Study assesses use of telemedicine for consulting on surgeries

Telemedicine can be effective for patients and surgeons as they start discussions on surgeries.

"We found that patients are just as satisfied with telehealth visits as in-person appointments,” said Alexander T. Hawkins, MD, MPH, FACS.

A new study found patients and physicians enjoyed the convenience, but also recognized limitations, in making decisions and communicating about medical procedures. The article in press “Shared Decision-Making in General Surgery: A Prospective Comparison of Telemedicine vs In-Person Visits,” was published in the Journal of the American College of Surgeons.1,2

Researchers compared survey responses from 301 patients who had in-person visits and 86 who used telehealth consultations from May 2021 to June 2022 at a Vanderbilt University Medical Center clinic in the Division of General Surgery.

The physicians used the Zoom online meeting program to meet with some patients. The patients completed questionnaires to rate decision-making, quality of life, satisfaction, computer comfort, and to share details about computer comfort and socioeconomics.

While the researchers hypothesized telehealth would be less effective for shared decision-making and communication, patients meeting in person and online “reported high levels of quality communication during these appointments,” said a news release about the study.

“We see patients that live hours away. When the COVID-19 pandemic hit, it threw fuel on the fire of our telehealth program,” coauthor Alexander T. Hawkins, MD, MPH, FACS, said in the news release. Hawkins is associate professor of surgery at Vanderbilt University Medical Center.²

“Across the entire healthcare system, we now do about 20,000 telehealth visits a month,” Hawkins said. “Previously, there had been concerns about whether we could effectively communicate with patients remotely, but we found that patients are just as satisfied with telehealth visits as in-person appointments.”

Patient reactions

A total of 327 patients also shared open-ended responses collated over five themes: physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communications quality.

Among their responses:

• Patients who visited in person “highlighted the importance of the physical exam and ability to obtain labs/imaging.”
• Telemedicine patients like the decreased exposure during the COVID-19 pandemic.
• Patients noted they and physicians needed greater commitment to be physically present for in-person visits.
• Online visits were more convenient, with less time needed for patient driving, and less time away from family and work.
• In-person visits were preferable for appropriateness of surgical consultations.
• For follow-up appointments, telemedicine was suitable.
• Communication quality in telehealth can be limited by technical problems with software.

“I was surprised by the qualitative responses,” co-author Thomas Ueland said is the news release. Ueland is a third-year medical student at Vanderbilt University School of Medicine.

“I expected that telemedicine visits would result in an inferior quality of communication,” Ueland said. “While we did see that in some responses, we also saw some very positive perspectives on telemedicine visits both in terms of how the actual interaction went and the overall convenience of the process. Many patients really enjoyed having this as an option.”

References

1. Hawkins AT, Ueland T, Aher C, et al. Shared decision-making in general surgery: A prospective comparison of telemedicine vs in-person visits. J Am Coll Surg. doi: 10.1097/XCS.0000000000000538

2. For shared decision-making, telemedicine may be as effective as in-person appointments. Accessed January 19, 2023. https://bit.ly/3Rr6Cqm