Gofeld Michael, Smith Kevin J, Djuric Vladimir, Motlani Faisal, Baldor Daniel
Silver Pain Centre, 4646 Dufferin St., Unit 9, Toronto, ON, M3H 5S4, Canada.
Department of General Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Interv Pain Med. 2023 May 20;2(2):100252. doi: 10.1016/j.inpm.2023.100252. eCollection 2023 Jun.
The COVID-19 pandemic forced numerous pain clinics to suspend their services. For chronic pain patients, even a temporary closure and inability to connect with their healthcare providers may result in adverse outcomes. There are serious concerns regarding worsening of physical and emotional suffering and a surge in substance abuse. Therefore, telemedicine, also called telehealth, would seem to be a reasonable alternative to in-person clinic visits during the lockdowns. However, it remains unclear whether a telemedicine consultation is adequate for diagnostic purposes and subsequent intervention planning.
This study was conducted as an open-label cohort study on new patients referred to an interdisciplinary community pain clinic focused on image-guided interventions. The primary outcome was to determine whether a video consultation was sufficient to make an initial diagnosis and plan subsequent interventions. Secondary variables included technical feasibility, patient satisfaction, calculated nonincurred cost and time-saving. Video consultations were performed using a secure videoconference system consistent with routine clinic practice.
Sixty-five participants were recruited, and 49 (75.4%) completed the study. Patients for whom interventional approaches were not recommended elected not to continue with clinic visits. The intra-observer agreement rate between the telemedicine and in-person encounter was 93.9% (95% CI 87.2-100) for the diagnostic codes and treatment plan. The median satisfaction score from the telemedicine encounter was seven on a scale of 0-7, and it remained 6 when the remote care experience was later compared with the in-person visit. There were considerable savings in travel time and expenses.
The study experimentally validated the ability of telemedicine encounters to establish a diagnosis and formulate an interventional pain management plan of care. The validity of virtual consultation for complex pain care remains to be determined. It is unreasonable to expect telemedicine to completely replace clinic visits in the foreseeable future. However, judicious use of technology may facilitate timely scheduling, save time and resources, and improve satisfaction without jeopardizing the quality of care.
新冠疫情迫使众多疼痛诊所暂停服务。对于慢性疼痛患者而言，即便诊所只是暂时关闭且无法与医护人员取得联系，都可能导致不良后果。人们严重担忧患者身体和精神痛苦会加剧，以及药物滥用情况会激增。因此，在封锁期间，远程医疗（也称为远程健康）似乎是替代亲自到诊所就诊的合理选择。然而，远程医疗咨询对于诊断目的及后续干预计划是否足够，仍不明确。
本研究作为一项开放标签队列研究，针对转介至一家专注于影像引导干预的跨学科社区疼痛诊所的新患者展开。主要结果是确定视频咨询是否足以做出初步诊断并规划后续干预措施。次要变量包括技术可行性、患者满意度、计算得出的未产生成本和节省的时间。视频咨询通过一个与常规诊所实践一致的安全视频会议系统进行。
招募了65名参与者，49名（75.4%）完成了研究。不建议采用介入方法的患者选择不再继续就诊。远程医疗与亲自面诊之间，诊断代码和治疗计划的观察者内一致率为93.9%（95%置信区间87.2 - 100）。远程医疗问诊的满意度中位数在0 - 7分制中为7分，后来将远程护理体验与亲自就诊相比较时，该分数仍为6分。在出行时间和费用方面节省了很多。
该研究通过实验验证了远程医疗问诊用于确立诊断和制定介入性疼痛管理护理计划的能力。虚拟咨询对于复杂疼痛护理的有效性仍有待确定。在可预见的未来，期望远程医疗完全取代诊所就诊是不合理的。然而，明智地使用技术可能有助于及时安排就诊、节省时间和资源，并提高满意度，同时又不损害护理质量。
