Is virtual clinic follow-up of hip and knee joint replacement acceptable to patients and clinicians? A sequential mixed methods evaluation

Abstract

ObjectiveTo evaluate the acceptability to key stake holders of a newly introduced virtual clinic follow-up pathway for hip and knee joint replacement.DesignA service evaluation comprising a questionnaire sent electronically to 115 patients and interviews with 10 individuals.SettingA newly introduced virtual clinic follow-up pathway for hip and knee replacement patients in a district general hospital.ParticipantsThe electronic questionnaire was distributed to all patients treated under the virtual clinic service over a 5-month period (n=115). Purposive sampling from volunteers among respondents, leading to semi-structured interviews with eight patients. Two orthopaedic consultants were also interviewed.InterventionConsultant review of web-based patient reported outcome measures and digital radiographs, with feedback to patients via letter, replacing face-to-face outpatient appointments for the follow-up of hip and knee joint replacement.ResultsThe response rate to the questionnaire was 40%. 44% indicated they would prefer a virtual appointment over a face-to-face consultation in future. The most common word in the free text comments was ‘good’ (n=107).Seven main themes were identified from the patient interviews: patient understanding and expectations, patient confidence, patient voice, managing deterioration of condition, patient benefit, patient satisfaction using technology and navigating the website.Two main themes were identified from the staff interviews: the adapting patient pathway and project management.Combined analysis elucidated that patients who were doing well liked the ‘click and go’ approach but those with problems were concerned about how to report these and were therefore less satisfied.ConclusionThe virtual clinic process appears to be well accepted by both patients and clinicians. However, appropriate patient selection and clear pathways of communication to address patient concerns are pivotal to success.

Effectiveness, Patient Satisfaction, and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty

“…It must be recognized that people value the personal interaction of face-to-face appointments [ 23 ]. In developing such virtual follow-up systems, clear pathways of communication are essential, especially when a problem or concern is identified.…”

Evaluation of the Feasibility of a Telemedical Examination of the Hip and Pelvis – Early Lessons from the COVID-19 Pandemic

“…Here as well, pitfalls abound. In the literature, it appears that the patients who willingly undergo a telemedical consultation are those without major health problems, whereas patients with relevant symptoms tend to be sceptical of the new methods 20 . Generally speaking, patients appear to view the notion of telemedical consultation critically 21 .…”

“…Auch hier bestehen bereits bekannte Fallstricke. So scheinen in der Literatur vor allem Patienten ohne große Probleme einer telemedizinischen Sprechstunde positiv gegenüber eingestellt zu sein, während Patienten mit relevanten Beschwerden dem neuen Verfahren eher skeptisch gegenüberstehen 20 . Generell scheinen Patienten Videokonsultationen gegenüber eher kritisch eingestellt zu sein 21 .…”

An Overview of Telehealth in Total Joint Arthroplasty

“…The field of orthopedic surgery is well suited to telehealth services due to its high-value based care. The literature suggests that telehealth services provide comparable patient satisfaction, increased cost savings, improved care access, and greater efficiency [8][9][10]19,24,26,27,33]. Additionally, success of implementing telehealth services in orthopedic surgery practices has been reported despite some challenges [25,38,42].…”