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Is phone follow-up safe after some surgeries?

‘Telehealth’ offers a safe and time-saving alternative to in-person appointments after some types of surgery, reports a study of phone follow-up after gallbladder or hernia operations.

BMJ Group News

What do we know already?

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‘Telehealth’ is a newer approach to providing health care. It involves using the phone, e-mail, Skype, and other electronic tools to allow patients and health care providers to interact. This reduces the need for face-to-face appointments and means that people can be in contact with their doctor and other health care providers more often.

There are many different ways telehealth can be used, from monitoring a patient’s blood pressure at home to following up on their response to treatment. However, the safety and effectiveness of these approaches is still a matter of some debate.

In the new study, researchers explored whether telehealth might provide a safe alternative to regular follow-up appointments after keyhole surgery to remove the gallbladder and open surgery to repair a hernia. (Keyhole surgery is done using tiny tools and a camera placed through small cuts, while open surgery is done through one larger cut.)

The researchers thought these operations might be well suited to telehealth follow-up because people usually recover at home, and problems from these operations are uncommon and fall into a few main categories, making them easier to spot.

To test this, researchers offered telehealth follow-up to 115 people who’d had a hernia repair and 26 people who’d had gallbladder surgery. All the people had already scheduled in-person follow-up appointments for three weeks after their surgery. However, two weeks after surgery, they got a follow-up call from a physician assistant. Following a script, the physician assistant asked the patients about their overall health, any concerns they had, and whether they had specific symptoms that might indicate a problem, such as pain, fever, and swelling. If there were no problems, the patient could then decide whether they wanted to keep their three-week follow-up appointment, or cancel it.

The researchers looked at how people responded to the telehealth follow-up and how frequent problems were.

What does the new study say?

The physician assistants tried to contact all of the people in the study and were able to have follow-up calls with 110 of them. Of these, 63 out of 89 hernia patients (71 percent) and 19 out of 21 gallbladder patients (90 percent) decided to cancel their appointments after the call.

Of all of the patients cancelling their appointments, only three had a problem after surgery, and only one needed to be treated in hospital. In none of these cases, did telehealth delay the diagnosis or treatment of the problem.

Nearly all of the patients said they were satisfied with the telehealth follow-up, noting that it saved them time they’d otherwise have spent travelling to their appointment and waiting in the clinic.

How reliable is the research?

These findings should be reliable. However, bear in mind that they relate only to these two types of surgery. Other research will need to explore the possible role of telehealth follow-up after other types of operations.

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