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Post-op phone checkups save time and travel

By Kathryn Doyle

NEW YORK (Reuters Health) - In a preliminary study of patients who had simple surgeries, most did well and seemed satisfied with post-operative checkups by telephone instead of seeing their surgeon in a clinic visit.

The phone follow-up saved doctors and patients the time and effort involved in clinic visits without compromising patient care, according to the study of California patients.

"These clinic visits are usually five minutes or less, very brief, the doctor asks ‘how are you, do you feel well, are you going to the bathroom okay, that kind of thing," said senior author Dr. Sherry Wren of the Stanford University School of Medicine.

Those questions can easily be asked over the phone, and only patients with unusual symptoms need to come see a doctor in person, she told Reuters Health. The study included patients who had hernia repairs and gallbladder removals, both routine surgeries with very low post-op complication rates.

But so-called telehealth follow-up would not be appropriate for all surgeries Wren said; for cancer patients, for example, follow-up doctors' visits include discussions of continuing care and treatment plans.

For the new study, Wren and her colleagues identified patients of the Palo Alto Veterans Administration Health Care System who were scheduled for one of two surgeries.

In total, 115 patients had hernia repairs and 26 had gallbladders removed. All were scheduled for a follow-up clinic visit three weeks after their surgeries. But two weeks post-surgery the patients were called by a physician assistant.

The assistant asked scripted questions about the patient's pain and activity levels, swelling, the look and feel of the incision, appetite and bowel movements.

If patient responses indicated normal recovery, the patient's scheduled follow-up clinic visit was canceled with the patient's consent. If recovery seemed abnormal, the patient was encouraged to keep the clinic appointment. Any patients who wanted in-person follow-up were also allowed to keep their appointment.

Calls went through to 110 of the patients; 63 hernia patients and 19 gallbladder patients agreed to have surgical follow up by phone only and canceled their clinic appointments.

None of the gallbladder patients and three hernia patients had surgical complications up to 10 months after surgery, which is comparable to complication rates in the general population, according to the results published in the journal JAMA Surgery.

The authors did not compare the outcomes of the telehealth group to a group going to traditional clinic visits.

Of the patients who said they wanted to visit the clinic, even after the phone checkup, most wanted to pick up a return-to-work form and thought they had to do so in person, whereas it can actually be mailed or faxed, Wren said.

Most patients said they were very satisfied with the telehealth checkups and seemed grateful that they didn't have to drive to the clinic, Wren said,

Of the patients who accepted the telehealth follow-up, the average round-trip travel distance from their homes to the hospital was 141 miles, and the average driving time Wren's team calculated would have been about two and a half hours.

Though research supports the safety and efficacy of telehealth, it is only used in some pockets of healthcare, Wren said. Some physicians balk at leaving behind the "gold standard" of in-person visits, she said.

The current study indicates that even the relatively low-tech telephone call can be a reliable telehealth option, and it may be more appealing to people, she said.

"Nothing about this was surprising, especially in this patient population and with what we would consider relatively routine procedures, especially if they travel great distances, we know people would like an alternative," said Dr. Glenn Ault of the department of surgery at the University of Southern California in Los Angeles.

Using telemedicine to make sure only surgical patients who need to be seen end up going to a clinic could help cut down on crowds and wait times, said Ault, who wrote a commentary to accompany the research.

He already uses telemedicine in his practice in L.A. health system, and has also had patients send pictures of their wounds before coming in to the office. The next step will be to study telehealth options for other procedures, he said.

"Healthcare as we view it will undergo some significant transformation in the years ahead, the status quo cannot continue," he said. "We are going to have to look for different ways to safely and efficiently provide care," and telehealth could play an important role, he said.

SOURCE: http://bit.ly/16GIKzS JAMA Surgery July 10, 2013.

(This story is refiled to include source link to JAMA Surgery article)

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