Cardiovascular disease pervades the country's Appalachian region, yet many Appalachians live far from any heart and vascular specialist. Follow-up doctor's visits in the weeks after cardiovascular surgery can involve hours-long drives down narrow, winding roads.
A new study published in the Annals of Vascular Surgery suggests telemedicine may improve these patients' satisfaction with their postoperative care as well as their quality of life.
With telemedicine, a healthcare provider can use a computer, tablet or other electronic device to remotely evaluate their patients' symptoms, diagnose illnesses or injuries, and prescribe treatments. They can also field their patients' questions.
The model has shown promise in creating new reimbursement streams for providers, as well as in improving the health of rural residents especially.
The 30 participants in the research were recovering from vascular surgery, and in each case, the surgeon made an incision in the patient's groin to access the arteries that needed rebuilding or rerouting. Whether the incisions healed without complications was the study's focus.
Sixteen patients received tablets with Enform -- a telemedicine app developed by TeleMed 2020 Inc. -- that facilitated communication with nurses managing their care. As part of an in-home monitoring kit, patients also received thermometers, blood pressure cuffs, scales and devices to measure blood oxygen saturation levels.
Each day, patients who had been discharged from the hospital weighed themselves, took their temperature, measured their pulse and blood pressure, and determined their blood oxygen levels using the app. They completed a wellness and symptom tracking quiz that included questions like "How is your pain today?" Each week they answered satisfaction and emotional wellness questions as well. The data, along with photos of the surgical incision sites that patients captured with the app, was made available to the patients' care team.
Care managers, in turn, logged into the telemedicine platform daily to review the information patients had submitted from their homes. Cares managers received notifications of abnormalities, such as blood pressure spikes and fevers. Based on the information they gathered, they intervened, answered patients' questions about symptoms or wound care, called in prescriptions, scheduled appointments with physicians and modified care plans based on consultations with the medical director.
Meanwhile, the other 14 participants had standard-of-care treatment. They received no monitoring equipment, tablet or telemedicine app.
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After 30 days, the researchers made a number of comparisons between the two groups. For example, were wound infections more common in one group than the other? Did one group require more hospital readmissions? How did members of each group rate their own well-being? Were they happy with the postoperative care they received?
Hospital-readmission and wound-infection rates did not differ significantly between groups. The researchers attribute this to the study's small sample size. But patients in the telemedicine group scored better on measures of their physical function, mental health and role limitations due to physical health problems.
In addition, the vast majority of patients who used the app found it intuitive to use. Using a five-point scale to measure ease of use, 91 percent of patients gave it a score of four or five. A similar percentage of patients said the app enriched the quality of care they received.
Likewise, the telemedicine patients' scores on quality-of-life assessments surged more dramatically between the study's beginning and end.
The authors envision that one day patients will be able to download a cell phone app that provides the telemedicine services highlighted in the research.
Telemedicine technology has been improving steadily over the past several years, and as the tech gets better, so does its reputation.
Increasingly, payers and providers are realizing that telemedicine has the potential to control costs, and the sector has now crossed a threshold. Complex clinical cases and behavioral health are now being treated viably using a virtual approach.