Efficacy and satisfaction of postoperative asynchronous TeleHealth compared to in-person visits following colorectal surgery
Catherine C. Beauharnais1, Susanna S. Hill2, Jennifer S. Davids1, Paul R. Sturrock1, Karim Alavi1, Justin A. Maykel1
1Colorectal Surgery, UMass Memorial Medical Center, Worcester, Massachusetts, United States, 2Surgery, Albany Medical Center, Albany, New York, United States
Objectives: The feasibility of remote visits in colorectal surgery has not been studied in relation to efficacy, patient satisfaction, and provider satisfaction. This study aims to assess reliability and satisfaction with a web-based questionnaire for post-operative visits, following abdominal colorectal surgery.
Design: Prospective single arm cohort study
Setting: Participants were recruited from a single tertiary care center during post-operative admission for abdominal colorectal surgery. This study was temporarily halted due to the COVID-19 pandemic.
Patients: A total of 70 patients were screened for eligibility: 13 patients declined, 24 did not meet inclusion criteria or were not enrolled due to logistical constraints (i.e. ICU stay, hospital discharge prior to enrollment). The final sample size consisted of 33 patients of which 30 (90.9%) successfully completed the web questionnaire. Our sample was primarily non-Hispanic White (n=29, 96.7%), female (n=18, 60%) with a median age of 61.5 (IQR 51.6 - 67.2).
Intervention: Using a patient portal, participants completed a web-based questionnaire 48 hours prior to their in-person follow-up visit. They were also asked to provide a picture of their incisions. Surgeons reviewed patient-entered data and responded within 24 hours. Following the subsequent in-person visit, surgeons completed a questionnaire to compare the accuracy of the web-based assessment vs. the in-person evaluation. Lastly, patients completed a satisfaction survey after their in-person visit.
Main Outcome Measures: Patient and provider satisfaction with the online questionnaire as a post-operative visit option.
Results: Providers reported the online questionnaire to be concordant with the in-person visit in 90% of cases. Of the patients who completed the study, only half found the survey alone to be acceptable for follow-up. Patients spent significantly less time completing the online questionnaire (≤10 minutes) than in-person visits, including travel time (75 minutes, IQR 50-100). Only 12 patients (40%) uploaded a picture of their incisions. Management changes were employed in five patients (16.7%), of which 3 required treatment of superficial SSIs (10%). Only one of the SSI patients had uploaded a picture of his/her incision.
Conclusion:This asynchronous web-based visit format was acceptable to colorectal surgeons but was only embraced by half of patients, despite considerable time savings. While patients appear to prefer in-person visits, there may be opportunities to expand TeleHealth acceptance that focus on patient selection and education.
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