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

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

• Anjali Mishra
• Additional Professor
• Dept of Endocrine Surgery, SGPGIMS,
• Lucknow- 226014, India

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Telemedicine Surgical Patients

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

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Post-operative Care Long-term Follow-up
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Reasons for Post-operative Visits

• Wound general care
• Suture Removal
• Pain, Infection, Bleeding
• Nutrition
• Medications dosages adjustment
• Histology (biopsy) reports
• Further planning
• Long- term follow up

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Issues

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

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Tele Follow-up

• Well established for some medical conditions
• Chronic diseases
• Cardiology
• Neurology
• Web based treatment planning for radiotherapy
• Surgery emerging

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SGPGIMS Experience
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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

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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
• Patients satisfaction
• Financial savings
• Leave saved

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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

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Photograph
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Department of Endocrine Surgery
Telemedicine Center Sanjay 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      Investigat
ion Report received Serum Tg. lt0.5
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       Doctors Name Dr. S.K. Mishra
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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)

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Financial Implications
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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

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Care Continuum So Far

• No of Patients (April 2004- June 2013) 88
• Age 44.3 13.8 years M F11.8
• 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
• gt 24 months 21.3
• Median no. of visits/ patient 2 ( 1-13)
• gt 5 visits 22.7

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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

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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

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Conclusions

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

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• Thank You