Abstract
Abstract
Introduction:
Telemedicine and surgical telementoring strive to provide equal access to specialized healthcare, regardless of patient location. It also aims to provide providers in remote locations real-time, second opinions from more experienced physicians who are otherwise not readily available. The goal of this study is to gauge the public perception of this technology in the pediatric population.
Methods:
Patient families in our pediatric surgery and gastroenterology clinics were asked to complete a seven-question survey after being shown a 1-minute video describing telemedicine and surgical telementoring.
Results:
A total of 129 people were surveyed. Among respondents, 89% were amenable to telemedicine for routine physician visit, 70% said “yes” for a postoperative visit, and 67% agreed to telemedicine and telementoring as a way to be evaluated by a specialist. Regarding surgical telementoring, 49% would consider it for their child, 58% would consider it for themselves, and 10% said “yes” for themselves, but “no” for their child. In addition, 24% and 19% were unsure about surgical telementoring for their child and themselves, respectively. Those with history of surgery without complications were more likely to say “yes” than “no” to telemedicine for a postoperative visit and surgical telementoring. Although a higher proportion of those with an annual income of >$100K said “no” to surgical telementoring for their child and themselves, this was not statistically significant (P = .23 and .25, respectively). Desire to see a physician in person was cited by 63% as a reason against telemedicine, although 35% reported concern about a physician's competence as a reason against surgical telementoring.
Conclusion:
Overall, surgical telementoring was only supported by about half of the respondents. We predict that with increased education about surgical telementoring, this technology will have increased public support in the pediatric population.
Introduction
A
Surgical telementoring has been used successfully in various subspecialties. It allows a specialized surgeon to remotely guide a surgeon who is less experienced in a complex procedure by offering feedback and assistance in the decision-making process. 4 This allows patients to receive newer and more specialized procedures that they otherwise may not have had access to. Based on a recent survey, surgical telementoring is supported by rural pediatric surgeons, potentially increasing the scope of procedures they are willing to provide. 5
Patient satisfaction research on telemedicine has shown positive feedback in adults, 6 however, it is unknown whether this will also be true in surgical telementoring and in the pediatric population. The aim of this study is to gauge the perception of telementoring in the pediatric population and to see whether they are willing to undergo procedures utilizing surgical telementoring.
Methods
After approval by our institutional review board, a survey was given to the parents of the children presenting to the Akron Children's Hospital Pediatric Surgery and Gastrointestinal Clinic. After the family was seated in a clinic room, the parent was asked by the provider or the clinical staff whether they would be willing to participate in a survey. If the parent agreed, he or she signed a waiver and the research team was notified. The participants were all shown the same 1-minute video explaining and showing examples of telemedicine and surgical telementoring. 7 They were then given an information sheet describing telemedicine and surgical telementoring, and given an 11-question survey. The results were recorded anonymously and analyzed using descriptive statistics, odds ratio, and Fisher's exact test.
Results
Demographics
There were 129 respondents, of which 31 (24.2%) were 0–15 minutes from a pediatric hospital, 39 (30.5%) were 16–30 minutes from a pediatric hospital, 38 (29.7%) were 30 minutes to 1 hour from a pediatric hospital, 18 (14.1%) were >1 hour from a pediatric hospital, and 2 (1.6%) were >2 hours from the hospital.
The annual income distribution was as follows: 27 (21.3%) made <20K, 18 (14.2%) made 20–30K, 31 (24.4%) made 30–50K, and 21 (16.5%) made >100K (Table 1). Fifty-seven respondents (48.7%) had private insurance, 59 (50.4%) had public insurance, and 7 (5.6%) had both private and public insurance. Only 1 respondent was self-pay.
Surgical history
One hundred six respondents personally had surgery or their child had surgery (83%). The participants were then asked whether they or their children have ever had a complication, although what they considered to be a complication was not clarified. Of those, 20 (19.1%) reported having a surgical complication, 79 (75%) had no complications, and 6 (5.7%) were unsure.
Routine and postoperative visits
When asked whether they would consider telemedicine with their primary care physician for a routine follow-up visit, 115 (89.2%) said “yes,” 9 (7%) said “no,” and 5 (3.9%) were unsure. For a routine postoperative visit (i.e., wound check), 90 said “yes” (70%), 28 (21.7%) said “no,” and 11 (8.5%) were unsure (Table 2).
The respondents who had previous history of surgery without complications were 4.7 times more likely to say “yes” to “no” for a postoperative visit using telemedicine (odds ratio [OR] with confidence interval [95% CI]: 4.7 [1.5–14.6]).
There were no associations with responses and distance to the pediatric hospital, income, or insurance status.
Specialist evaluation
In response to considering telemedicine for a subspecialty evaluation, 87 (68%) said “yes,” 21 (16.4%) said “no,” and 20 (15.6%) were unsure (Table 1). This also was not associated with distance to pediatric hospital, income, and insurance status.
Surgical telementoring
The participants were asked whether they would consider surgical telementoring for their child or themselves.
Child
Sixty-two (48.8%) respondents would consider it for their child, whereas 34 (26.8%) would not consider it, and 31 (24.4%) were unsure (Table 2).
Self
Seventy-four respondents (58.3%) would consider surgical telementoring for themselves, whereas 28 (22.1%) would not, and 25 (19.7%) respondents were unsure (Table 1). Eight respondents (10%) would consider surgical telementoring for themselves but not for their child. Of the 105 respondents who have had surgery in the past, 66 (63%) would consider telementoring for themselves. In addition, those who had surgery in the past were 4.2 times more likely to respond “yes” than “no” to surgical telementoring (OR with 95% CI: 4.2 [1.4–12.2]).
There were no statistically significant associations between these responses and distance to the hospital, income, or insurance status. However, a higher proportion of those with an annual income of >100K said “no” to surgical telementoring for their child and themselves (P = .23 and .25, respectively) (Table 1).
Reasons against telemedicine and surgical telementoring
The majority of respondents (63%; n = 40) cited desire to see a physician in person as a reason against telemedicine. Of those who said no to surgical telementoring, 21 respondents (33%) reported concern about physician competence. Other concerns were cost, privacy, and lack of infrastructure to support this technology in their local hospitals.
Discussion
Although telemedicine and surgical telementoring are increasingly being used to provide equal access to specialized healthcare, it will not be a reality without the interest and support of the patient population. This survey aims to gauge the public perception of this new emerging technology.
Most respondents would utilize telemedicine for routine follow-up visits and postoperative visits. Distance to a tertiary center and income/insurance status were initially theorized as predictors of patient acceptance of telementoring, as the technology is anticipated to save time and money. However, we did not find any associations between these factors. We now believe that previous healthcare encounters are likely the most influential factor. Because the majority of the population has had previous follow-up physician visits, it is not surprising that 89% would consider telemedicine for these types of visits, because they know what the visit entails and what to expect. This point is further made by our finding that those who have had a previous surgery without complications were 4.7 times more likely to consider telemedicine for postoperative visits. This signifies that the lack of knowledge of what surgery entails by the public is likely the reason why only half of the respondents would consider surgical telementoring.
The majority of the public has not experienced the operating room and does not understand the normalcy and frequency of obtaining second opinions from colleagues. So the decision of a surgeon to utilize surgical telementoring may not be seen as the norm by the public and, therefore, raise questions about the surgeon's competency, which is what we found in our survey.
We did have a significant number of “unsure” responses, and this is also likely from lack of patient understanding. A limitation of this study is that, although patients were educated about telemedicine and telementoring in both written and video form before administration of the survey, participant understanding of telemedicine and telementoring was not assessed. It is unknown how informed their decisions were, which could have contributed to the large number of “unsure” and even “no” responses. Owing to the high potential for miscommunication and misunderstanding, centers that plan to use telemedicine and surgical telementoring will likely need to have robust educational materials to ensure complete patient understanding of the process.
Overall, surgical telementoring was only supported by about half of the respondents, with >20% of them unsure. We predict that with increased education about surgical telementoring, this technology will have increased public support.
Footnotes
Disclosure Statement
T.A.P. is on the Conmed Advisory Board.