New data support televascular visits to help address rural vascular surgery shortage

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Jing Li

Researchers from the University of Minnesota unveiled new data supporting televascular consultations as a viable solution to the shortage of vascular surgeons in rural parts of the United States during the Midwestern Vascular Surgical Society (MVSS) annual meeting held virtually from Sept. 9–12. 

A team led by Amy Reed, MD, professor and chief in the division of vascular surgery, department of surgery, at the institution, found the telemedicine platform makes vascular surgery consultation feasible and able to replace direct office visits for patients in locations from where they find it difficult to access vascular care. 

The new study comes against the backdrop of heightened awareness of telemedicine amid the COVID-19 pandemic. The Minnesota research team highlighted a main draw of telemedicine in the current climate as the removal of the need for travel and exposure. “This has never been more evident than during the COVID-19 pandemic, where conventional options for patient evaluation were too high risk from a public health standpoint,” presenter and research team member Jing Li, MD, told the Midwestern Vascular 2020 gathering on Sept. 12. “Clearly these visits provide greater access, decreased wait times, decreased travel, and decreased exposure for our patients.” 

The investigation was a retrospective analysis of pre-pandemic telemedicine—or televascular—consultations conducted via live video over a five-year period (January 2014–December 2019) at the Minneapolis Veterans Affairs (VA) Medical Center, backed up by electronic medical record (EMR) reviews. On the patient side, the televascular visits were conducted from local VA clinics, from where many of the participants also underwent any imaging studies. 

The primary outcomes the researchers looked at were the location of patients, numbers of visits, types of visit, whether these were consultations or a follow-up, the types of provider, as well as the types of procedure patients went on to receive. 

They looked at a total of 708 telemedicine visits completed by 534 patients, of whom approximately 22.7% took part in multiple visits, explained Li. The majority had two visits, followed by those who took part in three. Further, a handful had four or more visits, Li added. 

Some 60.6% were new consultations, with the remainder representing follow-up evaluations either after an initial consultation, or post-surgically. Six providers were involved. Four were vascular surgeons, who performed 82.1% of evaluations. Two advanced practice providers (APPs) carried out the other consultations. 

The patient cohort analyzed hailed from across five states including and surrounding Minnesota—the others being Iowa, Wisconsin, North Dakota and South Dakota.  

The average distance that patients “ultimately did not travel,” observed Li, was 154 miles, (range: 20 to 601 miles). The average amount of time saved from traveling was 154 minutes (range: 27 to 532 minutes). Three locations—St. Cloud, Fargo and Sioux Falls—produced 79.2% of the visits studied, representing 79.8% of patients.  

For these cities, the average traveling distance was 148 miles, with an average time saved of 150 minutes. Within this trio, the majority of patients were from St. Cloud, followed by Fargo, then Sioux Falls. 

Furthermore, the researchers found that 36.3% (194) of the patients analyzed during the period went on to undergo 225 procedures. The majority received endovascular treatment (68.2%), a further 27.1% underwent open repair, while 4.3% had hybrid procedures. 

The data also revealed that for 83% of patients, the initial encounter they had with the vascular surgery team came via a televascular consultation. “When we looked at all of the televascular consultations, 37.6% of them went on to have procedures, and 89.2% had one or more encounters with a vascular surgeon,” added Li. 

The research team believes the findings show that “televascular consultation is a feasible way to serve patients who are in a more remote area where it is difficult for them to obtain access without significant travel.” 

Li concluded: “It’s an effective option for providing surgical evaluation. That makes it a lot easier for both the patient and the surgeon. It’s adequate in helping us facilitate treatment of a wide range of pathologies that we see from our experience.” 

In a brief question-and-answer session following her presentation, Li was asked about any potential reimbursement or physician licensing issues since the study covers consultations conducted across state lines. 

Li responded she was not aware of any problems, explaining that “we should keep in mind this was all within the VA system, so all the patients seen were VA patients, and they were being seen by VA physicians. That makes it a little different than what we typically see outside the VA system.” 

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