American College of Gastroenterology Annual Meeting
American College of Gastroenterology Annual Meeting
October 28, 2019
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Telehealth visit acceptable alternative prior to advanced endoscopic procedure

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SAN ANTONIO — Data from a small pilot study conducted in an academic VA medical system demonstrated that patients deemed a pre-procedure telehealth visit adequate to learn about the procedure and risk profile.

“Over the past decade the use of telehealth has risen substantially. Multiple academic and tertiary referral centers, as well as large integrated health systems, have already adopted this technology,”

Suraj Suresh, MD, of the University of Michigan Health System, said here. “As we had already been offering this telehealth service to many patients who were referred to us for advanced endoscopic procedures, we became interested in knowing how patients viewed the pre-procedure telehealth visits.

Suresh presented 40-patient survey data at the American College of Gastroenterology Annual Meeting. This presentation received the Fellows-in-Training Award in the Interventional Endoscopy Category.

The health system reviewed in the study had two pathways for advanced endoscopic procedures, which often are time sensitive – patient-gastroenterologist face-to-face or through a referral (“direct access”) by another physician who has identified the need for an advanced endoscopic procedure.

“Each of these referral pathways has its own benefits and drawbacks,” Suresh said.

Face-to-face visits with the endoscopists allows for detailed discussion of procedural risk and outcomes and “allow physicians to develop a rapport with their patients ahead of the procedure itself thereby improving the patients’ comfort level.” But travel time and wait time to travel to an appointment are often detriments to these often time-sensitive procedures.

“Direct access on the other hand, reduces financial and time costs associated with an additional clinic visit and may allow for less procedure delay,” he said. “The downside, however, is this could potentially come at the cost of patient understanding of procedural-related risk.”

Suresh said that the VA system offers clinic-based video teleconference visits between the patient and their health care provider.

Of the patients surveyed, 20 patients had direct access, nine had telehealth visits and 11 had face-to-face visits.

“There was an overall trend for patients who had face-to-face and telehealth visits to report better procedural comprehension,” Suresh said. “When it came to overall visit satisfaction, confidence in the proceduralist and understanding of risk and benefits and adequacy of the visit, there was no statistical difference between [face-to-face and telehealth patients].

“Looking at this preliminary data, we found that most respondents who were referred either face-to-face or telehealth were satisfied with their visit modality and would choose the same visit type in the future,” Suresh said.

Carol A. Burke , MD, vice chair of the Department of Gastroenterology, Hepatology & Nutrition at Cleveland Clinic, asked how generalizable the data were to the general population given that the survey was done with VA patients “because when I provide telehealth visits and my next available is next year, and my secretary says ‘if you would like to get in sooner we can do a virtual visit or telehealth’ but when the patient has to swipe their charge card for the visit they say ‘oh, I’ll drive in from West Virginia.’”

Suresh responded that, “the VA population is not necessarily indicative of the usual patient population but for the purpose of this study, it is an entry way into understanding how well telehealth can work.” He then noted that they will look at the general population as a next step. by Joan-Marie Stiglich, ELS

Reference: Suresh S. Abstract 4. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 25-30, 2019; San Antonio.

Disclosures: Suresh reports no relevant financial disclosures.