Online Follow-Up with Surgery Patients Is on the Rise

Patients are more likely to keep pre- and post-surgical virtual appointments. Uploading photos for healthcare providers works, too. Here's what you should know.

Surgical patients often don’t have easy transportation in rural areas, or they may lack time to keep their doctor visits before and after a procedure.

Enter virtual care.

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In a study with data from seven clinics in Alabama, covering more than 553,000 visits, 11.7 percent of participants didn’t show up at scheduled in-person appointments, compared to 2.5 percent who missed a virtual visit.

As lead author Connie Shao, MD, a general surgery resident at the University of Alabama, Birmingham, pointed out, “timely care before and after surgery improves quality care, reduces costs for the patient, and helps ensure our patients are able to maintain a higher level of health.”

Virtual visits help more vulnerable groups. In the study, blacks were nearly 70 percent more likely to miss an appointment than white patients, and Asians were 32 percent more likely. Medicaid patients were twice as likely to be no-shows, compared to privately insured people. Patients from poorer counties were 13 percent more likely to miss their visits.

Some older and more sickly patients may need help getting access to appointments and navigating technology. Offering audio-only, low-tech options is one idea.

"Some care is better than no care," Shao said.

Post-surgical patients in the study also responded well to the option of uploading photos for healthcare providers, in a separate pilot study at Vanderbilt University Medical Center, in Nashville, Tenn.

That study included 50 patients who had either gallbladder removal or hernia repair procedures, which are relatively simple. The patients sent online photos of their incisions to their doctors along with symptom reports. Surgeons responded but did not need to be online at the same time as the patient.

Seventy-six percent of the group said online visits were “acceptable” as the only form of follow-up care.

Lead author Kristy Broman, MD, MPH, now at the University of Alabama, noted that the approach isn’t for every patient. Some cases are more complex.

Previous studies have shown that telemedicine including online assessment can significantly cut health-related travel time for you.

Researchers have specifically looked at the use of telemedicine for diabetes and blood pressure control, and to reduce the frequency and severity of chronic obstructive pulmonary disease symptoms.

Emory University’s transplant center in Atlanta has used online patient-doctor visits for several years via telehealth centers that are part of a statewide network.

While the visits aren’t home-based, they do save patients who have had transplant surgery many hours of drive time. When the transplant center looked at 41 transplant patients over a two-year period, staff determined that patients saved about 9,400 miles in drive time.

Telehealth has also proven useful for end-of-life, or palliative, care, but lack of coverage for the costs remains a major barrier. The regulatory climate on telemedicine also has been a jumble but is improving as Congress addresses its use.

Some primary care physicians have been reluctant to incorporate telemedicine, including online interfaces, into their practices because the healthcare environment is changing fast. But soon it’s likely to be a common practice.

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