Post-operative Care & Long-term Follow-up Using Telemedicine Analysis of Social & Financial Impact

Post-operative Care & Long-term Follow-up Using Telemedicine Analysis of Social & Financial ImpactAnjali MishraAdditional Professor Dept of Endocrine Surgery, SGPGIMS,Lucknow- 226014, India

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Telemedicine & Surgical PatientsTeleconsultationPre-referral screeningTelementoring/ TelesurgeryPost-operative care (tele- follow up)Transforming Health Care With IT


Post-operative Care & Long-term Follow-upTransforming Health Care With IT


Reasons for Post-operative VisitsWound & general careSuture RemovalPain, Infection, BleedingNutritionMedications dosages adjustmentHistology (biopsy) reportsFurther planningLong- term follow upTransforming Health Care With IT


IssuesInconvenience/ AnxietyFinancial lossWork hour lossLeave issuesDomestic/ social issuesTransforming Health Care With IT


Tele Follow-upWell established for some medical conditionsChronic diseasesCardiologyNeurologyWeb based treatment planning for radiotherapy Surgery emergingTransforming Health Care With IT


SGPGIMS ExperienceTransforming Health Care With IT


Transforming Health Care With ITAims & ObjectivesPilot 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 & MethodsApril 2004 December 2007Follow- up data of patients, operated at our center & thereafter consenting to report at telemedicine center Cuttack for tele-consultations analyzedNature of SurgeryReason of consultationA questionnaire was given to pts.to assessed Patients satisfaction Financial savingsLeave saved



ProcedureFirst tele-follow up appointment fixed at the time of discharge after explaining the procedure to the patientOn 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 Transforming Health Care With IT


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Department of Endocrine Surgery

Telemedicine CenterSanjay Gandhi Postgraduate Institute of Medical Sciences, LucknowTELE-FOLLOW UPName : Ayesha MohantiCr No : 2004113413 Diagnosis: Post-Op Case of Minimally Invasive Follicular Carcinoma Date: 11.04.05Tele-Follow No.: 4th Clinical Status: No symptomsInvestigation Report received: Serum Tg.

Reasons For TeleconsultationsReview of histology report: 18 (53.0)Further visits not required: 13 (72.2)Dosage adjustment: 27 (79.4)Thyroxin dose adjustment: 24Calcium dosage adjustment: 08Thyroid cancer follow-up: 05 (14.7)Transforming Health Care With IT


Financial ImplicationsTransforming Health Care With IT


OutcomeSatisfactionExcellent: 69% Very good: 31%Leave savedPer visit : 7.2 (4-12) daysPer patient: 14.5 daysWould prefer tele-follow-up



Care Continuum So FarNo of Patients (April 2004- June 2013): 88Age: 44.3 + 13.8 years;M: F=1:1.8Diagnosis 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% Transforming Health Care With IT


Care Continuum- Changing NeedsIndications of first follow- up visitReview of final histology Medicine dosages adjustmentIndication of subsequent follow- up visitsMedicine dosages adjustment Tumour surveillanceTransforming Health Care With IT


SummaryIndications: Clean, low risk surgeriesLaparaoscopic cholecystectomy, Hernia surgerySkin & superficial surgeriesThyroidectomy & parathyroidectomyBenefitsPermit better resource utilizationEarly and safe dischargeCan support Rural, remote, mobile surgeryGood follow up ensured Transforming Health Care With IT


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



Transforming Health Care With ITThank You


Documents

Post-operative Care & Long-term Follow-up Using Telemedicine Analysis of Social & Financial Impact