Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy.
Surgery. 2021 Aug;170(2):405-411. doi: 10.1016/j.surg.2021.01.049. Epub 2021 Mar 22.
Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field.
A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds.
Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease.
This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.
2019 年冠状病毒病正在彻底改变医疗保健服务模式。本研究旨在就远程医疗在肛肠领域的可能应用达成专家共识。
一个临床指导小组根据证据和专家意见的融合制定了 55 条临床实践建议。意大利肛肠病学远程医疗工作组包括 47 名意大利结直肠外科学会提名的专家，他们根据已发表的 RAND/UCLA 方法，在两轮评估中评估每项临床实践建议的适宜性。
利益攸关者的中位年龄为 53 岁（四分位距范围为 40-60），其中 38 人（81%）为男性。9 名（19%）小组成员在大流行之前没有远程医疗经验。在开始远程咨询之前，他们至少需要在肛肠领域有 3-5 年的实践经验，并定期付费，将咨询建议和处方纳入正式报告，通过电子邮件发送给患者，并附上收据。在小组成员中，47 人中有 35 人（74%）认为远程咨询有癌症误诊的风险，因此建议在安排任何手术之前进行亲自评估。在第二轮中，重新制定了 15 条额外的临床实践建议，并由 47 名小组成员中的 44 人进行了评估。远程医疗在常见肛肠疾病（如痔病、肛门脓肿和瘘管、肛门湿疣和肛裂）和功能性盆底障碍的诊断中的应用通常被认为是不合适的。远程咨询则被认为适合于诊断和管理藏毛窦疾病。
这项电子共识揭示了远程医疗在意大利的界限。基础设施、物流和合法性的标准化仍有待进一步阐明。
