Most patients who undergo routine, uncomplicated operations prefer online postoperative consultations to in-person visits, according to results from a study published online in the Journal of the American College of Surgeons.
In this prospective pilot study from Vanderbilt University Medical Center in Nashville, TN, researchers tracked 50 patients who completed both online and in-person visits after their operations. The patients underwent elective laparoscopic cholecystectomy, laparoscopic ventral hernia repair, umbilical hernia repair, or inguinal hernia repair. Seventy-six percent of this group said that online visits were acceptable as the only form of follow-up care.
“This is beneficial not just for those far away, but those who are busy and don’t want to take time off work and whatever else they’re doing, go to an appointment, and wait in room, especially for a postop visit, which takes 5-10 minutes to see the surgeon,” says lead study author Kristy Kummerow Broman, MD, MPH, resident physician in general surgery.
The surgeons conducting the study said that for 68% of patients, online and in-person visits were equally effective, which indicates that offering an option for online care might have largely impacted patient preferences. Also, while clinic visits took an average of 10 minutes, the online visits took only five minutes, says Kummerow Broman. “Theoretically, it opens up clinics to see more patients,” she says.
The research team approached the study by questioning whether all aspects of perioperative care need to take place in person. Members of the team thought that there might be a role for moving some postoperative care for certain operations to an online environment. The study authors wrote, “To date, there has been minimal incorporation of these new care delivery modalities into general surgical care, and patients have been less frequently relied upon to generate their own data in the form of digital images.”
An online patient portal was used for the study that had previously been established at Vanderbilt as a way for patients to access health data and communicate with their care providers. The system used for the survey was REDCap (Research Electronic Data Capture). (For more information, go to http://www.projectredcap.org.)
As a prerequisite for participating, all study patients were required to have internet access and be able to take and upload digital images to the online portal. Patients were asked to upload digital wound images using a smartphone, tablet, digital camera, or computer to the online portal. Surgeons then responded to patients about their symptom reports and wound images. The surgeons and patients did not need to be online at the same time, but they uploaded and accessed information at their own convenience.
“That makes a difference,” Kummerow Browman says. With video or telephone, both people have to be communicating at the same time, she points out.
Images of patient wounds previously have been used more for provider-to-provider interaction, but having patients generate images for patient-to-provider consultation is a relatively new concept, according to Kummerow Broman. “By the end, all of our surgeons saw utility in the concept of online care,” she says.
Despite the optimism from patients and surgeons, the researchers acknowledged certain limitations to the study. “The data revealed potential advantages of online postoperative care, including convenient access for patients, decreased patient travel times, and surgeon efficiency gains; however, these [benefits] must be carefully weighed against potential detriments of using patient-generated data to provide clinical assessment, including concerns about liability, provider work burden, and modified patient-provider relationships,” study authors noted.
Another potential disadvantage is that patients must have access to a smartphone, tablet, or computer and have the ability to use them, Kummerow Browman says. Also, some providers might be concerned about whether they are obtaining all of the information they need when it is conveyed online, she says.
One patient in the study had a seroma under the wound, Kummerow Broman says. “This patient’s online visit suggested the possibility of a seroma, and it was confirmed on physical exam,” she says. “This supports our conclusion that online visits should be used as a triage tool to determine which patients require in-person care for complete assessment. … We think the key is designing our tools for online care and developing appropriate standards for adequate online assessment so that providers can determine when online care is adequate and when in-person care may be needed.”
The study was designed to measure patient acceptance and not to measure safety or quality of care, Kummerow Broman emphasized. “We wanted to first establish whether this method is something that patients wanted, and now that we feel we have done so, we are continuing our research in this area trying to develop ways to measure safety and quality,” she says. (Access the study abstract at http://bit.ly/1X95bxI.)
Kummerow Broman also participated in a Veterans Administration (VA) study that allowed surgery patients to have follow-up visits on the phone, in person, or by video inside the VA facility to determine if remote follow-up was feasible and if patients preferred it. All veterans in the study had all three visit types. The researchers found most veterans preferred follow-up visits using one of the remote methods: phone or video. (Access the research letter at http://bit.ly/1FfNg0j.)
Society already is moving in the direction of using technology such as smartphones to bank and shop, Kummerow Broman says. “Consumers are expecting to be able to use these basic tools, like take picture with a smartphone, and integrate that into clinical care,” she says. “They’re expecting we can take their electronic responses. It’s time for the surgical community to develop the quality standards and infrastructure to make this accessible to patients.”
Sherry Wren, MD, FDACS a professor of surgery at Stanford University and a physician with the Palo Alto Veterans Affairs Health Care System in California, has studied using phone follow-up with patients.
“Finding alternative ways to follow patients can be very patient-centric and can be very helpful to them,” Wren says. (Read an abstract of Wren’s study at http://bit.ly/1PVxHNB.)
