1. Post-operative Care & Long-term Follow-up
Using Telemedicine
Analysis of Social & Financial Impact
Anjali Mishra
Additional Professor
Dept of Endocrine Surgery, SGPGIMS,
Lucknow- 226014, India
Transforming Health Care With IT

2. Telemedicine & Surgical Patients
• Teleconsultation
• Pre-referral screening
• Telementoring/ Telesurgery
• Post-operative care (tele- follow up)
Transforming Health Care With IT

3. Post-operative Care & Long-term
Follow-up
Transforming Health Care With IT

4. Reasons for Post-operative Visits
• Wound & general care
– Suture Removal
– Pain, Infection, Bleeding
– Nutrition
– Medication’s dosages adjustment
• Histology (biopsy) reports
• Further planning
• Long- term follow up
Transforming Health Care With IT

5. Issues
• Inconvenience/ Anxiety
• Financial loss
• Work hour loss
• Leave issues
• Domestic/ social issues
Transforming Health Care With IT

6. Tele Follow-up
• Well established for some medical conditions
– Chronic diseases
• Cardiology
• Neurology
– Web based treatment planning for radiotherapy
• Surgery emerging
Transforming Health Care With IT

7. SGPGIMS Experience
Transforming Health Care With IT

8. Transforming Health Care With IT
Aims & Objectives
• Pilot study was undertaken to assess the
feasibility of tele-follow up in post-operative
cases of thyroid and parathyroid disorders, to
establish the indications of the same, and to
know the outcome in terms of patient
satisfaction, financial and work hour savings
incurred by them

9. Materials & Methods
• April 2004 –December 2007
• Follow- up data of patients, operated at our center &
thereafter consenting to report at telemedicine center
Cuttack for tele-consultations analyzed
– Nature of Surgery
– Reason of consultation
• A questionnaire was given to pts.to assessed
– Patient’s satisfaction
– Financial savings
– Leave saved
Transforming Health Care With IT

10. Transforming Health Care With IT

11. Procedure
• First tele-follow up appointment fixed at the time of
discharge after explaining the procedure to the
patient
• On the day of appointment, telemedicine staff
contacted the Senior Resident in Endocrine
Surgery.
• Patients records and required reports eg: Histology
retrieved from HIS & placed in a file
Transforming Health Care With IT

12. Transforming Health Care With IT
Photograph

13. Transforming Health Care With IT

14. Transforming Health Care With IT

15. Telemedicine Center
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
TELE-FOLLOW UP
Name : Ayesha Mohanti
Cr No : 2004113413
Diagnosis: Post-Op Case of Minimally Invasive Follicular Carcinoma
Date: 11.04.05 Tele-Follow No.: 4th
Clinical Status: No symptoms
Investigation Report received:
Serum Tg. <0.5 ng/ml
Advice:
Continue Tab. Eltroxin 100 ugm. Daily as advised
Serum TSH estimation
Next Follow-up:
After six months with serum Thyroglobulin and Serum TSH
Doctor’s Name: Dr. S.K. Mishra
Transforming Health Care With IT

16. Reasons For Teleconsultations
• Review of histology report : 18 (53.0)
– Further visits not required : 13 (72.2)
• Dosage adjustment : 27 (79.4)
– Thyroxin dose adjustment : 24
– Calcium dosage adjustment : 08
• Thyroid cancer follow-up : 05 (14.7)
Transforming Health Care With IT

17. Financial Implications
Transforming Health Care With IT

18. Outcome
• Satisfaction
– Excellent : 69%
– Very good : 31%
• Leave saved
– Per visit : 7.2 (4-12) days
– Per patient : 14.5 days
• Would prefer tele-follow-up
Transforming Health Care With IT

19. Transforming Health Care With IT

20. Transforming Health Care With IT

21. Care Continuum So Far
• No of Patients (April 2004- June 2013): 88
• Age: 44.3 + 13.8 years; M: F=1:1.8
• Diagnosis
– Thyroid carcinoma : 49.3%
– Benign thyroid diseases : 40.2%
– Primary hyperparathyroidism : 08.0%
– Adrenal Disorders : 02.3%
• Duration of follow up (months) : 1 - 90
> 24 months : 21.3%
• Median no. of visits/ patient : 2 ( 1-13)
> 5 visits : 22.7%
Transforming Health Care With IT

22. Care Continuum- Changing Needs
• Indications of first follow- up visit
– Review of final histology
– Medicine dosages adjustment
• Indication of subsequent follow- up visits
– Medicine dosages adjustment
– Tumour surveillance
Transforming Health Care With IT

23. Summary
• Indications: Clean, low risk surgeries
– Laparaoscopic cholecystectomy, Hernia surgery
– Skin & superficial surgeries
– Thyroidectomy & parathyroidectomy
• Benefits
– Permit better resource utilization
– Early and safe discharge
– Can support Rural, remote, mobile surgery
– Good follow up ensured
Transforming Health Care With IT

24. Conclusions
• We believe that tele-follow up facility could play an
important role in improving health care delivery
system in our country
Transforming Health Care With IT

25. Transforming Health Care With IT
Thank You