Technology and Care

“Virtual fracture clinics” that started in Glasgow, Scotland under the UK’s National Health Service allow patients with common fractures that tend to heal well to manage their own care (1). The incorporation of websites, communication portals, academic images and videos, video calls, decision aids, and other aspects of technology allow people to recover much more independently and take charge of their own health, all while saving time, money, and effort. Recent research has shown that people in the United States are open to this type of self-care rather than scheduling multiple visits with a specialist. In addition, good outcomes are independent of the number of in-person visits (2).

Technology is increasingly used with patients and between clinicians to coordinate care. It was found that surgeons viewing images of wrist fractures on a  messaging phone app could effectively facilitate remote decision-making (4). A quantitative study also found that a “suitable space” at home can increase interest in remote video consultations, which have benefits of increased convenience, lower costs, and less waiting times. However, people have concerns about remote video visits, including a lack of physical examination, technical issues, privacy issues, less personal interaction, and the patient’s familiarity with technology.

The tendency of many patients to try to learn about their condition online before seeing a specialist doesn’t seem to relate to how unsettled they are about their problem (3). However, a recent, randomized trial found that patients had significantly less decision regret concerning minor hand problems after a visit when utilizing computer-based, interactive decision aids rather than standard care. There were no differences in pain self-efficacy, pain intensity, satisfaction with the visit, physical function, or treatment choice.

Our research on technology-based care is focusing on several areas:

1. Utilizing the options of an initial phone contact or remote video contact prior to an in-person visit
2. Using interactive, computer-based informed consent rather than pen and paper
3. Qualitative studies on patient perceptions of different technological means of communication with clinicians
4. Developing video preparation for minor hand surgery and studying its effects
5. Conducting a randomized trial over the use of a question prompt list during a specialist visit
6. Studying patient ratings of decision aids and the barriers of decision aids

References

1. Jayaram PR, Bhattacharyya R, Jenkins PJ, Anthony I, Rymaszewski LA. A new "virtual" patient pathway for the management of radial head and neck fractures. J Shoulder Elbow Surg. 2014 Mar;23(3):297-301. doi: 10.1016/j.jse.2013.11.006. PubMed PMID: 24524978.
2. Finger A, Teunis T, Hageman MG, Thornton ER, Neuhaus V, Ring D. Do patients prefer optional follow-up for simple upper extremity fractures: A pilot study. Injury. 2016 June 27 pii: S0020-1383(16)30270-4. doi: 10.1016/j.injury.2016.06.029. [Epub ahead of print] PubMed PMID: 27418457.
3. Özkan S, Mellema JJ, Ring D, Chen NC. Interobserver Variability of Radiographic Assessment Using a Mobile Messaging Application as a Teleconsultation Tool. Arch Bone Jt Surg. 2017 Sep;5(5):308-314. PubMed PMID: 29226202; PubMed Central PMCID: PMC5712397.
4. Özkan S, Mellema JJ, Nazzal A, Lee SG, Ring D. Online Health Information Seeking in Hand and Upper Extremity Surgery. J Hand Surg Am. 2016 Oct 14. pii: S0363- 5023(16)30611-6. doi: 10.1016/j.jhsa.2016.09.006. [Epub ahead of print] PubMed PMID: 27751778.