Patients Approve of Telemedicine Consultations for Postoperative Care

Most patients are willing to consider replacing an in-person postoperative appointment with a telephone consultation according to patient satisfaction survey results published in the Canadian Journal of Ophthalmology. The study was conducted during the coronavirus disease 2019 (COVID-19) pandemic, but may have implications for the future. 

The survey included 53 patients who were treated for  retinal detachment at the Moorfields Eye Hospital in London spanning a 6-week period starting on March 23, 2020, which was the beginning of the United Kingdom’s COVID-19 lockdown.

After each patient underwent an emergency vitrectomy for retinal detachment repair, they received a telephone consultation. On the 2-week follow-up call, patients were asked detailed questions about pain, redness, visual improvement, approximate size of gas bubble, new shadows, worsening vision and confirmed their drop regime.

Based on the telephone conversations, “patients who were thought to have any symptoms of raised intraocular pressure (IOP) or redetachment were asked to attend the vitreoretinal emergency (VRE) department for a face-to-face assessment. Patients with a long acting gas bubble were booked in for a further phone call at 6-weeks following the date of the surgery. Asymptomatic patients were discharged with retinal detachment warning.”

Of the patients who required further postoperative treatment following the telephone consultation, “3 patients were asked to return to VRE for a further assessment to rule out a redetachment, of which, 2 patients had a redetachment and underwent a further emergency procedure,” according to investigators. “Following the phone consultation, a further 3 patients presented to the vitreoretinal emergency unit with a redetachment over the following 6 months since their surgery. There were no reports of other postsurgical complications such as endophthalmitis, vitreous haemorrhage, optic capture or optic neuropathy.” 

The survey, which included 10 questions and a text box to allow for patients to share anything not covered in the questions, indicated that 64% of patients would consider replacing an in-person follow-up appointment with a telephone consultation, even after COVID-19 restrictions are lifted. 

Patients reported a mean overall satisfaction rate of 4.3 out of 5 and rated the technology a 4.9 out of 5 for clarity. Most (96%) of patients felt that the clinician was able to answer any management questions over the telephone and 91% said they received appropriate advice regarding postoperative drop regime (9% felt that this subject was not broached at the time of the phone consultation).

The current pandemic has increased the use of telemedicine in practices. The investigators note that “the growing capacity issues within ophthalmic practice means that telemedicine platforms will become a key tool in delivering these care to a wider population in the future.” Though, a compromised approach with both in-person and telephone consultations could be best for patients to ensure metrics such as asymptomatic raised IOP are not missed. 

Reference

SM Shahid , R Anguita , L daCruz. Telemedicine as a platform for postoperative consultations following vitrectomy for retinal detachment repair during the Covid-19 crisis: A patient satisfaction survey. Can J Ophthalmol. Published online December 7, 2020. doi:10.1016/j.jcjo.2020.11.011