A Multicenter Evaluation of the Feasibility, Patient/Provider Satisfaction, and Value of Virtual Spine Consultation During the COVID-19 Pandemic

Abstract

Objective To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic. Methods Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected. Results A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits ( P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation. Conclusions This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.

Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis

“…Although patient sex was not associated with the utilization of telemedicine in some prior research [ 6 , 9 , 15 ], a few studies did show that being female is negatively associated with the success rate or satisfaction of a video visit. Eberly et al [ 13 , 14 ] reported that female patients are less likely to complete video visits, and Ramaswamy et al [ 7 ] found that female patients have lower satisfaction with video visits compared to male patients.…”

“…Second, unlike most prior studies that focused only on patient-level variables that may affect the use of virtual clinics [ 12 , 13 , 36 , 37 , 48 ], we used multilevel analyses to show that insurance type, disease type, physician’s attitude, and specialties are associated with the utilization of virtual clinics independent of patient demographic characteristics. Third, many prior telemedicine studies were small and focused on specific patient populations of 1 specific medical specialty [ 6 , 9 , 10 , 13 , 25 ]. Our study was performed across various specialties and departments, and the patient volume of each virtual clinic was controlled by individual physicians; therefore, physician-level variables could be investigated.…”

Orthopedic Telemedicine Outpatient Practice Diagnoses Set during the First COVID-19 Pandemic Lockdown—Individual Observation

“…However, telemedicine-oriented patient education may well solve the problem [37,61,62]. Studies conducted for virtual consultations for orthopedics usually focus on new solutions and technologies [59,[63][64][65][66][67][68][69], patient and clinician satisfaction [4,24,26,46,49,[70][71][72][73][74][75][76][77], clinical outcome measures [78][79][80][81][82], and cost analysis of traditional versus teleconsultation [82][83][84][85][86][87].…”

Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS

“…Assessing patient satisfaction and experiences with virtual care is essential in determining whether it is an appropriate modality for diagnosis and treatment of specific conditions. 12 Our quality improvement study explores participant characteristics and barriers to virtual care, overall patient satisfaction, accessibility and comfort with virtual care, as well as satisfaction with specific elements of virtual care such as the timeline from referral to appointment, the virtual physical exam, and the virtual decision to treat suspected CRPS with prednisone and hand therapy.…”

“… 2 , 16 Some studies assessing patient satisfaction with virtual physical examination for spinal injuries showed that an adequate array of physical exam maneuvers could be performed by the patient—with the help of a family member, if needed—and the findings of our survey suggest that patients are satisfied with these modified physical exams. 12 , 13 In our study, the virtual physical exam was modified (e.g., reflexes were not tested) to diagnose the signs of CRPS and was found to be acceptable by the majority of patients. The Budapest Criteria rely on patient-reported symptoms, which are not altered in the virtual context.…”