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Saroj Mishra , MS, FACS Prof & Head, Dept. of Endocrine Surgery &

Post-operative care through tele follow-up visits in patients undergoing thyroidectomy & para thyroidectomy in a resource-constrained enviornment. Saroj Mishra , MS, FACS Prof & Head, Dept. of Endocrine Surgery & Faculty I/C, SGPGI Telemedicine Program

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Saroj Mishra , MS, FACS Prof & Head, Dept. of Endocrine Surgery &

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  1. Post-operative care through tele follow-up visits in patients undergoing thyroidectomy & para thyroidectomy in a resource-constrained enviornment SarojMishra, MS, FACS Prof & Head, Dept. of Endocrine Surgery & Faculty I/C, SGPGI Telemedicine Program Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Lucknow, India skmishra@sgpgi.ac.in www.sgpgi-telemedicine.org APAN-TW 4th March 09

  2. Background • India, a vast country with few specialized Endocrine surgery centers • Referrals from far- off places • Pt may bear one time cost of surgery • Frequent visits to hospital • Inconvenience • Substantial financial loss • Work- hours loss Patients and escorts

  3. Background • Usually post op visits involve • Confirming histopathology reports • Reviewing reports & modifying dose of medication Physical examination of patient may not be required • Telephonic conversation • Misinterpretation of values & dosages at both end • E mail • Viable option for few informed pts only

  4. Background • Tele-visits is a viable alternative for follow-up in post-surgical continuity of care, Chronic disease setting • Compared to first time encounter e.g. tele-consultation, tele-follow up more acceptable to the concerned parties

  5. Aims & Objectives • Assess feasibility of tele- follow up in post thyroidectomy & parathyroidectomy patients • To study cost-benefit, user acceptance • To evolve best practice model & integrate into existing healthcare delivery system

  6. Materials & Methods • Telemedicine project at SGPGI: 1999 • Telemedicine infrastructure at SCB Medical College, Cuttack: 2001 Rail distance- 1500 km • Research grant from the • Department of Information Technology, Ministry of Communication & IT, Govt of India Connectivity through 128 kbps ISDN • Indian space research organization (ISRO),   satellite based connectivity with 384 kbps

  7. 1500 KM

  8. Materials & Methods • Study Period: April 2004 –December 2007 • Follow- up data of patients belonging to state of Orissa undergoing thyroidectomy and parathyroidectomy at our center & thereafter reporting at telemedicine center at Cuttack for tele-follow up were analysed • Demography • Nature of Surgery • Indications for tele-follow up • A questionnaire was given to patients to assess • Patient’s satisfaction • Financial savings • Workdays saved

  9. Snap Shot

  10. Sample report received

  11. Sample Prescription

  12. Department of Endocrine Surgery Telemedicine Center Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow TELE-FOLLOW UP Name : Ayesha Mohanti Cr No : 2004113413 Diagnosis: Post-Op Case of Minimally Invasive Follicular Carcinoma Date: 11.04.05 Tele-Follow No.: 4th Clinical Status: No symptoms Investigation Report received: Serum Tg. <0.5 ng/ml Advice: Continue Tab. Eltroxin 100 ugm. Daily as advised Serum TSH estimation Next Follow-up: After six months with serum Thyroglobulin and Serum TSH Doctor’s Name: Dr. S.K. Mishra

  13. Results • 34 postoperative patients on tele –follow up • M:F-9:25 • The operations performed were • Total thyroidectomy -29 • Hemithyroidectomy -05 • Thyroid biopsy -01 • Parathyroidectomy -03

  14. Indication of Tele-follow up • Confirmation of histology report : 18 • Further visits required : 05 • Dosage adjustment • Thyroxin dose adjustment : 24 • Calcium dosage adjustment : 05 • Confirmation of Diagnosis : 03 • Prior to Surgery

  15. Details of Follow-up Visits • Total no. of visits : 66 • Average visit per pt : 2 • Range : 1-6

  16. Response Grading • Satisfied • Excellent - 69% • Very good - 31% • Good - nil • Average - nil • Unsatisfied -None • Good audiovisual transmission

  17. Financial Implications S.N. Conventional Follow-up Cost (INR) Tele-Follow-up Cost (INR) Diff. (INR) 1 Hospital Registration (Annual) 250 - 250 Consultation 2 - - - 3. Investigation 1250 1250 - 4. Travel 3000** 500 2500 5. Food & lodging 2000*** 100 1900 Total 6500 1850 4650 (Annual) *1 US$=~45 INR ** - Ordinary second class railway ticket & bus transport for patient & 1 escort *** - Budget non-star hotel

  18. Workdays Saved Per visit (range) : 4-12 Total Leave saved /visit : 114 Average : 7.2 Cumulative (66 visit) : 403.2

  19. Others Good follow up ensured Women reluctant to come for frequent follow-up Less disturbance in domestic routine Language barrier can be overcome Felt secure, & confident in familiar surroundings

  20. Conclusion Tele follow up is a feasible method for follow up in a subset of patients Early results showed great patient satisfaction & up to 90% financial & leaves savings Cost incurred by institute & legal implications need to be looked into

  21. Collaborators • Anjai Mishra : Assistant Professor, Dept of Endocrine Surgery, SGPGI, Lucknow • Lily Kapoor :Telemedicine Centre,SGPGI, Lucknow

  22. Thank You www.telemedindia.org www.sgpgi-telemedicine.org

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