Telemedicine in the Evaluation and Management of Neurosurgical Spine Patients

Questionnaire Assessment of 346 Consecutive Patients

Alexander C.M. Greven, BS; Beau M. McGinley, BS; Ndeye F. Guisse, BS; Lynessa J. McGee, BS; Sarah Pirkle, BS; James G. Malcolm, MD, PhD; Gerald E. Rodts, MD; Daniel Refai, MD; Matthew F. Gary, MD

Disclosures

Spine. 2021;46(7):472-477. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective questionnaire study of all patients seen via telemedicine during the COVID-19 pandemic at a large academic institution.

Objective: This aim of this study was to compare patient satisfaction of telemedicine clinic to in-person visits; to evaluate the preference for telemedicine to in-person visits; to assess patients' willingness to proceed with major surgery and/or a minor procedure based on a telemedicine visit alone.

Summary of Background Data: One study showed promising utility of mobile health applications for spine patients. No studies have investigated telemedicine in the evaluation and management of spine patients.

Methods: An 11-part questionnaire was developed to assess the attitudes toward telemedicine for all patients seen within a 7-week period during the COVID-19 crisis. Patients were called by phone to participate in the survey. χ 2 and the Wilcoxon Rank-Sum Test were performed to determine significance.

Results: Ninety-five percent were "satisfied" or "very satisfied" with their telemedicine visit, with 62% stating it was "the same" or "better" than previous in-person appointments. Patients saved a median of 105 minutes by using telemedicine compared to in-person visits. Fifty-two percent of patients have to take off work for in-person visits, compared to 7% for telemedicine. Thirty-seven percent preferred telemedicine to in-person visits. Patients who preferred telemedicine had significantly longer patient-reported in-person visit times (score mean of 171) compared to patients who preferred in-person visits (score mean of 137, P = 0.0007). Thirty-seven percent of patients would proceed with surgery and 73% would proceed with a minor procedure based on a telemedicine visit alone.

Conclusion: Telemedicine can increase access to specialty care for patients with prolonged travel time to in-person visits and decrease the socioeconomic burden for both patients and hospital systems. The high satisfaction with telemedicine and willingness to proceed with surgery suggest that remote visits may be useful for both routine management and initial surgical evaluation for spine surgery candidates.

Level of Evidence: 3

Introduction

With the spread of the novel coronavirus 2019 (COVID-19), clinics around the world are utilizing telemedicine in an effort to keep up with patient demand and slow the spread of the virus. The process of rapidly implementing spine telemedicine services in the context of a changing regulatory landscape and global pandemic has been detailed in a recent publication about the benefits and limitations of telemedicine during COVID.[1] Otherwise, the neurosurgical literature on telemedicine is sparse and primarily relates to routine follow-up care,[2] economic benefit of remote visits for patients,[3] and the usefulness of telemedicine for triaging neurotrauma in rural, resource-poor areas.[4] The literature on telemedicine in spine surgery is even more sparse, limited to the evaluation of mobile applications for increasing medication and protocol adherence.[5] Thus, the COVID-19 pandemic provides a unique opportunity to investigate the utility of telemedicine in both the evaluation and management of spine pathology. During normal times, patients who would not feel comfortable with telemedicine would opt to be seen in clinic only. This would skew any pre-COVID analysis of patient experiences and satisfaction in favor of telemedicine. Since all spine patients at our institution were required to be seen via telemedicine from March 23 to May 8, we can better generalize how patients perceive telemedicine.

Objective

The purpose of this study was to evaluate the satisfaction, socioeconomic benefit, and feasibility of utilizing telemedicine in both the evaluation and management of spinal pathology. The primary objective was to compare patient satisfaction of the newly implemented telemedicine clinic to satisfaction with previous in-person visits. The secondary objective was to evaluate what percentage of patients preferred telemedicine to traditional in-person visits, and what the differences were between these two groups. To compare, we looked at age, sex, new (initial surgical evaluation) versus established (either post-op or routine follow-up), length of telemedicine and in-person visits, the need to take off work, and the need for assistance to travel to in-person visits. The tertiary goal was to assess whether patients would feel comfortable proceeding with major surgery and/or a minor procedure (i.e., injection) based off a telemedicine visit alone. The differences between the group that would proceed with surgery versus the group that would not were also analyzed.

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