Original Title: État des connaissances - Soins virtuels en chirurgie générale

Authors' objectives: The aging of the population and the increased prevalence of chronic diseases will undoubtedly, lead to a significant increase in the demand for continuous home and institutional care, this in the current context of limited professional resources in Québec. Furthermore, the COVID-19 pandemic has led to the accelerated deployment of virtual care tools to ensure access to care and services and to promote the continuity of care. In addition to the information and communication technologies now frequently used, the integration of virtual care modalities into care pathways is of growing interest for the evaluation, treatment and follow-up of patients in specialty medicine. These modalities have the potential to improve access to health care for most patients, but also to foster their engagement in the management of their illness. In the context of a national project on virtual care, the Ministère de la Santé et des Services sociaux (MSSS) has requested the Institut national d'excellence en santé et en services sociaux (INESSS) to provide a state-of-knowledge report to guide the use of virtual care in specialty medicine. This work will help maintain or optimize care pathways and support clinical practices and the provision of care and services to patients. The objective of this work is to inform public decision-makers, medical associations, and health and social services professionals about virtual care practices in specialty medicine. The project involves the following seven reports: 1) Pediatrics, 2) Psychiatry, 3) Neurology, 4) Hematology/Oncology, 5) Respirology, 6) General Surgery (this report) and 7) Internal Medicine.

Authors' results and conclusions: RESULTS: (#1 FINDINGS CONCERNING VIRTUAL CARE IN GENERAL SURGERY): Telemonitoring is the most studied intervention in most of the care pathways studied. • The results concerning virtual care interventions identified in the care pathways often involve several modalities (e.g., telemonitoring, teleconsultation, teleeducation, teleintervention and teleassistance). (#2 CARE PATHWAYS IN GENERAL SURGERY): Supportive care for managing postoperative lifestyle changes for patients who have undergone bariatric surgery. • Pre- and postoperative care for patients who are about to undergo or have undergone any type of surgery. (#3.1 VIRTUAL CARE MODALITIES FOR WHICH A POSITIVE IMPACT HAS BEEN REPORTED): Telemonitoring for patients who have undergone surgery assisted by the Internet of Things (interconnected devices and applications), to improve the early detection of unforeseen postoperative complications and the patient’s rehabilitation and to reduce postoperative pain and nausea. (#3.2 ASPECTS OF CLINICAL EFFICACY TO BE CLARIFIED BY FURTHER STUDIES): Pre- and postoperative healthcare delivery via teleconsultation or tele-education for patients who have undergone bariatric surgery; • The perioperative monitoring of physiological parameters via telemonitoring or teleassistance for patients who have undergone surgery using surgical practices integrated with the Internet of Things. (#3.3 VIRTUAL CARE PATHWAYS REPORTED AS HAVING POTENTIAL ORGANIZATIONAL EFFICACY, SUCH AS): Teleassistance, teleconsultation and postoperative telemonitoring to reduce care service utilization and improve health professionals’ skills in surgical practices; • Teleconsultation to reduce the number of healthcare visits for hospitalized patients or those being followed on an outpatient basis after surgery. (#3.4 VIRTUAL CARE MODALITIES REPORTED AS HAVING A POSITIVE IMPACT ON EQUITY OF ACCESS TO CARE, SUCH AS: ): Telemedicine to improve access to care for patients who have undergone any type of surgery. • eHealth to improve access to care and care teams at any time for patients who have undergone bariatric surgery. (#3.5 FEW RESULTS CONCERNING PATIENT’S SAFETY:): With the use of telemedicine, patients feel more secure about the problems pertaining to their recovery and about the follow-up visits in the context of the COVID-19 pandemic. • No adverse effects have been reported with the use of telemonitoring or teleconsultation for perioperative monitoring and support for patients who have undergone any type of surgery. (#3.6 A PROMISING LEVEL OF SATISFACTION HAS BEEN REPORTED BY PATIENTS AND HEALTHCARE PROVIDERS, ACCORDING TO THE STUDIES CONSULTED, ALBEIT WITH CERTAIN CONCERNS): Patients and healthcare providers generally express satisfaction with virtual care, particularly because of the flexibility, ease of use, accessibility or easier care management. • Some patients express certain concerns about using virtual care (e.g., challenges establishing a trust relationship with the healthcare professional). • Some healthcare professionals express certain concerns about using virtual care (e.g., challenges in responding quickly to patient expectations and increased workloads). LIMITATIONS: This report is limited by the following methodological constraints: the type of documents selected, the literature review period of 5 years, the independent study selection for only 10% of the studies, the absence of a formal evidence assessment, and the descriptive data synthesis with no meta-analysis. Most of the selected systematic reviews aggregate or consider, without distinction, data from primary studies conducted in various care settings with a variety of comparators, clinical situations, and technologies. For meta-analyses, the heterogeneity of the studies and interventions, the small number of studies compared and/or the small number of participants, and the poor quality of the studies are often listed in the limitations. In addition, cultural sensitivity or cultural adaptation and collaborative care, which are topics that should not be overlooked for equity in virtual care, were very rarely addressed. Also, selection, confounding and measurement biases in the studies generally need to be taken into consideration. CONCLUSION: For the use of virtual care in general surgery, the two most studied care pathways are 1) postoperative monitoring for patients who have undergone surgery, and 2) supportive care and the management of postoperative lifestyle and health behaviour changes for patients who have undergone bariatric surgery. Telemonitoring is the most used care modality in the care pathways studied. Overall, the modalities are used alone or in combination with other modalities, and virtual care can be used in place of or in addition to usual care.

Authors' methods: A scoping review of the scientific and grey literature was conducted for the past five years to portray the care pathways that might be supported or optimized with the use of virtual care. The existing national and international guidelines, guidance and discussion documents, and health technology assessment (HTA) reports published on the topic were also consulted to identify additional care pathways or to confirm those identified in the systematic reviews. Documents were selected according to predefined inclusion and exclusion criteria. These steps were carried out by one reviewer, and 10% of the titles and abstracts evaluated were independently re-evaluated by a second reviewer. The data extraction from the selected documents was carried out by a reviewer. The extracted data were analyzed and presented in the form of a narrative synthesis and outcome tables for each of the care pathway examined. Given the rapid nature of this work and the type of review conducted, the methodological quality of the selected documents was not assessed. In addition, the findings on care pathways and virtual care modalities that maintain or optimize clinical practices in specialty medicine were formulated taking into account the consistency of the study results, the number and perceived quality of the studies, the biaises raised and the statistical analyses of the meta-analyses.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/OrganisationsSoins/INESSS_Soins_virtuels_Chirurgie_generale_EC.pdf

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/OrganisationsSoins/INESSS_Soins_virtuels_Chirurgie_generale_EC.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)