McMaster Thomas, Wright Timothy, Mori Krinal, Stelmach Wanda, To Henry
Medical School, The University of Melbourne, Parkville, VIC, Australia.
Department of Surgery, St. Vincent's Hospital, Fitzroy, VIC, Australia.
Ann Med Surg (Lond). 2021 Jun;66:102378. doi: 10.1016/j.amsu.2021.102378. Epub 2021 May 8.
Telemedicine has emerged as a powerful tool in the delivery of healthcare to surgical patients and enhances clinician-patient encounters during all phases of patient care. Our study aims were: to review the current use and applicability of telemedicine; evaluate its suitability, safety and effectiveness in a surgical outpatient setting, particularly in the era of social distancing restrictions and provide insight into future applications.
Databases searched included: PubMed, OVID Medline, Embase, Scopus, Web of Science and review of reference lists. Key words used were "telemedicine"; "telehealth"; "videoconference"; "outpatient" and "surgical clinic". For inclusion, articles required to be in English, published between 2000 and 2021, were in an outpatient surgical setting and if they had a focus during the COVID-19 pandemic.
335 articles were identified and screened, so that 63 articles were included in the review. Almost all articles were from Western countries (n = 60), mostly in surgical journals (n = 35) and from a range of sub-specialities, but pre-dominantly orthopaedics (n = 12) and general surgery (n = 7). The majority were original comparative studies where 31 studies directly compared telemedicine to in-person appointments and 14 papers focused on implementation during COVID-19.
DISCUSSION/CONCLUSIONS: Telemedicine has been safely used across various phases of surgical outpatient care, with its effectiveness evaluated by clinical outcomes, economics and user/provider satisfaction. Telemedicine has multiple accepted benefits including time efficiency, patient/healthcare cost savings and community access, but with reported limitations of clinical uncertainty, technology infrastructure requirements, cybersecurity vulnerabilities and healthcare regulatory restraints. These limitations are being overcome by accelerated implementation during COVID-19 via fast-tracked practice development. Further work is required via development of research protocols to refine the application of emerging telemedicine technologies and their applicability to different surgical sub-specialties.
远程医疗已成为为外科患者提供医疗服务的强大工具，并在患者护理的各个阶段增强了临床医生与患者的互动。我们的研究目的是：回顾远程医疗的当前使用情况和适用性；评估其在外科门诊环境中的适用性、安全性和有效性，特别是在社交距离限制的时代，并深入了解其未来应用。
检索的数据库包括：PubMed、OVID Medline、Embase、Scopus、Web of Science，并查阅参考文献列表。使用的关键词为“远程医疗”；“远程健康”；“视频会议”；“门诊”和“外科诊所”。纳入的文章要求为英文，发表于2000年至2021年之间，处于外科门诊环境，且聚焦于新冠疫情期间。
共识别并筛选出335篇文章，最终63篇文章纳入综述。几乎所有文章都来自西方国家（n = 60），大多发表于外科期刊（n = 35），涵盖一系列亚专业，但主要是骨科（n = 12）和普通外科（n = 7）。大多数是原创比较研究，其中31项研究直接将远程医疗与面对面预约进行比较，14篇论文聚焦于新冠疫情期间的实施情况。
讨论/结论：远程医疗已在外科门诊护理的各个阶段安全使用，其有效性通过临床结果、经济学以及用户/提供者满意度进行评估。远程医疗有多个公认的益处，包括时间效率、节省患者/医疗成本以及社区可及性，但也有报道称存在临床不确定性、技术基础设施要求、网络安全漏洞和医疗监管限制等局限性。在新冠疫情期间，通过快速推进实践发展加速实施，这些局限性正在被克服。需要通过制定研究方案开展进一步工作，以完善新兴远程医疗技术的应用及其对不同外科亚专业的适用性。
