Teleconsultation in the management of elective orthopaedic and spinal conditions during the COVID-19 pandemic: A prospective cohort study of patient experiences (Preprint)

BACKGROUND The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. OBJECTIVE To evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopaedic and spinal procedures. METHODS This was a prospective observational cohort study of 853 patients receiving orthopaedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely; and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for four weeks during the mandated COVID-19 lockdown, followed by four weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using Chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. RESULTS We report that 91% of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (p=0.000). A combined-group analysis shows that 55.3% of all patients preferred teleconsultation compared to 31.2% who preferred in-person office visits (p=0.000). Patients in the telephone group reported significantly higher satisfaction scores (9.95 +/- 0.04, 95% CI [9.87-10.03]) compared to patients in the in-person group (9.53 +/- 0.04, 95% CI [9.45-9.62]; p=0.000). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 min +/-0.18, 95% CI [6.32-7.02] compared to 5.10 min +/-0.17, 95% CI [4.73-5.42], respectively (p=0.000). CONCLUSIONS Patients who utilize telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopaedic surgery, which may even extend beyond the COVID-19 pandemic. CLINICALTRIAL N/A

Teleconsultation in the Management of Elective Orthopaedic and Spinal Conditions During the COVID-19 Pandemic

Purpose: The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. The purpose of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopaedic and spinal procedures.Methods: This was a prospective observational cohort study of 853 patients receiving orthopaedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely; and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for four weeks during the mandated COVID-19 lockdown, followed by four weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using Chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results: We report that 91% of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (p=0.000). A combined-group analysis shows that 55.3% of all patients preferred teleconsultation compared to 31.2% who preferred in-person office visits (p=0.000). Patients in the telephone group reported significantly higher satisfaction scores (9.95 +/- 0.04, 95% CI [9.87-10.03]) compared to patients in the in-person group (9.53 +/- 0.04, 95% CI [9.45-9.62]; p=0.000). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 min +/-0.18, 95% CI [6.32-7.02] compared to 5.10 min +/-0.17, 95% CI [4.73-5.42], respectively (p=0.000).Conclusion: Patients who utilize telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopaedic surgery, which may even extend beyond the COVID-19 pandemic.

Telemedicine for Disparity Patients With Diabetes: The Feasibility of Utilizing Telehealth in the Management of Uncontrolled Type 2 Diabetes in Black and Hispanic Disparity Patients: A Pilot Study

Background: Non-Hispanic Black (NHB) and Hispanic/Latinx (H/L) patients bear a disproportionate burden of type 2 diabetes and associated complications. Regular visits to a primary care doctor or diabetes specialist are warranted to maintain glycemic control, but for a myriad of reasons disparity populations may have difficulties receiving diabetes care. We seek to determine the feasibility of telehealth added to care as usual and secondarily to improve health outcomes (hemoglobin A1c [HbA1c]) in NHB and H/L with uncontrolled type 2 diabetes managed with two or three noninsulin agents. Methods: Twenty-nine patients were randomized to monthly phone calls or weekly to biweekly telehealth visits. Feasibility outcomes were summarized descriptively for the telehealth arm. Differences scores for A1C level and surveys were computed between baseline and three months and compared across arms using a two-sample t test or Mann-Whitney U test. Results: Patients in the telehealth arm completed a median of eight visits (IQR: 5, 8), and 53% of those in the telephone arm completed 100% of their calls. Change in HbA1c was greater for those in the telephone arm (−2.57 vs −2.07%, P = .70) but the mean baseline HbA1c was higher in the telephone group (11.1% vs 10.3%). Although the change in HbA1c was not statistically different across arms, it was clinically significant. Conclusions: Augmenting care as usual with telehealth provided by telephone or tablet can be of benefit in improving glycemic control in NHB and H/L with type 2 diabetes. Larger studies need to explore this further.

Effective methods for reactivating inactive blood donors: a stratified randomized controlled study

Background: Recruiting of sufficient numbers of donors of blood products is vital worldwide. In this study we assessed the efficacy and cost-effectiveness of telephone calls and SMS reminders for re-recruitment of inactive blood donors. Methods: This single-centre, non-blinded, parallel randomized controlled trial in Guangzhou, China included 11,880 inactive blood donors whose last donation was between January 1 and June 30, 2014. The donors were randomly assigned to one of two intervention groups (telephone call or short message service [SMS] communications) or to a control group without intervention. SMS messages with altruistic appeal were adopted in the SMS group; in addition to altruistic appeal, reasons for deferral of blood donation were also asked in the telephone group. All participants were followed up for 1 year. The primary outcome was re-donation rate, and rates in different groups were compared by intention-to-treat (ITT) analysis and estimation of the average treatment effect on the treated (ATT). Secondary outcomes were the self-reported deterrents. Other outcomes included the re-donation interval, and the incremental cost-effectiveness ratio (ICER) of telephone calls and SMS reminders on re-recruitment. Results: ITT analysis revealed no significant differences in the re-donation rate among the three groups. ATT estimations indicated that among compliers, telephone calls significantly increased re-donation compared to both SMS reminders and no intervention. Donor return behaviour was positively associated with receiving reminders successfully, being male, older age, and previous donation history. The SMS reminder prompted donors to return sooner than no reminder within 6 months, and according to ICER calculations, SMS reminders were more cost-effective than telephone calls. Donors reported time constraints as the most main causes of self-deferral in the telephone group, and altruistic appeal had a positive effect on these donors. Conclusions: Interventions to reactivate inactive blood donors can be effective, with telephone calls prompting more donors to return but at a greater cost than SMS messages. SMS reminder with altruistic appeal can urge donors to re-donate sooner within 6 months than no reminder.

Effective methods for reactivating inactive blood donors: a stratified randomized controlled study

Background: Recruiting of sufficient numbers of donors of blood products is vital worldwide. In this study we assessed the efficacy and cost-effectiveness of telephone calls and SMS reminders for re-recruitment of inactive blood donors. Methods: This single-centre, non-blinded, parallel randomized controlled trial in Guangzhou, China included 11,880 inactive blood donors whose last donation was between January 1 and June 30, 2014. The donors were randomly assigned to either one of two intervention groups (received telephone or short message service [SMS] communications) or to a control group without intervention. SMS messages with altruistic appeal were adopted in the SMS group; in addition to altruistic appeal, reasons for deferral of blood donation were also asked in the telephone group. All participants were followed up for 1 year. The primary outcome were re-donation rates, compared by intention-to-treat (ITT) analysis, average treatment effect (ATE) and average treatment effect on the treated (ATT) estimations. Secondary outcomes were the self-reported deterrents. Other outcomes included the re-donation interval, and the incremental cost-effectiveness ratio (ICER) of telephone calls versus SMS reminders on re-recruitment. Results: ITT analysis discovered no significant differences in the re-donation rate among the three groups. ATE estimation showed that participants who were randomly assigned to the telephone group were more likely to re-donate than those in the SMS group. ATT estimations indicated that among compliers, telephone calls significantly increased re-donation compared to both SMS reminders and no intervention. Donor return behaviour was positively associated with receiving reminders successfully, being male, older age, and previous donation history. The SMS reminder prompted donors to return sooner than no reminder within 6 months, and according to ICER calculations, SMS reminders were more cost-effective than telephone calls. Donors reported time constraints as the most main causes of self-deferral in the telephone group, and altruistic appeal had a positive effect on these donors. Conclusions: Interventions to reactivate inactive blood donors can be effective, with telephone calls prompting more donors to return but at a greater cost than SMS messages. SMS reminder with altruistic appeal can urge donors to re-donate sooner within 6 months than no reminder.

Comparison of Internet and Telephone Interventions for Weight Loss Among Cancer Survivors: Randomized Controlled Trial and Feasibility Study (Preprint)

BACKGROUND Weight loss interventions have been successfully delivered via several modalities, but recent research has focused on more disseminable and sustainable means such as telephone- or Internet-based platforms. OBJECTIVE The aim of this study was to compare an Internet-delivered weight loss intervention to a comparable telephone-delivered weight loss intervention. METHODS This randomized pilot study examined the effects of 6-month telephone- and Internet-delivered social cognitive theory–based weight loss interventions among 37 cancer survivors. Measures of body composition, physical activity, diet, and physical performance were the outcomes of interest. RESULTS Participants in the telephone intervention (n=13) showed greater decreases in waist circumference (–0.75 cm for telephone vs –0.09 cm for Internet, P=.03) than the Internet condition (n=24), and several other outcomes trended in the same direction. Measures of engagement (eg, number of telephone sessions completed and number of log-ins) suggest differences between groups which may account for the difference in outcomes. CONCLUSIONS Cancer survivors in the telephone group evidenced better health outcomes than the Internet group. Group differences may be due to higher engagement in the telephone group. Incorporating a telephone-based component into existing weight loss programs for cancer survivors may help enhance the reach of the intervention while minimizing costs. More research is needed on how to combine Internet and telephone weight loss intervention components so as to maximize engagement and outcomes. CLINICALTRIAL ClinicalTrials.gov NCT01311856; https://clinicaltrials.gov/ct2/show/NCT01311856 (Archived by WebCite at http://www.webcitation.org/6tKdklShY)

Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED

Summary Objective: Consultation, the process of an Emergency Physician seeking an opinion from other specialties, occurs frequently in the Emergency Department (ED). The aim of this study was to determine the effect of secure messaging application (WhatsApp) usage for medical consultations on Emergency Department Length of Stay (ED LOS) and consult time. Methods: We conducted a prospective, randomized controlled trial in the ED using allocation concealment over three months. Consultations requested in the ED were allocated into two groups: consultations requested via the secure messaging application and consultations requested by telephone as verbal. Results: A total of 439 consultations requested in the ED were assessed for eligibility and 345 were included in the final analysis: 173 consultations were conducted using secure messaging application and 172 consultations were conducted using standard telephone communications. The median ED LOS was 240 minutes (IQR:230-270, 95% CI:240 to 255.2) for patients in the secure messaging application group and 277 minutes (IQR:270-287.8, 95% CI:277 to 279) for patients in the telephone group. The median total ED LOS was significantly lower among consults conducted using Secure messaging application relative to consults conducted by telephone (median dif: -30, 95%CI:–37to-25, p<0.0001). The median consult time was 158 minutes (IQR:133 to 177.25, 95% CI:150 to 169) for patients in the Secure messaging application group and 170 minutes (IQR:165 to 188.5, 95% CI:170-171) for patients in the Telephone group (median dif: –12, 95%CI:-19 to-7,p<0.0001). Consultations completed without ED arrival was 61.8% in the secure messaging group and 33.1% in the Telephone group (dif: 28.7, 95% CI:48.3 to 66, p<0.001). Conclusions: Use of secure messaging application for consultations in the ED reduces the total ED LOS and consultation time. Consultation with secure messaging application eliminated more than half of in-person ED consultation visits.Gulacti U, Lok U. Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED. Appl Clin Inform 2017; 8: 742–753 https://doi.org/10.4338/ACI-2017-04-RA-0064

Impact of Pharmacist Follow-up Intervention on Patient Return to a Community Pharmacy From a Convenient Care Clinic

Background: Convenient Care Clinics (CCCs) located within the same facility as a retail pharmacy offer the opportunity for immediate fill of prescriptions from the CCC and may also provide a source of new customers for the pharmacy. Objective: To assess the impact of a follow-up intervention on new patients seen at a CCC returning to the pharmacy for subsequent prescription fills compared to the control group. Methods: New patients who filled a prescription from the CCC in November and December 2015 received an initial follow-up telephone call or letter, respectively, from the pharmacist within 10 days of their prescription fill date. The primary end point of the percentage of patient return was assessed for 3 months following the initial fill date. Secondary end points included number of prescriptions transferred and customer satisfaction scores. Results: Thirty-four out of 214 patients in the control group returned to the pharmacy for subsequent prescription fills (15.9%). Fourteen out of 52 patients in the telephone group returned to the pharmacy for additional prescription fills following a telephone call from the pharmacist. (26.9%, P = .063) Sixteen out of 77 patients in the letter group returned to the pharmacy after their first prescription. (20.8%, P = .329). Conclusions: Following-up with new patients to the pharmacy in the form of a personalized telephone call increases the likelihood of patients continuing to utilize the pharmacy for their prescription needs.