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Journal of Shoulder and Elbow Surgery

The future of health care service in orthopedic practice: telemedicine or in-person visits?

      Background

      The objective of this study was to assess patient satisfaction and preference for telemedicine vs. in-person visits for outpatient shoulder and elbow musculoskeletal consultation during the coronavirus disease 2019 (COVID-19) pandemic and in the future.

      Methods

      Patients who had telemedicine visits for shoulder and elbow musculoskeletal complaints at a single institution from March through June 2020 were invited to respond to a post-visit survey. The survey included a standardized questionnaire that focused on the patient’s satisfaction with the telemedicine visits during the pandemic and preference for using the telemedicine platform in the future, following the pandemic. Additional details regarding their virtual visits (severity of medical condition, as well as previous virtual or emergency department visits) were also obtained. Data regarding patient demographic characteristics and visit details (primary diagnosis, type of visit, length of visit, and treating physician) were extracted from the electronic medical records.

      Results

      In total, 153 patients participated in the study. Overall, high satisfaction scores regarding the telemedicine visits were noted: 91% of patients reported that their concerns were adequately addressed, 89% would recommend telemedicine to a friend, and 94% stated that they would use the telemedicine platform again in the presence of a situation similar to the COVID-19 pandemic. However, the majority of patients (76%) reported a preference for in-person visits for the same musculoskeletal complaint if it were not for COVID-19. A telemedicine visit duration > 10 minutes and a first-time telemedicine visit correlated with higher satisfaction rates (P = .037 and P = .001, respectively).

      Conclusions

      COVID-19 has provided a boost to the use of our telemedicine platform, with a high satisfaction rate among patients with shoulder and elbow musculoskeletal complaints, largely owing to safety reasons and limited access to in-person doctor visits. However, a considerable number of patients would have preferred in-person visits for similar health complaints if there were no pandemic. Further research on optimizing the selection of patients for telemedicine visits and addressing their expectations and concerns regarding their visits will improve patients’ preference for future telemedicine visits.

      Level of evidence

      Keywords

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      References

        • Aarnio P.
        • Lamminen H.
        • Lepistö J.
        • Alho A.
        A prospective study of teleconferencing for orthopaedic consultations.
        J Telemed Telecare. 1999; 5: 62-66
        • Bakken S.
        • Grullon-Figueroa L.
        • Izquierdo R.
        • Lee N.J.
        • Morin P.
        • Palmas W.
        • et al.
        Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire.
        J Am Med Inform Assoc. 2006; 13: 660-667https://doi.org/10.1197/jamia.M2146
        • Benger J.R.
        • Noble S.M.
        • Coast J.
        • Kendall J.M.
        The safety and effectiveness of minor injuries telemedicine.
        Emerg Med J. 2004; 21: 438-445https://doi.org/10.1136/emj.2002.004028
        • Brennan J.A.
        • Kealy J.A.
        • Gerard iLH.
        • Shih R.
        • Allegra J.
        • Sannipoli L.
        • et al.
        Telemedicine in the emergency department: a randomized controlled trial.
        J Telemed Telecare. 1995; 5: 18-22
        • Bokolo A.J.
        Use of telemedicine and virtual care for remote treatment in response to COVID-19 pandemic.
        J Med Syst. 2020; 44: 132https://doi.org/10.1007/s10916-020-01596-5
        • Buvik A.
        • Bugge E.
        • Knutsen G.
        • Smabrekke A.
        • Wilsgaard T.
        Patient reported outcomes with remote orthopaedic consultations by telemedicine: a randomised controlled trial.
        J Telemed Telecare. 2019; 25: 451-459https://doi.org/10.1177/1357633X18783921
        • Buvik A.
        • Bugge E.
        • Knutsen G.
        • Smabrekke A.
        • Wilsgaard T.
        Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial.
        BMC Health Serv Res. 2016; 16: 483https://doi.org/10.1186/s12913-016-1717-7
        • Couturier P.
        • Tyrrell J.
        • Rhul C.
        • Woodward C.
        • Franco A.
        Feasibility of orthopaedic teleconsulting in a geriatric rehabilitation service.
        J Telemed Telecare. 1998; 4: 85-87
        • Duffy S.
        • Lee T.H.
        In-person health care as option B.
        N Engl J Med. 2018; 11: 104-106https://doi.org/10.1056/NEJMp1710735
        • Ernsting C.
        • Dombrowski S.U.
        • Oedekoven M.
        • O’Sullivan J.L.
        • Kanzler M.
        • Kuhlmey A.
        • et al.
        Using smartphones and health apps to change and manage health behaviors: a population-based survey.
        J Med Internet Res. 2017; 19: e101https://doi.org/10.2196/jmir.6838
        • Gordon N.P.
        • Hornbrook M.C.
        Differences in access to and preferences for using patient portals and other ehealth technologies based on race, ethnicity, and age: a database and survey study of seniors in a large health plan.
        J Med Internet Res. 2016; 18: e50https://doi.org/10.2196/jmir.5105
        • Grandizio L.C.
        • Foster B.K.
        • Klena J.C.
        Telemedicine in hand and upper-extremity surgery.
        J Hand Surg Am. 2020; 45: 239-242https://doi.org/10.1016/j.jhsa.2019.09.007
        • Haukipuro K.
        • Ohinmaa A.
        • Winblad I.
        • Linden T.
        • Vuolio S.
        The feasibility of telemedicine for orthopaedic outpatient clinics: a randomized controlled trial.
        J Telemed Telecare. 2000; 6: 193-198
        • Kane L.T.
        • Thakar O.
        • Jamgochian G.
        • Lazarus M.D.
        • Abboud J.A.
        • Namdari S.
        • et al.
        The role of telehealth as a platform for postoperative visits following rotator cuff repair: a prospective, randomized controlled trial.
        J Shoulder Elbow Surg. 2020; 29: 775-783https://doi.org/10.1016/j.jse.2019.12.004
        • Makhni M.C.
        • Riew G.J.
        • Sumathipala M.G.
        Telemedicine in orthopaedic surgery: challenges and opportunities.
        J Bone Joint Surg Am. 2020; 102: 1109-1115https://doi.org/10.2106/JBJS.20.00452
        • Mann D.M.
        • Chen J.
        • Chunara R.
        • Testa P.A.
        • Nov O.
        COVID-19 transforms health care through telemedicine: evidence from the field.
        J Am Med Inform Assoc. 2020; 27: 1132-1135https://doi.org/10.1093/jamia/ocaa072
        • Marsh J.
        • Bryant D.
        • MacDonald S.J.
        • Naudie D.
        • Remtulla A.
        • McCalden R.
        • et al.
        Are patients satisfied with a web-based followup after total joint arthroplasty?.
        Clin Orthop Relat Res. 2014; 472: 1972-1981https://doi.org/10.1007/s11999-014-3514-0
        • Parisien R.L.
        • Shin M.
        • Constant M.
        • Saltzman B.M.
        • Li X.
        • Levine W.N.
        • et al.
        Telehealth utilization in response to the novel coronavirus (COVID-19) pandemic in orthopaedic surgery.
        J Am Acad Orthop Surg. 2020; 28: e487-e492https://doi.org/10.5435/JAAOS-D-20-00339
        • Pastora-Bernal J.M.
        • Martin-Valero R.
        • Barón-López F.J.
        • Estebanez-Peréz M.J.
        Evidence of benefit of telerehabitation after orthopedic surgery: a systematic review.
        J Med Internet Res. 2017; 19: e142https://doi.org/10.2196/jmir.6836
        • Patterson B.M.
        • Eskildsen S.M.
        • Clement R.C.
        • Lin F.C.
        • Olcott C.W.
        • Del Gaizo D.J.
        • et al.
        Patient satisfaction is associated with time and provider but not clinic wait time among orthopedic patients.
        Orthopedics. 2017; 40: 43-48https://doi.org/10.3928/01477447-20161013-05
        • Russell T.G.
        • Buttrum P.
        • Wootton R.
        • Jull G.A.
        Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial.
        J Bone Joint Surg Am. 2011; 93: 113-120https://doi.org/10.2106/JBJS.I.01375
        • Sathiyakumar V.
        • Apfeld J.C.
        • Obremskey W.T.
        • Thakore R.V.
        • Sethi M.K.
        Prospective randomized controlled trial using telemedicine for follow-ups in an orthopedic trauma population: a pilot study.
        J Orthop Trauma. 2015; 29: e139-e145https://doi.org/10.1097/BOT.0000000000000189
        • Singh J.A.
        • Lu X.
        • Rosenthal G.E.
        • Ibrahim S.
        • Cram P.
        Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data.
        Ann Rheum Dis. 2014; 73: 2107-2115https://doi.org/10.1136/annrheumdis-2013-203494
        • Sinha N.
        • Cornell M.
        • Wheatley B.
        • Munley N.
        • Seeley M.
        Looking through a different lens: patient satisfaction with telemedicine in delivering pediatric fracture care.
        J Am Acad Orthop Surg Glob Res Rev. 2019; 3: e100https://doi.org/10.5435/JAAOSGlobal-D-19-00100
        • Tachakra S.
        • Lynch M.
        • Newson R.
        • Stinson A.
        • Sivakumar A.
        • Hayes J.
        • et al.
        A comparison of telemedicine with face-to-face consultations for trauma management.
        J Telemed Telecare. 2000; 6: S178-S181
        • Tanaka M.J.
        • Oh L.S.
        • Martin S.D.
        • Berkson E.M.
        Telemedicine in the era of COVID-19: the virtual orthopaedic examination.
        J Bone Joint Surg Am. 2020; 102: e57https://doi.org/10.2106/JBJS.20.00609
        • Viswanath A.
        • Monga P.
        Working through the COVID-19 outbreak: rapid review and recommendations for MSK and allied heath personnel.
        J Clin Orthop Trauma. 2020; 11: 500-503https://doi.org/10.1016/j.jcot.2020.03.014
        • Vuolio S.
        • Winblad I.
        • Ohinmaa A.
        • Haukipuro K.
        Videoconferencing for orthopaedic outpatients: one-year follow-up.
        J Telemed Telecare. 2003; 9: 811https://doi.org/10.1258/135763303321159620