E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study

Abstract

Coronavirus disease 2019 (COVID-19) is revolutionizing healthcare delivery. The aim of the study was to reach consensus among experts on the possible applications of telemedicine in colorectal surgery. A group of 48 clinical practice recommendations (CPRs) was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Colorectal Surgery Italian Working Group included 54 colorectal surgeons affiliated to the Italian Society of Colo-Rectal Surgery (SICCR) who were involved in the evaluation of the appropriateness of each CPR, based on published RAND/UCLA methodology, in two rounds. Stakeholders’ median age was 44.5 (IQR 36–60) years, and 44 (81%) were males. Agreement was obtained on the applicability of telemonitoring and telemedicine for multidisciplinary pre-operative evaluation. The panel voted against the use of telemedicine for a first consultation. 15/48 statements deemed uncertain on round 1 and were re-elaborated and assessed by 51/54 (94%) panelists on round 2. Consensus was achieved in all but one statement concerning the cost of a teleconsultation. There was strong agreement on the usefulness of teleconsultation during follow-up of patients with diverticular disease after an in-person visit. This e-consensus provides the boundaries of telemedicine in colorectal surgery in Italy. Standardization of infrastructures and costs remains to be better elucidated. Supplementary Information The online version contains supplementary material available at 10.1007/s13304-021-01139-8.

Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study

“…Existing criteria and practice recommendations for patient selection to emergency and elective surgeries have been revised in some countries in order to lessen the burden on medical resources, maximizing, when possible, the use of non-operative treatments and ambulatory or minimally invasive surgery, and the referral of patients to sub-specialty trained, high-volume surgeons [37] . In this instance, one must acknowledge the advantages of telemedicine, which consists of the healthcare delivered remotely to a patient through information and communication technology, including the provision of diagnosis, monitoring, and treatment services [38] . Telemedicine practices in outpatient follow-up or in non-operative treatments can also play an important role in high demand settings and for very common conditions such as management of appendicitis by reducing the number of hospital admissions, providing an alternative to triage, and facilitating peer-to-peer exchange between healthcare providers [ 37 , 39 , 40 ].…”

A Narrative Review of the Launch and the Deployment of Telemedicine in Italy during the COVID-19 Pandemic

“…The eligibility process applied to the selected references, after the elimination of the duplicated ones, returned 39 works [ 5 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], including a review focused on the relationship between telemedicine and radiotherapy [ 39 ].…”

“…The neurology sector has also recorded an important use of applications in Parkinson’s disease [ 44 ]; in the use of telemedicine for the multidisciplinary assessment of patients with Amyotrophic Lateral Sclerosis [ 47 ]; for multiple sclerosis [ 28 ]; for a headache specialist center; and in applications of telephysiotherapy [ 47 ]. The overview also reported the application of telemedicine in other sectors less common in telemedicine solutions, such as: colorectal surgery [ 24 ]; wound care [ 20 ]; urological benign diseases [ 32 ]; endocrinology [ 34 ]; inflammatory bowel disease [ 37 ]; teleconsulting with a bariatric center; and chronic liver disease [ 42 ]. There has been the use of systems, in some simple cases, such as telephony [ 32 , 50 ], and in other more complex cases, such as specialized servers [ 53 ], which have allowed the application of telemedicine with success.…”

“…Gallo, G., et al [24]. Telemedicine in Colorectal Surgery Italian Working Group, Grossi U. E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study.…”

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

“…The development of more advanced platforms of telemedicine with a strict observance of GDPR (general data protection regulation) and cybersecurity rules is also warranted. Although initial investments in resources, software, training, and maintenance will be necessary at the beginning, telemedicine is going to be, in the long term, helpful for health organizations to reduce the burden associated with IBD [34][35][36].…”