Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics

Abstract

The clinical effectiveness and costs of videoconferencing in orthopaedics between primary and secondary care were examined in an eight-month prospective, comparative study. The general surgery outpatient clinics of two Finnish district hospitals were compared: Peijas Hospital, with telemedicine, and Hyvinkää Hospital, without it. The three study primary-care centres referred a total of 419 adult patients to the outpatient clinics. The population-based number of referrals to Peijas Hospital was similar to that to Hyvinkää Hospital after adjusting for the proportion of older people living in the Hyvinkää Hospital municipalities. Of the 225 patients referred to Peijas Hospital, 168 (75%) were given appointments at the outpatient clinic of surgery and the rest of the referred patients received a teleconsultation. All patients referred to Hyvinkää Hospital were given appointments at the outpatient clinic. The direct costs of an outpatient visit were 45% greater per patient than for a teleconsultation, with a marginal cost decrease of EU48 for every new teleconsultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU2500 in favour of teleconsultations. The use of videoconferencing between primary and secondary care was modest in orthopaedics, although the use of this telemedicine method was shown to reduce direct costs and be cost-effective.

Economic Evaluation of Web-Based Compared with In-Person Follow-up After Total Joint Arthroplasty

“…Others have investigated remote orthopaedic consultations by various means (videoconference [18][19][20][21][22] , Skype 23 , or teleconference 24 ) and reported cost-savings and similar clinical outcomes compared with in-clinic assessments. Although those alternative methods may achieve savings in some circumstances, the webbased system for routine arthroplasty follow-up provides greater flexibility to complete the assessment at a time and location *The values are given as the mean and the standard deviation.…”

Effect of telemedicine on patients' diagnosis and treatment

“…8 An eight-month prospective study compared orthopaedic surgery outpatient clinics with telemedicine to those clinics without telemedicine (n ¼ 419 patients). 4 The findings demonstrated that the diagnoses were revised to a similar degree after orthopaedic surgery teleconsultations (12%) and after face-to-face clinic visits (16%), when compared with the diagnoses established by the general practitioners. Results from an experimental study (n ¼ 108 patients with 123 acute fractures) indicated that additional information provided by viewing electronically transmitted images of radiographs changed the acute 15 A six-month pilot teleconsultative project was designed to examine the effectiveness of telemedicine on the clinical decision-making process for patients with urolithiasis (urinary calculi).…”

“…Previous studies have been performed to assess the effect of telemedicine on changes in the patient's diagnosis and treatment plan. [2][3][4][7][8][9][10][11][12][13] The University of Arkansas for Medical Sciences (UAMS) began a project in 1995 to provide telemedicine for a poor, under-served, rural population in the East Arkansas Delta. The target area was seven counties in Arkansas.…”

Postoperative care using a secure online patient portal: changing the (inter) face of general surgery

“…32 Accordingly, some surgeons have removed "hands-on" assessments, conducting perioperative visits using secure two-way interactive video. [33][34][35][36][37] Still others have eliminated both "hands-on" and visual assessments, using telephone to follow-up adults after laparoscopic cholecystectomy and inguinal hernia repair as well as a variety of minor pediatric general surgical procedures. [38][39][40] Both video and telephone-based care are limited in that they must be performed in a synchronous fashion, with both patient and surgeon available concurrently to participate in follow-up.…”