Telemedicine “essential for maintaining spine care” during COVID-19

Assem Sultan

A study of the use of virtual visits for paediatric spinal deformity patients suggests that telemedicine can provide faster care for patients, with comparable satisfaction. The findings of the study, published in the Journal of Pediatric Orthopaedics, should provide more confidence to those seeking to employ telemedicine in an orthopaedic setting as physicians continue to provide services despite limitations on healthcare activities posed by COVID-19, the  authors suggest.

Assem Sultan and colleagues (Cleveland Clinic, Cleveland, Ohio, USA) sought to evaluate the feasibility and patient satisfaction associated with virtual visit utilisation in comparison to general paediatric orthopaedic indications. “Many patients, particularly those with limited geographical availability or those who are in need of flexible scheduling times, have greatly benefited from telemedicine platforms,” the authors write. Additionally, they state, “many patients who have telemedicine visits are still able to develop a rapport with their physician and feel satisfied with their physician’s clinical competence and interpersonal skills”. Although telemedicine has been shown to reduce wait times and maintain patient satisfaction in fields such as oncology and dermatology, the Sultan and colleagues acknowledge that literature pertaining to orthopaedic patients has been limited.

“In the age of the COVID-19 global pandemic and with the employment of social distancing and other public health measures, telemedicine and virtual clinic visits became essential for maintaining healthcare delivery to our orthopaedic patients in general, and particularly for those with spinal deformities”, Sultan commented. “Providing such care through telemedicine to paediatric spinal deformity patients may initially seem more challenging. However, our study demonstrated equally high patient satisfaction scores compared to the general paediatric orthopaedic patient population from the comfort and safety of their homes,” he added.

“Telemedicine visits add value to both patients as well as health systems, especially in paediatric medicine,” commented Ryan Goodwin, surgeon and senior author for the study. “Parents do not have to take an average of a half day away from work and spend money for transportation to take the child out of school to the doctor’s office. There is significant potential savings in overhead from health systems by leveraging telemedicine platforms to provide the same level and quality of care virtually in a wide array of clinical settings and specialties. While there will always be situations where in-person care is best, telemedicine platforms have already transformed our ability as health care providers to deliver highly reliable, timely care  and add value to all parties in a vast array of clinical scenarios,” he added.

Senior author for the study Ryan Goodwin

A total of 189 virtual visits were conducted by paediatric orthopaedic surgeons in the study’s analysis, with patient satisfaction scores collected at the end of each visit. Data on patient demographics, as well as characteristics of visits and connectivity sessions, were additionally collected. A specialised telemedicine technology platform was used to conduct virtual visits, which allowed patients to use their mobile phones to conduct visits with physicians. Physicians were able to evaluate patients for surgical and nonsurgical factors while utilising the software, which enabled them to share imaging data and laboratory values with patients through the platform.

The study team reported that the majority of telemedicine visits (80%) were conducted on mobile devices, while the rest were conducted on tablets or other video recording devices. Compared with patients who had a virtual visit for general paediatric orthopaedic follow-up, paediatric spinal deformity patients tended to be older (mean: 15±3.7 vs. 12±4.7 years; p<0.01), were mostly female (76% vs. 47% male; p=0.003), and had lengthier visits (mean: 8±4.6 vs. 5±3.6 minutes; p=0.003).

Paediatric spinal deformity patients demonstrated similarly high satisfaction scores with surgeon performance (PSD : 5±0 points vs. general: 4.8±0.1 points; p=0.08). Overall satisfactory scores with the telemedicine service were similarly comparable between the groups (3±2.4 vs. 3.5±2.1; p=0.23). Compared with their subsequent office visits, paediatric spinal deformity patients encountered significantly shorter wait times (13±10 vs. 41±30 minutes; p<0.001), the study’s results suggest.

In discussing the findings, the authors suggest that telemedicine virtual visits can provide convenient, high quality, and satisfactory care to paediatric spinal deformity patients. Some of the most notable advantages pertain to its economic benefits as well as its associated convenience for both patients and providers.. However, Sultan et al also note that a major concern related to telemedicine implementation relates to insurance coverage for these virtual visits. “Although all patients included in our analysis were able to receive coverage from their respective providers, there remains to be a nationwide adoption of parity laws mandating that telemedicine should be covered and reimbursed at the same level as in-person services. Without this legislation, patients with limited access to healthcare providers, especially subspecialty care, are  further impeded if their insurance company fails to cover these more convenient visits.”

The study concludes: “There is limited information reported regarding telemedicine use among paediatric spine patients. Our analysis found that telemedicine virtual visits provided a convenient alternative to traditional in-office visits for paediatric spinal deformity patients. Specifically, we found that paediatric spinal deformity patients received faster care with comparable satisfaction.”


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