted for postoperative surveillance but requires evaluation for efficacy. This study tested a telephone Wound Healing Questionnaire (WHQ) to diagnose surgical site infection (SSI) after abdominal surgery in low- and middle-income countries.

METHOD

A multi-centre, international, prospective study was embedded in the FALCON trial; a factorial RCT testing measures to reduce SSI in seven low- and middle-income countries (NCT03700749). It was conducted according to a pre-registered protocol (SWAT126) and reported according to STARD guidelines. The reference test was in-person review by a trained clinician at 30 postoperative days according to US Centres for Disease Control criteria. The index test was telephone administration of an adapted WHQ at 27 to 30 postoperative days by a researcher blinded to the outcome of in-person review. The sum of item response scores generated an overall score between 0 and 29. The primary outcome was the diagnostic accuracy of the WHQ, defined as the proportion of SSI correctly identified by the telephone WHQ, and summarized using the area under the receiving operator characteristic curve (AUROC) and diagnostic test accuracy statistics.

RESULTS

Patients were included from three upper-middle income (396 patients, 13 hospitals), three lower-middle income (746 patients, 19 hospitals), and one low-income country (54 patients, 4 hospitals). 90.3% (1088 of 1196) patients were successfully contacted. Those with non-midline incisions (adjusted odds ratio: 0.36, 95% c.i. 0.17 to 0.73, P=0.005) or a confirmed diagnosis of SSI on in-person assessment (odds ratio: 0.42, 95% c.i. 0.20 to 0.92, P=0.006) were harder to reach. The questionnaire correctly discriminated between most patients with and without SSI (AUROC 0.869, 95% c.i. 0.824 to 0.914), which was consistent across subgroups. A representative cut-off score of ≥4 displayed a sensitivity of 0.701 (0.610-0.792), specificity of 0.911 (0.878-0.943), positive predictive value of 0.723 (0.633-0.814) and negative predictive value of 0.901 (0.867-0.935).

CONCLUSION

SSI can be diagnosed using a telephone questionnaire (obviating in-person assessment) in low resource settings.

eHealth interventions to support colorectal cancer patients' self-management after discharge from surgery-an integrative literature review

INTRODUCTION

Colorectal cancer (CRC) creates elevated self-management demands and unmet support needs post-discharge. Follow-up care through eHealth post-primary surgery may be an effective means of supporting patients' needs. This integrative review describes the evidence regarding eHealth interventions post-hospital discharge focusing on delivery mode, user-interface and content, patient intervention adherence, impact on patient-reported outcomes and experiences of eHealth.

METHODS

A university librarian performed literature searches in 2021 using four databases. After screening 1149 records, the authors read 30 full-text papers and included and extracted data from 26 papers. Two authors analysed the extracted data using the 'framework synthesis approach'.

RESULTS

The 26 papers were published between 2012 and 2022. The eHealth interventions were mainly delivered by telephone with the assistance of healthcare professionals, combined with text messages or video conferencing. The user interfaces included websites, applications and physical activity (PA) trackers. The interventions comprised the monitoring of symptoms or health behaviours, patient information, education and counselling. Evidence showed a better psychological state and improved PA. Patients reported high satisfaction with eHealth. However, patient adherence was inadequately reported.

CONCLUSIONS

eHealth interventions may positively impact CRC patients' anxiety and PA regardless of the user interface. Patients prefer technology combined with a human element.

The benefits of index telephone consultations in patients referred on the two-week wait colorectal cancer pathway

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England.

METHODS

Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed.

RESULTS

In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group.

CONCLUSION

Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.

Shared Decision-Making in General Surgery: Prospective Comparison of Telemedicine vs In-Person Visits

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has accelerated a shift toward virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesize that telemedicine visits are associated with lower quality of shared decision-making.

STUDY DESIGN

We performed a mixed-methods, prospective, observational cohort trial. All patients presenting for a first-time visit at general surgery clinics between May 2021 and June 2022 were included. Patients were categorized by type of visit: in-person vs telemedicine. The primary outcome was the level of shared decision-making as captured by top box scores of the CollaboRATE measure. Secondary outcomes included quality of shared decision-making as captured by the 9-item Shared Decision-Making Questionnaire and satisfaction with consultation survey. An adjusted analysis was performed accounting for potential confounders. A qualitative analysis of open-ended questions for both patients and practitioners was performed.

RESULTS

During a 13-month study period, 387 patients were enrolled, of which 301 (77.8%) underwent in-person visits and 86 (22.2%) underwent telemedicine visits. The groups were similar in age, sex, employment, education, and generic quality-of-life scores. In an adjusted analysis, a visit type of telemedicine was not associated with either the CollaboRATE top box score (odds ratio 1.27; 95% CI 0.74 to 2.20) or 9-item Shared Decision-Making Questionnaire (β -0.60; p = 0.76). Similarly, there was no difference in other outcomes. Themes from qualitative patient and surgeon responses included physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communication quality.

CONCLUSIONS

In this large, prospective study, there does not appear to be a difference in quality of shared decision making in patients undergoing in-person vs telemedicine appointments.

Parents' understanding and attitudes toward the use of the WeChat platform for postoperative follow-up management of children with congenital heart disease

OBJECTIVE

This study aimed to investigate parents' understanding and attitudes toward using the WeChat platform for postoperative follow-up management of children with congenital heart disease (CHD).

METHODS

A total of 196 children with CHD were followed up using the WeChat platform. A self-designed questionnaire was administered to their parents at discharge.

RESULTS

Only 188 parents completed the questionnaire. One hundred nineteen parents (63.3%) confirmed that they heard about using the WeChat platform for postoperative follow-up, and 104 (87.4%) of them expressed that they were willing to accept the WeChat platform for their follow-up. A total of 42 parents (35.3%) were willing to undergo a follow-up of 1 to 3 months, and 32 (26.8%) were willing to undergo a long-term follow-up. Eighty parents (67.2%) had a positive attitude toward the effect of the WeChat platform on follow-up. Parents in rural areas and those educated at the middle school level or below were more willing to engage with the WeChat platform for postoperative follow-up management (P < 0.05).

CONCLUSIONS

Although the WeChat platform is an essential tool for daily communication, its application in postoperative follow-up management is still under study. Most parents who participated in the follow-up study had a positive attitude toward the WeChat platform, especially those in rural areas and with lower education levels.

Exploring the impact of patient, physician and technology factors on patient video consultation satisfaction

Objective

Video consultations (VCs) were made available to the general population during the COVID-19 pandemic to compensate for the cutback of face-to-face doctor-patient interactions. However, little is known about what patient-related (e.g. age), physician-related (e.g. patient-physician relationship) and technology-related (e.g. online privacy concerns) factors contribute to video consultation satisfaction among patients. This study aims to gain a better understanding of what makes patients satisfied with video consultations.

Methods

A total of 180 patients who recently engaged in a video consultation were invited to answer questions about patient-, physician- and technology-related variables and their satisfaction with the video consultation. To examine which factors predict patient video consultation satisfaction, a multiple hierarchical regression analysis was performed.

Results

Overall, patients were satisfied with their video consultation. The final hierarchical model, including all patient-related, physician-related and technology-related factors, significantly contributed to patient video consultation satisfaction. Predictors of higher patient video consultation satisfaction were experiencing less technical issues, having higher general positive attitudes towards online communication, reporting higher importance of less travel time and being more satisfied with physicians' affective and instrumental communication.

Conclusions

Video consultations can be appropriate in a variety of situations, provided that technical issues can be minimized, patients have a positive attitude towards online communication and attach value to reduced travel time and online patient-physician interactions can be experienced as affective and instrumental. Findings from this study contribute to understanding how video consultations can be best utilized for effective patient-physician communication.

Expansion of patient eligibility for virtual glaucoma clinics: a long-term strategy to increase the capacity of high-quality glaucoma care

AIMS

The virtual glaucoma clinic (VGC) is a well-established diagnostic pathway for delivery of glaucoma care. Current UK national guidance recommends VGCs for patients with ocular hypertension, glaucoma suspects or early glaucoma. This study evaluates whether expanded eligibility criteria, including other glaucoma phenotypes and disease stages, can deliver safe and effective care with a positive patient experience.

METHODS

Records of over 8000 patients were reviewed in order to determine suitability for VGC attendance using expanded eligibility criteria. Patients with three prior consecutive visits within the glaucoma service were included. Follow-up interval, clinic type, visual acuity (VA), intraocular pressure (IOP) and visual field performance were recorded. Patient satisfaction was recorded for a sample of 118 patients.

RESULTS

2017 patients over 31 months were included. Two-thirds of eyes had ocular comorbidities, a fifth of eyes had undergone prior cataract surgery and 10% of eyes had undergone a prior laser treatment for glaucoma. After three visits, 32% of patients remained in the VGC, 42% were seen in face-to-face clinics and 25% were discharged. There were no clinically significant changes in VA, IOP and visual field performance during follow-up. 72% of patients expressed a preference to continue their care within VGCs.

CONCLUSIONS

This study demonstrates that VGCs with expanded patient eligibility criteria can deliver high-quality glaucoma care that is safe, effective and with high levels of patient satisfaction. This approach provides a long-term solution to adapt delivery of glaucoma care to our expanding and ageing population.

Using video consultations for clinical assessment and decision of treatment readiness before chemotherapy: A mixed-methods study among patients with gastrointestinal cancer and oncology nurses

Objective

To investigate the feasibility of clinical assessment and decision of treatment readiness before chemotherapy using video consultations, as perceived by gastrointestinal cancer patients and oncology nurses. In addition, to estimate reductions in travel time for patients and environmental carbon dioxide (CO2) emissions.

Methods

In a mixed-method study, patients with gastrointestinal cancer who participated in at least one video consultation during April-October 2019 completed a questionnaire on socioeconomic status, time and kilometers saved on travel. Kilometers saved were converted into reduced CO2 emissions. Descriptive statistics were used for analysis. Patients (n = 15) participated in semi-structured individual interviews, and five oncology nurses participated in a focus group interview.

Results

A total of 84/119 patients (71%) consented to video consultation and responded to the questionnaire. 69% were male, with a mean age of 66 years. For 46% of patients, a video consultation saved more than an hour of travel time. Avoiding a median travel distance of 120 km per patient (range, 2-450 km) reduced CO2 emissions by 7018 lb. Video consultations had other positive effects on patients, including avoiding waiting rooms, having more energy, and experiencing more focused interactions with nurses. Technical issues occurred rarely. Nurses found technical issues more troublesome, sometimes precluding complete assessments. They reported a need to rethink nursing practice to effectively provide care during video consultations.

Conclusions

Video consultations reduced CO2 emissions. In addition, they were beneficial for patients with gastrointestinal cancer. However, providing an optimal clinical assessment and decision of treatment readiness before chemotherapy requires testing patient equipment, technical skills and new oncology nursing competencies.

Innovations and Implementation of Telemedicine in Surgical Clinics Beyond COVID-19: A Narrative Review

Introduction: Telemedicine has emerged as a powerful tool in the delivery of health care to surgical patients and innovations are developing to address challenges in the technology, enhancing consumer-provider encounters while located remotely. Our study aims at collating and commenting on the published evidence for how current challenges in telemedicine for surgical clinics are met by innovations currently in development. We also comment on the implementation and monitoring strategies for telemedicine. Methods: Databases searched included: PubMed, OVID Medline, Embase, Scopus, Web of Science, and review of reference lists. Key words used were "telemedicine"; "telehealth"; "videoconference"; "outpatient"; and "surgical clinic." For inclusion, articles required to be in English, published between 2000 and 2021, were in an outpatient surgical setting, and if they had a focus during the COVID-19 pandemic. Results: Three hundred forty-five articles were identified and screened, so that 73 articles were included in the review. Almost all articles were from Western countries (n = 69), mostly in surgical journals (n = 39) and from a range of sub-specialties, but pre-dominantly orthopedics (n = 12) and general surgery (n = 9). The majority were original comparative studies, with 31 studies directly comparing telemedicine with in-person appointments and 22 articles focused on implementation during COVID-19. Discussion/Conclusion: Advanced telecommunication technology has enabled telemedicine to become an effective and safe form of health care delivery, with high consumer and provider satisfaction. Innovative protocol and technology developments have addressed the limitations of telemedicine. Sophisticated and familiar medical software integrates with electronic medical records to automate and streamline documentation, consent, and billing processes. Surgical clinics are investing in telehealth workflow co-ordination and information technology support to troubleshoot any technical difficulties as well as education for providers and consumers to address technology illiteracy. As health care services continue to transition their systems to an online network, further research is required to understand the ability and assess the feasibility of telemedicine to fully integrate.

A brief pre-visit educational video improved patient engagement after telehealth visits; results from a randomized controlled trial

Objective

To test an intervention designed to improve patient engagement in telehealth visits by encouraging patients to use active communication behaviors.

Methods

US Veterans with type 2 diabetes mellitus receiving primary care using telehealth were randomized 1:1 to receive both a pre-visit educational video and pamphlet (intervention) or pamphlet alone (control) prior to their scheduled telehealth visit. Data were collected before and after the intervention from the medical record and at telephone interviews (questionnaires). Analyses compared the intervention and control groups using bivariate statistics and multiple regression.

Results

There were no statistically significant differences in baseline Hemoglobin A1c (HbA1c) between intervention and control groups (P > 0.05). Patient's ratings of physicians' communication and post-visit empathy were higher (P ≤ 0.05) in the intervention group than control group and after adjusting for baseline values the intervention group reported higher scores on post-visit therapeutic alliance with the provider and higher patient engagement, compared with the control group, P = 0.01 and P = 0.04, respectively, but post-visit HbA1c was not statistically different.

Conclusions

The educational video was useful as pre-visit preparation for patients prior to a primary care telehealth visit.

Innovation

This study showed the efficacy of a pre-visit video to improve patient engagement and therapeutic alliance after telehealth visits.ClinicalTrials.govIdentifier: NCT02522494.

Introducing video consultations at public sexual health clinics in the Netherlands: a mixed-methods study

Video consultations (in combination with remote STI testing) can benefit both public sexual health clinics (SHCs) and their clients. The Dutch public SHCs explored the extent to which video consultations are accepted and appreciated-compared to face-to-face consultations-by both young clients (under 25 years) and nurses who normally carry out consultations. A mixed-methods study, using online questionnaires and telephone interviews with both young clients (aged under 25 years) and nurses (focus groups), was conducted to evaluate acceptance and appreciation of video and face-to-face consultations of the SHCs. Young clients evaluated 333 video consultations and 100 face-to-face consultations. Clients rated the VCs and F2F consultations as being of equal high level on five evaluation criteria (e.g. how it feels to talk about sex with a nurse, contact with the nurse). These positive results were confirmed in the interviews. Most important perceived advantages of VCs were time saving, ease, and feelings of comfort and safety. The nurses evaluated 422 VCs and 120 F2F consultations, rating the VCs and F2F consultations on an equal high level on three evaluation criteria (e.g., contact with the client, possibility to continue asking questions). Increasing accessibility of SHC consultations, getting faster to the point and saving time were mentioned as advantages of VCs during the focus group sessions with nurses. Video consultations are accepted and appreciated by young clients and nurses. They can be used for standard STI consultations that do not require a physical examination.

Exploring cancer patients', caregivers', and clinicians' utilisation and experiences of telehealth services during COVID-19: A qualitative study

OBJECTIVES

The COVID-19 pandemic has significantly impacted oncology. With pandemic restrictions limiting close contact between individuals, telehealth (the use of teleconferencing/videoconferencing to conduct real-time medical consultations) has been increasingly utilised. This qualitative study aimed to explore adult cancer patient, caregiver, and clinician (doctor, nurse, allied health) telehealth experiences during COVID-19 in urban and rural Australian settings and identify potential enablers and barriers to sustained telehealth implementation.

METHODS

English-speaking participants completed semi-structured interviews regarding their telehealth experiences since March 2020. Interviews ceased when data saturation occurred. Iterative thematic analysis was conducted using NVivo 12 Pro.

RESULTS

Thirty-four interviews (clinician=14, patient=13, caregiver=7) were conducted from April to August 2021. Analysis generated seven themes relating to telehealth use: 1) Acceptability as a form of consultation, 2) Impacts on healthcare provision, 3) Communication & relationships, 4) Efficient form of consultation, 5) Comfort of conducting telehealth in different environments, 6) Technological barriers and 7) Future preferences.

CONCLUSIONS

The rapid uptake of telehealth during the pandemic has mostly been well-received, and telehealth can be appropriately used in oncology.

PRACTICE IMPLICATIONS

Barriers including providing appropriate facilities, technology, and telehealth training; and selecting appropriate patients must be addressed to enable sustained telehealth use in future cancer care.

The perceived quality of video consultations in geriatric outpatient care by early adopters

PURPOSE

The COVID-19 pandemic caused rapid implementation and upscaling of video consulting. This study examined the perceived quality of care delivered through video consulting at a geriatric outpatient clinic, and how this related to adoption issues and barriers early adopting professionals found themselves confronted with.

METHODS

We performed a qualitative study using semi-structured interviews with healthcare professionals complemented by the views of geriatric patients, family caregivers and medical secretaries. Participants from five academic centers and six teaching hospitals were included. Three researchers conducted the interviews, coded the data, and used thematic analysis.

RESULTS

Interviews were conducted with 13 healthcare professionals, 8 patients, 7 family caregivers, and 4 medical secretaries. From these early adopters, we infer five criteria positively contributing to perceived quality of care provided by video consulting: (1) the patient has an intact cognitive function; (2) a family caregiver with digital literacy can be present; (3) doctor and patient already have an established relationship; (4) no immediate need for physical examination or intervention; and (5) the prior availability of a comprehensive and concise medical history. Overall, the uptake of video consulting in geriatric outpatient care appeared to be slow and laborious due to several implementation barriers.

CONCLUSION

The implementation of video consulting use among geriatricians and geriatric patients at the geriatric outpatient clinic was slow due to the absence of many facilitating factors, but video consulting might be offered as an alternative to face-to-face follow-up to suitable patients in geriatric outpatient clinics.

Healthcare workers' perceptions of how eHealth applications can support self-care for patients undergoing planned major surgery

Background

In planned major surgery the duration of inpatient hospital care during the last decade has decreased because of a combination of different perioperative interventions. It is expected that patients can manage the needed pre- and postoperative self-care to a large extent on their own. This entails challenges to healthcare system to deliver appropriate information to patients in a safe and efficient manner. The aim of this study was therefore to describe healthcare workers’ perceptions of how eHealth applications can support patients’ self-care in relation to planned major surgery.

Methods

Semi-structured interviews were performed with sixteen healthcare workers from different disciplines. The interviews were transcribed and analysed using the phenomenography approach.

Results

Healthcare workers perceived both positive aspects and challenges with eHealth applications for self-care. eHealth applications can work as an information source, affect patients’ understanding of self-care, improve patients’ participation in self-care, streamline communication with healthcare professionals and improve patient safety during the pre- and postoperative period. The challenges included perceptions of that eHealth applications may have negative impact on personal interaction in care. eHealth applications may not be useful to all patients because of lack of equipment or knowledge and may increase patients’ suffering if physical visits are replaced by digital solutions.

Conclusions

This study improves our understanding of healthcare workers’ perceptions of how the use of self-care eHealth applications can support patients in performing pre- and postoperative self-care for major surgery. Access to appropriate and personalized information and instructions can improve patients’ understanding of self-care and enhance the participation and safety of those who can afford and handle digital tools. All these aspects must be considered in future digital development of eHealth applications to guarantee a person-centered care.

Patient Acceptance and Intention to Use e-Consultations During the COVID-19 Pandemic in the Eastern Province of Saudi Arabia

Background

Over the last decade, the use of digital technology has increased immeasurably and transformed both our personal and professional lives. The medical profession quickly embraced this development, especially after the spread of the COVID-19 pandemic. Medical consultations were transitioned to online settings as a substitute for face-to-face consultations. This exponential acceleration of the use of remote online consultations (e-consultations) was deemed necessary to respond to the impact of the global pandemic. This study identifies the factors that influence actual patient use and the intention to use e-consultations in Saudi Arabia.

Methods

A cross-sectional survey was distributed online via social media platforms targeting the population living in Saudi Arabia from August to December 2020. The questionnaire measured patient perceptions of and attitudes toward utilizing e-consultations using a validated questionnaire informed by the technology acceptance model (TAM). Analyses were performed in SPSS to identify the external factors that influence patients' actual use of e-consultations and to assess the TAM factors (usefulness, social influence, and ease of use) that influence the intention to use e-consultations across both actual users and never-users.

Results

A total of 150 participants completed the questionnaire; the average age was 38 years old, 85% of the participants were females, and 67% reported never using e-consultations. Additionally, motivation, trust, attitude, and social influence were significantly related to participants' intention to use e-consultations.

Conclusion

Participants' trust in and perception of the usefulness of e-consultations were significant factors in their intention to use e-consultation services. Policymakers' attention to those factors could play a role in increasing public acceptance and the use of e-consultations to improve distance medical care.

Healthcare Professionals' Experience of Performing Digital Care Visits-A Scoping Review

The use of digital care visits has been increasing during the COVID-19 pandemic. Learning more about healthcare professionals' technology experiences provides valuable insight and a basis for improving digital visits. This study aimed to explore the existing literature on healthcare professionals' experience performing digital care visits. A scoping review was performed following Arksey & O'Malley's proposed framework using the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The collected data were analyzed using thematic content analysis. Five main themes were identified in the literature: positive experiences/benefits, facilitators, negative experiences/challenges, barriers, and suggestions for improvement. Healthcare professionals mostly reported having an overall positive experience with digital visits and discovered benefits for themselves and the patients. However, opinions were mixed or negative regarding the complexity of decision making, workload and workflow, suitability of this type of care, and other challenges. The suggestions for improvement included training and education, improvements within the system and tools, along with support for professionals. Despite overall positive experiences and benefits for both professionals and patients, clinicians reported challenges such as physical barriers, technical issues, suitability concerns, and others. Digital care visits could not fully replace face-to-face visits.

Telemedicine Implementation Trends in Surgical Specialties Before and After COVID-19 Shelter in Place: Adjusting to a Changing Landscape

Background

The COVID-19 pandemic caused a shift from in-person care to telemedicine, providing a unique opportunity to evaluate trends and efficiency of telemedicine usage within surgical subspecialties in a large, integrated health care system before and after shelter in place mandates.

Methods

This retrospective cohort study included all of the Kaiser Permanente Northern California members referred to surgical services from January 1, 2019 to June 13, 2020 and receiving a surgical procedure. We compared the patient referrals (categorized as benign, urgent, or cancer) before and after shelter in place mandates, and we examined rates of telemedicine (video or telephone) usage for preoperative consultations, postoperative visits, time from referral to first surgical encounter, and to surgery or procedure. In multivariate analyses, we assessed the patient and provider characteristics associated with telemedicine usage.

Results

There was a total of 34,875 surgical referrals resulting in a procedure, with a significant decline in referral after shelter in place mandates. Preoperative encounter types shifted from 89.8% in-person before shelter in place mandates to 70.2% telemedicine after shelter in place mandates (P < .0001). The median time from referral to first encounter decreased after shelter in place mandates, as did median time to procedure. After shelter in place mandates, postoperative encounters were mainly telemedicine (65.8%) compared with before shelter in place mandates (41.7%) (P < .0001). Overall, there was a comparable uptake of telemedicine usage in almost all evaluated categories of patient characteristics after shelter in place mandates.

Conclusion

Within a health care system with prior telemedicine capability, surgical specialties were able to shift to telemedicine rapidly, equitably, and efficiently in the preoperative and postoperative encounters of benign, urgent, and cancer diagnosis during mandated COVID-19 restrictions.

Digital NHS Wales: a coding reliability analysis based on the voices of 22 978 patients and clinicians on the benefits, challenges and sustainability of video consulting

INTRODUCTION

The use of video consulting (VC) in Wales UK has expanded rapidly. Previous VC evidence has been the subject of small-scale projects and evaluations. Technology Enabled Care Cymru is an all-Wales digital service and rolls out digital interventions and evaluates on large scales, thus capturing representative data sets across Wales, and therefore a wide range of National Health Service (NHS) specialties.

OBJECTIVE

To extract and analyse narrative feedback from patients and clinicians using the NHS Wales VC Service for 6 months (September 2020 to March 2021).

DESIGN

A coding reliability approach of a cross-sectional study was conducted.

SETTING

From all health boards across Wales.

PARTICIPANTS

NHS patients and clinicians across primary, secondary and community care settings in Wales.

RESULTS

Data were captured on benefits, challenges and sustainability of VC. A coding reliability analysis was used with six domain summaries materialising to include: 'The Ease of VC'; 'The Personal Touches'; 'The Benefits of VC'; 'The Challenges of VC'; 'Technical Quality'; and 'Recommendations & Future Use'. An additional 17 subdomains are included. Direct quotations from patients and clinicians are provided for context.

CONCLUSIONS

A total of 22 978 participants were included. These data help demonstrate that NHS remote service delivery, via the method of VC, can be highly satisfactory, well accepted and clinically suitable yielding many benefits. Despite this, the data are not without its challenges surrounding engagement and suitability for VC. The NHS Wales VC Service rolled out and evaluated at scale and demonstrates that VC has potential for long-term sustainability. For the future, use a 'blended approach' for NHS appointments that are clinically judged and centred on patient choice.

Cancer patients' perspectives on remote monitoring at home during the COVID-19 pandemic- a qualitative study in Norway

BACKGROUND

The COVID-19 pandemic triggered an unprecedented demand for digital health technology solutions, such as remote monitoring. Previous research has focused on patients with chronic diseases, and their experiences with remote monitoring during the pandemic. Several recommendations have been presented to reduce the frequency of cancer patients' visits to oncology centers and minimizing the risk of exposure to COVID-19, such as remote monitoring. However, few studies have explored how this has influenced the healthcare services to cancer patients.

AIM

To explore cancer patients' perspectives on remote monitoring at home during the COVID-19 pandemic.

DESIGN

The study had a qualitative design, using in-depth, individual interviews.

METHODS

A total of eleven interviews were conducted with patients who received remote monitoring during the COVID-19 outbreak. Three of the interviews were conducted by telephone, and eight on a digital platform, audio recorded, and transcribed verbatime. Data were analyzed using reflexive thematic analysis as recommended by Braun & Clarke.

RESULTS

All participants were conscious about being vulnerable to infections due to having cancer and receiving cancer treatment, and the pandemic to them represented an extra burden. Most of the participants experienced that their healthcare services had changed due to the pandemic, but there was no consensus on how the services had changed. All of the participants presented remote monitoring as something «new». Whether they received remote monitoring by telephone, video consultations or more advanced solutions with the possibility to complete a questionnaire or fill in measurements, did not seem to impact their views. However, all agreed that remote monitoring could never totally replace physical consultations in hospital. Participants' views seemed to grow more positive over time, but still they emphasized both positive and negative aspects of remote monitoring solutions in cancer care.

CONCLUSION

Remote monitoring was introduced as a necessity in cancer care during the COVID-19 outbreak. This may seem as an efficient solution, allowing for patients to stay at home and avoid infection. Our results indicate that, in the case of cancer patients, it is important that healthcare personnel balance the remote monitoring solution with person-to-person contact.

Telemedicine Is an Effective Tool to Monitor Disease Activity in IBD Patients in the COVID-19 Era: A Single Centre Experience Based on Objective Data

Background: The COVID-19 outbreak has led IBD clinics to adopt a remote monitoring approach in order to guarantee an adequate follow-up of patients with inflammatory bowel disease (IBD) and ensure the rules of social distancing. Aim: The aim of the study was to perform a survey on IBD patients who underwent remote monitoring in our tertiary referral center, to assess adherence, patients’ perceptions and satisfaction, and finally their opinions for future monitoring. Furthermore, we evaluated changes in disease activity and Quality of Life (QoL) using validated questionnaires. Methods: Consecutive patients with IBD scheduled for follow-up visits were switched to remote monitoring through e-mail from March 2020 to February 2021. Patients were asked to complete a questionnaire focusing on the following elements of the intervention: (1) self-assessment questions, (2) action plans, and (3) educational messages. Results: Four hundred and twenty four Caucasian patients completed the survey. 233 (55.1%) were male, 220 (52.0%) had Crohn’s Disease (CD). Median baseline Mayo Score and Harvey Bradshaw Index were 3 and 4, respectively. 9 (2.1%) patients were referred to the emergency department because of disease flares. 410 (96.9%) patients were satisfied with telemedicine, and 320 (76.5%) patients reported that they would maintain this approach also after COVID-19 pandemic. Overall, on univariate logistic regression analysis, none of the variables were related to patients’ satisfaction or to an improved QoL. The presence of ulcerative colitis was associated with the need for treatment change. Conclusions: Our results suggest that a telemedicine approach is well accepted by patients with IBD and could represent an effective tool in monitoring disease activity. Further controlled studies are warranted to properly assess if telemedicine can replace face-to-face consultations in IBD.

Remote shared decision making through telemedicine: A systematic review of the literature

OBJECTIVES

To assess the extent to which shared decision making (SDM) can take place in telemedicine (remote SDM).

METHODS

We searched Medline, Cochrane, and Scopus from 2010 until August 7th, 2020 for articles on remote SDM in the care of any patient using any technology. We also conducted a search for telemedicine articles citing key reports on SDM outcome measures. Two reviewers independently screened titles and abstracts, reviewed full text eligible studies, and synthesized their content using thematic analysis.

RESULTS

Of the 12 eligible articles, most were European with patients with chronic disease or mental and behavioral health. 8 articles used synchronous remote SDM and 1 used asynchronous remote SDM. Themes related to interactional workability of both telemedicine technologies and SDM emerged, namely access to broadband, digital literacy, and satisfaction with the convenience of remote visits.

CONCLUSIONS

Telemedicine technologies may foster virtual interactions that support remote SDM, which, in turn, may promote productive patient-clinician interactions and patient-centered care.

PRACTICE IMPLICATIONS

Digitally-mediated consultations surged amidst the COVID-19 pandemic. The extent to which SDM frameworks developed for in-person use need any adaptation for remote SDM remains unclear. Investment in innovation, design, implementation, and effectiveness research to advance remote SDM are needed.

The Use of Telemedicine in Older Patients with Gastrointestinal Diseases

Purpose of Review

The COVID-19 pandemic helped us understand that telemedicine provides an alternative way to manage patients remotely, with an added benefit of saving time and travel costs. However, barriers may exist in an older population of patients such as inadequate technology availability and knowledge, and lack of internet connectivity. This systematic review and analysis of data at an academic medical center examines the current literature and investigates the efficacy of telemedicine for older adults requiring gastrointestinal care.

Recent Findings

In the systematic review, we included 22 manuscripts from an initial 120 that were identified based on inclusion and exclusion criteria. In this existing literature, telemedicine visits were equivalent or better than in-person visits based on many metrics, including patient satisfaction, time and money saved, and standard patient outcomes. At a rural academic medical center, there was a steady decrease in the failure rate of telemedicine visits from April 2020 to May 2022 in all age groups, including the 65 + age group, from 17% in April 2020 to 3% in May 2022.

Summary

Telemedicine offers a comparable alternative to in-person visits that is convenient, low-cost, and does not compromise quality of care for older patients obtaining GI care. The COVID-19 pandemic has accelerated progress and uptake of telemedicine, and the successful use by all ages including older patients opens the broader conversation about the continued use of telemedicine for care in various areas of medicine.

Impact of the first COVID-19 outbreak on mental health service utilisation at a Dutch mental health centre: retrospective observational study

BACKGROUND

Previous studies into mental health service utilisation during the COVID-19 pandemic are limited to a few countries or specific type of service. In addition, data on changes in telepsychiatry are currently lacking.

AIMS

We aimed to investigate whether the COVID-19 pandemic is associated with changes in mental health service utilisation, including telepsychiatry, and how these changes were distributed among patients with mental illness during the first COVID-19 outbreak.

METHOD

This retrospective study obtained routinely assessed healthcare data from a large Dutch mental healthcare institute. Data from the second quarter of 2020 (the first COVID-19 outbreak period) were compared with the pre-pandemic period between January 2018 and March 2020. Time-series analyses were performed with the quasi-Poisson generalised linear model, to examine the effect of the COVID-19 lockdown and the overall trend of mental health service utilisation per communication modality and diagnostic category.

RESULTS

We analysed 204 808 care contacts of 28 038 patients. The overall number of care contacts in the second quarter of 2020 remained the same as in the previous 2 years, because the number of video consultations significantly increased (B = 2.17, P = 0.488 × 10-3) as the number of face-to-face out-patient contacts significantly decreased (B = -0.98, P = 0.011). This was true for all different diagnostic categories, although this change was less pronounced in patients with psychotic disorders.

CONCLUSIONS

Diminished face-to-face out-patient contacts were well-compensated by the substantial increase of video consultations during the first COVID-19 outbreak in The Netherlands. This increase was less pronounced for psychotic disorders. Further research should elucidate the need for disorder-specific digital mental healthcare delivery.

A population-based survey of patients' experiences with teleconsultations in cancer care in Denmark during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, teleconsultations (TC) have been increasingly used in cancer care as an alternative to outpatient visits. We aimed to examine patient-related and cancer-specific characteristics associated with experiences with TC among patients with cancer during the COVID-19 pandemic.

MATERIAL AND METHODS

This population-based survey included patients with breast, lung, gastrointestinal, urological, and gynaecological cancers with appointments in the outpatient clinics, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in March and April 2020. Age- and sex-adjusted logistic regression analyses were used to study associations of sociodemographics, cancer and general health, anxiety, and health literacy with patients' experiences of TC in regards to being comfortable with TC, confident that the doctor could provide information or assess symptoms/side effects and the perceived outcome of TC.

RESULTS

Of the 2119 patients with cancer receiving the electronic survey, 1160 (55%) participated. Two thirds of patients (68%) had consultations with a doctor changed to TC. Being male, aged 65-79 years, and having TC for test results were statistically significantly associated with more comfort, confidence, and perceived better outcome of TC. Having breast cancer, anxiety, low health literacy, or TC for a follow-up consultation were statistically significantly associated with less positive experiences with TC. Living alone, short education, disability pension, and comorbidity were statistically significantly associated with anxiety and low health literacy.

CONCLUSIONS

Most patients reported positive experiences with TC, but in particular patients with anxiety and low health literacy, who were also the patients with fewest socioeconomic and health resources, felt less comfortable and confident with and were more likely to perceive the outcome negatively from this form of consultation. TC may be suitable for increasing integration into standard cancer care but it should be carefully planned to meet patients' different information needs in order not to increase social inequality in cancer.

Oncologist Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network Survey

PURPOSE

The use of telemedicine expanded dramatically in March 2020 following the COVID-19 pandemic. We sought to assess oncologist perspectives on telemedicine's present and future roles (both phone and video) for patients with cancer.

METHODS

The National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group formed a Workgroup to assess the state of oncology telemedicine and created a 20-question survey. NCCN EHR Oncology Advisory Group members e-mailed the survey to providers (surgical, hematology, gynecologic, medical, and radiation oncology physicians and clinicians) at their home institution.

RESULTS

Providers (N = 1,038) from 26 institutions responded in Summer 2020. Telemedicine (phone and video) was compared with in-person visits across clinical scenarios (n = 766). For reviewing benign follow-up data, 88% reported video and 80% reported telephone were the same as or better than office visits. For establishing a personal connection with patients, 24% and 7% indicated video and telephone, respectively, were the same as or better than office visits. Ninety-three percent reported adverse outcomes attributable to telemedicine visits never or rarely occurred, whereas 6% indicated they occasionally occurred (n = 801). Respondents (n = 796) estimated 46% of postpandemic visits could be virtual, but challenges included (1) lack of patient access to technology, (2) inadequate clinical workflows to support telemedicine, and (3) insurance coverage uncertainty postpandemic.

CONCLUSION

Telemedicine appears effective across a variety of clinical scenarios. Based on provider assessment, a substantial fraction of visits for patients with cancer could be effectively and safely conducted using telemedicine. These findings should influence regulatory and infrastructural decisions regarding telemedicine postpandemic for patients with cancer.

Eligibility for live, interactive otolaryngology telemedicine: 19-month experience before and during the COVID-19 pandemic in Taiwan

Background

Unequal access to healthcare is a global medical problem. Telemedicine, recently made possible by technological advances, may mitigate this inequity. However, the usefulness of telemedicine for procedure-driven disciplines, such as otolaryngology, under infectious conditions (e.g., the COVID-19 pandemic) is unknown.

Methods

Telemedicine was made legal in Taiwan by an amendment to the Physician Act in 2018. Kaohsiung Chang Gung Memorial Hospital was the first hospital in Taiwan to provide the telemedicine service by connecting to the Chenggong Branch of Taitung Hospital (CGBTH) in November 2018. This retrospective cohort study included all new and established otolaryngology outpatient consultations between November 2018 and May 2020 at CGBTH. The Current Procedural Terminology and International Classification of Disease, 10th Revision codes, patient demographic data, and questionnaire data were obtained.

Results

The study included 123 patients with 218 encounters over 19 months. The majority of complaints were ear-related (52.6%). Overall, 49% of the encounters required a specialized procedure for diagnosis and treatment; of these, cerumen removal was the most common procedure. The patient subjective improvement rate increased over the study period (from 62.0% to 78.9%). The rates of return and case closure were both around 90% in 2018 and 2019. The number of otolaryngology consultations and rate of return declined after the start of the COVID-19 pandemic; however, the subjective improvement and case closure rates remained stable. The telemedicine service saved at least 2 h driving time per visit.

Conclusion

Telemedicine for otolaryngology is a promising approach for remote and underserved regions, as well as during an infectious disease pandemic.

Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia

Expedited diagnostic processes for all suspected cervical cancer cases remain essential in the effort to improve clinical outcomes of the disease. However, in some developing countries like Zambia, there is paucity of data that assesses factors influencing diagnostic and treatment turnaround time (TAT) and other metrics vital for quality cancer care. We conducted a retrospective hospital-based study at the Cancer Diseases Hospital (CDH) for cervical cancer cases presenting to the facility between January 2014 and December 2018. Descriptive statistics were used to summarize demographic characteristics while a generalized linear model of the negative binomial was used to assess determinants of overall TAT. Our study included 2121 patient case files. The median age was 49 years (IQR: ±17) and most patients (n = 634, 31%) were aged between 41 and 50 years. The International Federation of Gynaecology and Obstetrics (FIGO) Cancer stage II (n = 941, 48%) was the most prevalent while stage IV (n = 103, 5.2%) was the least. The average diagnostic TAT in public laboratories was 1.48 (95%CI: 1.21-1.81) times longer than in private laboratories. Furthermore, referral delay was 55 days (IQR: 24-152) and the overall TAT (oTAT) was 110 days (IQR: 62-204). The age of the patient, HIV status, stage of cancer and histological subtype did not influence oTAT while marital status influenced oTAT. The observed longer oTAT may increase irreversible adverse health outcomes among cervical cancer patients. There is a need to improve cancer care in Zambia through improved health expenditure especially in public health facilities.

E-consensus on telemedicine in proctology: A RAND/UCLA-modified study

BACKGROUND

Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field.

METHODS

A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds.

RESULTS

Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease.

CONCLUSION

This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.

The impact of medical teleconsultations on general practitioner-patient communication during COVID- 19: A case study from Poland

According to the outbreak of the Covid-19 pandemic, medical teleconsultations using various technologies have become an important tool to mediate communication between general practitioners (GP) and the patients in primary health care in many countries. The quality of the GP-patient communication is an essential factor, which improves the results of treatment and patient satisfaction. The objective of this paper is to study patients' satisfaction from teleconsultation in primary care and the impact of teleconsultations on GP-patient communication through the Covid-19 pandemic in Poland. We analyse whether the teleconsultations performed without physical examinations have a positive impact on GP-patient communication. The quality of teleconsultation and GP-patient communication have been measured using a questionnaire regarding the quality of medical care in a remote care conditions. Among 36 items, nine questions have been related to the dimension of GP-patient communication and ten to system experience. Our results suggest that the quality of teleconsultations is not inferior to the quality of consultation during a face-to-face visit. The patients indicated a high level of satisfaction regarding communication with their GP during teleconsultation. We have also identified that the technical quality and the sense of comfort during teleconsultation positively impact the communication quality.

Measurement of Patient Satisfaction With the Trend of Virtual Clinics During the COVID-19 Pandemic

Background

The consequences of the coronavirus 2019 (COVID-19) pandemic on healthcare systems worldwide are undeniably disrupting regularly provided care for non-COVID-19 patients. Since the start of the pandemic, medical services in Saudi Arabia have adapted to the situation by providing medical care through virtual clinics. This article aims to evaluate patient satisfaction with virtual clinics during the COVID-19 pandemic.

Material and methods

A cross-sectional study was conducted among patients who had experience with the virtual clinics of Unaizah College of Medicine, Qassim University, Saudi Arabia. An online questionnaire was sent to all participants who visited the virtual clinic between May 2020 and July 2020. The questionnaire included demographic data and 16 statements to assess patient satisfaction with the virtual clinic experience. 

Results

A total of 123 participants completed the questionnaire. Their mean age was 33 ± 12 years; 61% were females and 39% were males. Most of the participants were from the Qassim region (77.2%), while 22.8% were from other regions in Saudi Arabia. Dermatology clinics were the most frequently visited virtual clinics, followed by psychiatry clinics. Most of the participants were satisfied with the virtual clinics, with average scores greater than three for most of the components of the questionnaire.

Conclusions

The participants showed considerable satisfaction for virtual clinics in the time of the COVID-19 pandemic, even though the service was relatively new to them. Future additional efforts will be needed to support clinically appropriate and acceptable virtual visits combined with in-person visits after the pandemic.

Sinus and anterior skull base surgery during the COVID-19 pandemic: systematic review, synthesis and YO-IFOS position

PURPOSE

The COVID-19 pandemic has caused significant confusion about healthcare providers' and patients' pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic.

METHODS

PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework.

RESULTS

15 International publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients' COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited.

CONCLUSIONS

Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing the use of PPE is essential with sinus and anterior skull base surgery.

The impact of COVID-19 on provision of UK audiology services & on attitudes towards delivery of telehealth services

OBJECTIVE

To (i) identify the impact of COVID-19 on provision of UK audiology services across sectors (ii) compare teleaudiology service provision between private and public sectors before and after the introduction of restrictions and (iii) identify barriers to teleaudiology delivery amongst UK hearing care professionals in both sectors.

DESIGN

A mixed-methods cross-sectional survey study design. Responses to the structured questionnaire were analysed using descriptive and non-parametric statistics.

STUDY SAMPLE

UK based hearing care professionals (HCP) (n = 323) completed the survey (218 public sector; 89 private sector).

RESULTS

Changes in working patterns varied greatly between different sectors, with 61% of national employed and 26% of independent HCPs being furloughed, compared with 1% in the public sector. Use of telehealth was under-utilised across all sectors and groups in UK hearing healthcare, despite 92% of public and 75% of private HCPs reporting feeling comfortable conducting remote consultations.

CONCLUSION

This study highlights a variation in teleaudiology adoption and key barriers across sector in the UK. A collaborative approach between hearing device manufacturers, research centres, HCPs and professional bodies is required for the creation of targeted guidance and training materials according to sector, to support clinicians in effective teleaudiology provision.

Colorectal Cancer Care and Patients' Perceptions Before and During COVID-19: Implications for Subsequent SARS-CoV-2 Infection Waves

Background

Changes in colorectal cancer (CRC) care planning because of the coronavirus disease 2019 (COVID-19) pandemic and associated health-related quality of life (HRQoL) and well-being of patients with CRC are unknown. We report changes in CRC care and patient-reported outcomes including HRQoL, distress, and loneliness during the first wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods

In April 2020, 4984 patients included in the nationwide Prospective Dutch Colorectal Cancer cohort were invited to complete a COVID-19–specific questionnaire, together with the validated European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30), De Jong Gierveld, and Hospital Anxiety and Depression Scale. Clinical data were obtained from the Netherlands Cancer Registry. Scores were compared with the year prior to COVID-19 and with an age- and sex-matched control population during COVID-19.

Results

In total, 3247 (65.1%) patients responded between April and June 2020. Of the patients, 17% had canceled, postponed, or changed hospital visits to a telephone or video consult, and 5.3% had adjusted, postponed, or canceled treatment. Compared with controls, patients reported worse HRQoL but comparable distress and less social loneliness (patients = 21.2%; controls = 32.9%). Compared with pre–COVID-19, clinically meaningful deterioration of HRQoL was more prevalent in patients with changes in cancer care planning than in patients without changes. Prior to undergoing or currently undergoing treatment and infection worries were associated with lower HRQoL.

Conclusions

CRC patients reported equal anxiety and depression but worse HRQoL than the control population. Changes in care planning were associated with deterioration of HRQoL and increased anxiety. In case of 1 or more risk factors, health-care specialists should discuss (mental) health status and possible support during future SARS-CoV-2 infection waves or comparable pandemics.

Current and future use of telemedicine in surgical clinics during and beyond COVID-19: A narrative review

Introduction

Telemedicine has emerged as a powerful tool in the delivery of healthcare to surgical patients and enhances clinician-patient encounters during all phases of patient care. Our study aims were: to review the current use and applicability of telemedicine; evaluate its suitability, safety and effectiveness in a surgical outpatient setting, particularly in the era of social distancing restrictions and provide insight into future applications.

Methods

Databases searched included: PubMed, OVID Medline, Embase, Scopus, Web of Science and review of reference lists. Key words used were "telemedicine"; "telehealth"; "videoconference"; "outpatient" and "surgical clinic". For inclusion, articles required to be in English, published between 2000 and 2021, were in an outpatient surgical setting and if they had a focus during the COVID-19 pandemic.

Results

335 articles were identified and screened, so that 63 articles were included in the review. Almost all articles were from Western countries (n = 60), mostly in surgical journals (n = 35) and from a range of sub-specialities, but pre-dominantly orthopaedics (n = 12) and general surgery (n = 7). The majority were original comparative studies where 31 studies directly compared telemedicine to in-person appointments and 14 papers focused on implementation during COVID-19.

Discussion/conclusions

Telemedicine has been safely used across various phases of surgical outpatient care, with its effectiveness evaluated by clinical outcomes, economics and user/provider satisfaction. Telemedicine has multiple accepted benefits including time efficiency, patient/healthcare cost savings and community access, but with reported limitations of clinical uncertainty, technology infrastructure requirements, cybersecurity vulnerabilities and healthcare regulatory restraints. These limitations are being overcome by accelerated implementation during COVID-19 via fast-tracked practice development. Further work is required via development of research protocols to refine the application of emerging telemedicine technologies and their applicability to different surgical sub-specialties.

Video consultations during the coronavirus disease 2019 pandemic are associated with high satisfaction for both doctors and patients

Background and Aim

Telehealth has become the standard of care during the COVID-19 outbreak. This study aimed to assess doctor and patient satisfaction of endoscopy-related telehealth clinics with video consultations.

Methods

A prospective observational study of patients consecutively booked to attend two endoscopy-related telehealth clinics at an ambulatory tertiary care setting was conducted from July to October 2020. Data collected from our previously published study using phone consultations (data collected in April-May 2020) were used as a control arm. The primary outcome (satisfaction) was assessed through the six-question score (6Q_score) as per previous research. Secondary outcomes included failure-to-attend (FTA) rate and perceived necessity of physical examination/in-person follow-up appointment.

Results

There were 962 endoscopy clinic appointments between July and October, of which 157 were conducted through video. Data on 127 doctor questionnaires and 94 patient questionnaires were analyzed. The median age (years) of patients reviewed via video [57, interquartile range (IQR) 48-66] was lower than those reviewed via phone (65, IQR 55-74, P < 0.01). Patient average 6Q_score was higher with video compared to phone (85.1% vs 78.4%, P = 0.01), as was doctors' 6Q_score (97.5% vs 91.9%, P = 0.02). FTA rates remained similar between the two assessments (6.4% in April/May and 4.4% between July/October, P = 0.12). The requirement for in-person follow-up/physical examination was identified in two video consultations (1.6%).

Conclusion

Video consultations during the COVID-19 outbreak demonstrated higher patient and doctor satisfaction compared to phone consultations. There was no significant difference in FTA rates and need for in-person follow-up consultations/physical examination between the telehealth two modalities.

Video Visits Using the Zoom for Healthcare Platform for People Receiving Maintenance Hemodialysis and Nephrologists: A Feasibility Study in Alberta, Canada

Background:

Demand for virtual visits (an online synchronous medical appointment between a health care provider and patient) is increasing due to the COVID-19 pandemic. There may be additional benefits of virtual visits as they appear to be convenient and potentially cost-saving to patients. People receiving maintenance hemodialysis require ongoing care from their nephrologist and may benefit from virtual visits; however, the optimal model for a virtual kidney clinic is unknown.

Objective:

To codesign and assess the feasibility of a virtual (video) kidney clinic model with clinic staff, nephrologists, and patients receiving maintenance hemodialysis, to be used for routine follow-up visits.

Design:

Mixed-methods study.

Setting:

Two main kidney clinics in central Calgary, Alberta.

Participants:

Adults with kidney failure receiving maintenance hemodialysis, nephrologists, and clinic staff.

Methods:

First, we individually interviewed clinic staff and nephrologists to assess the needs of the clinic to deliver virtual visits. Then, we used participant observation with patients and nephrologists to codesign the virtual visit model. Finally, we used structured surveys to evaluate the patients’ and nephrologists’ experiences when using the virtual model.

Results:

Eight video visits (8 patients; 6 nephrologists) were scheduled between October 2019 and February 2020 and 7 were successfully completed. Among completed visits, all participants reported high satisfaction with the service, were willing to use it again, and would recommend it to others. Three main themes were identified with respect to factors influencing visit success: IT infrastructure, administration, and process.

Limitations:

Patients received training on how to use the videoconference platform by the PhD student, whom also set up the technical components of the visit for the nephrologist. This may have overestimated the feasibility of virtual visits if this level of support is not available in future. Second, interviews were not audio-recorded and thematic analysis relied on field notes.

Conclusions:

Video visits for routine follow-up care between people receiving hemodialysis and nephrologists were acceptable to patients and nephrologists. Video visits appear to be feasible if clinics are equipped with appropriate equipment and IT infrastructure, physicians are remunerated appropriately, and patients receive training on how to use software as needed.

Benefits of phone consultation for endoscopy-related clinics in the COVID-19 pandemic

BACKGROUND AND AIM

During COVID-19 outbreak, restrictions to in-person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess "failure-to-attend" (FTA) rate and satisfaction for two endoscopy-related compulsory telehealth clinics during the COVID-19 outbreak.

METHODS

Consecutive patients booked for endoscopy-related telehealth clinics at a tertiary hospital were prospectively assessed. In-person clinic control data were assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on six Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review.

RESULTS

There were 691 patients booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, P < 0.01). The patient 6Q_score was higher for the advanced endoscopy clinic (84.6% vs 73.8%, P < 0.01), while the doctor 6Q_score was similar between both advanced clinics and post endoscopy clinics (91.1% vs 92.5% respectively, P = 0.80). An in-person follow-up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%.

CONCLUSIONS

The use of phone consultations in endoscopy-related clinics during the COVID-19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in-person follow-up consultations and physical examination were low.