Telemedicine during the COVID-19 pandemic

Abstract

Aims The COVID-19 pandemic led to a swift adoption of telehealth in orthopaedic surgery. This study aimed to analyze the satisfaction of patients and surgeons with the rapid expansion of telehealth at this time within the division of adult reconstructive surgery at a major urban academic tertiary hospital. Methods A total of 334 patients underging arthroplasty of the hip or knee who completed a telemedicine visit between 30 March and 30 April 2020 were sent a 14-question survey, scored on a five-point Likert scale. Eight adult reconstructive surgeons who used telemedicine during this time were sent a separate 14-question survey at the end of the study period. Factors influencing patient satisfaction were determined using univariate and multivariate ordinal logistic regression modelling. Results A total of 68 patients (20.4%) and 100% of the surgeons completed the surveys. Patients were “Satisfied” with their telemedicine visits (4.10/5.00 (SD 0.98)) and 19 (27.9%) would prefer telemedicine to in-person visits in the absence of COVID-19. Multivariate ordinal logistic regression modelling revealed that patients were more likely to be satisfied if their surgeon effectively responded to their questions or concerns (odds ratio (OR) 3.977; 95% confidence interval (CI) 1.260 to 13.190; p = 0.019) and if their visit had a high audiovisual quality (OR 2.46; 95% CI 1.052 to 6.219; p = 0.042). Surgeons were “Satisfied” with their telemedicine experience (3.63/5.00 (SD 0.92)) and were “Fairly Confident” (4.00/5.00 (SD 0.53)) in their diagnostic accuracy despite finding the physical examinations to be only “Slightly Effective” (1.88/5.00 (SD 0.99)). Most adult reconstructive surgeons, seven of eight (87.5%) would continue to use telemedicine in the future. Conclusion Telemedicine emerged as a valuable tool during the COVID-19 pandemic. Patients undergoing arthroplasty and their surgeons were satisfied with telemedicine and see a role for its use after the pandemic. The audiovisual quality and the responsiveness of physicians to the concerns of patients determine their satisfaction. Future investigations should focus on improving the physical examination of patients through telemedicine and strategies for its widespread implementation. Cite this article: Bone Joint J 2021;103-B(6 Supple A):196–204.

Cost and Satisfaction Implications of Using Telehealth for Plagiocephaly

“…Provider responses indicated that pre-telehealth review of clinical documentation and photographs enabled them to adequately examine the patient’s head shape. This is consistent with other studies reporting high levels of provider confidence in telehealth effectiveness 17–19 and moderately positive physician experiences which was much higher when the audiovisual quality was high. 20…”

“…5 NA How easy was it to take the preappointment photographs? effectiveness [17][18][19] and moderately positive physician experiences which was much higher when the audiovisual quality was high. 20 The timing of this study during a pandemic may have influenced overall satisfaction with telehealth consults.…”

Telehealth for a better service delivery in orthopaedic surgery

“…16,22 Smartphone-based applications can be used for assessment of patient-reported outcome measures and rehabilitation, which result in similar outcomes when compared to in-person care, while access to video platforms can allow sharing of material to patients. 16,22-24…”

“…Figure 1 presents patient pathways and illustrates a framework to aid decision-making with telemedicine. 18,19,24,25…”

Yet more challenges for orthopaedic and trauma surgeons

“…Some took on leadership positions in response to the COVID-19 pandemic; others changed their practice from elective to emergency and trauma work, and many put aside their core work and helped in the general medical care of patients that was required at the height of the pandemic. [1][2][3][4][5][6][7][8] Little did we expect that colleagues in Europe would now have to turn wholly from elective surgery to the management of battlefield injuries. That challenge extends beyond the war zone to other countries where education, equipment, and expertise in this area is being sourced and disseminated.…”