post-operative care & long-term follow-up using telemedicine analysis of social & financial...

Post-operative Care & Long-term Follow-up Using Telemedicine

Analysis of Social & Financial Impact

Anjali MishraAdditional Professor

Dept of Endocrine Surgery, SGPGIMS,Lucknow- 226014, India

Transforming Health Care With IT

Telemedicine & Surgical Patients

• Teleconsultation• Pre-referral screening• Telementoring/ Telesurgery• Post-operative care (tele- follow up)


Post-operative Care & Long-term Follow-up


Reasons for Post-operative Visits

• Wound & general care– Suture Removal– Pain, Infection, Bleeding– Nutrition– Medication’s dosages adjustment

• Histology (biopsy) reports• Further planning• Long- term follow up


Issues

• Inconvenience/ Anxiety• Financial loss• Work hour loss• Leave issues• Domestic/ social issues


Tele Follow-up

• Well established for some medical conditions– Chronic diseases

• Cardiology• Neurology

– Web based treatment planning for radiotherapy

• Surgery emerging


SGPGIMS Experience



Aims & Objectives

• Pilot study was undertaken to assess the feasibility of tele-follow up in post-operative cases of thyroid and parathyroid disorders, to establish the indications of the same, and to know the outcome in terms of patient satisfaction, financial and work hour savings incurred by them

Materials & Methods

• April 2004 –December 2007• Follow- up data of patients, operated at our center &

thereafter consenting to report at telemedicine center Cuttack for tele-consultations analyzed– Nature of Surgery– Reason of consultation

• A questionnaire was given to pts.to assessed – Patient’s satisfaction – Financial savings– Leave saved


Procedure

• First tele-follow up appointment fixed at the time of discharge after explaining the procedure to the patient

• On the day of appointment, telemedicine staff contacted the Senior Resident in Endocrine Surgery.

• Patients records and required reports eg: Histology retrieved from HIS & placed in a file



Photograph

Telemedicine CenterSanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

TELE-FOLLOW UP Name : Ayesha Mohanti Cr No : 2004113413 Diagnosis: Post-Op Case of Minimally Invasive Follicular Carcinoma Date: 11.04.05 Tele-Follow No.: 4th Clinical Status: No symptoms Investigation Report received: Serum Tg. <0.5 ng/ml Advice: Continue Tab. Eltroxin 100 ugm. Daily as advised Serum TSH estimation Next Follow-up: After six months with serum Thyroglobulin and Serum TSH Doctor’s Name: Dr. S.K. Mishra


Reasons For Teleconsultations

• Review of histology report : 18 (53.0)– Further visits not required : 13 (72.2)

• Dosage adjustment : 27 (79.4)– Thyroxin dose adjustment : 24– Calcium dosage adjustment : 08

• Thyroid cancer follow-up: 05 (14.7)


Financial Implications


Outcome

• Satisfaction– Excellent : 69% – Very good : 31%

• Leave saved– Per visit : 7.2 (4-12) days– Per patient : 14.5 days

• Would prefer tele-follow-up


Care Continuum So Far• No of Patients (April 2004- June 2013): 88• Age: 44.3 + 13.8 years; M: F=1:1.8• Diagnosis

– Thyroid carcinoma : 49.3%– Benign thyroid diseases : 40.2% – Primary hyperparathyroidism : 08.0%– Adrenal Disorders : 02.3%

• Duration of follow up (months) : 1 - 90 > 24 months : 21.3%

• Median no. of visits/ patient : 2 ( 1-13)> 5 visits : 22.7%


Care Continuum- Changing Needs

• Indications of first follow- up visit– Review of final histology – Medicine dosages adjustment

• Indication of subsequent follow- up visits– Medicine dosages adjustment – Tumour surveillance


Summary

• Indications: Clean, low risk surgeries– Laparaoscopic cholecystectomy, Hernia surgery– Skin & superficial surgeries– Thyroidectomy & parathyroidectomy

• Benefits– Permit better resource utilization– Early and safe discharge– Can support Rural, remote, mobile surgery– Good follow up ensured


Conclusions

• We believe that tele-follow up facility could play an important role in improving health care delivery system in our country



Thank You

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