title: Telephone follow-up by a midlevel provider after laparoscopic inguinal hernia repair instead of face-to-face clinic visit.
abstract: OBJECTIVE
  The need for more cost- and time-efficient provision of medical care has prompted an interest in remote or telehealth approaches to delivery of health care. We present a study examining the feasibility and outcomes of implementation of a telephone follow-up program for laparoscopic inguinal hernia repair.
  
  
  METHODS
  This is a retrospective review of consecutive patients who prospectively agreed to undergo telephone follow-up after laparoscopic inguinal hernia repair instead of standard face-to-face clinic visits. Patients received a telephone call from a dedicated physician assistant 2 to 3 weeks after surgery and answered a predetermined questionnaire. A face-to-face clinic visit was scheduled based on the results of the call or on patient request.
  
  
  RESULTS
  Of 62 patients who underwent surgery, all agreed to telephone follow-up instead of face-to-face clinic visits. Their mean round-trip distance to the hospital was 122 miles. Fifty-five patients (88.7%) successfully completed planned telephone follow-up. Three patients (4.8%) were lost to follow-up, and 4 (6.5%) were erroneously scheduled for a clinic appointment. Of the 55 patients who were reached by telephone, 50 (90.9%) were satisfied and declined an in-person clinic visit. Five patients (9.1%) returned for a clinic appointment based on concerns raised during the telephone call. Of these, 1 was found to have an early hernia recurrence and 1 had a seroma.
  
  
  CONCLUSIONS
  Telephone follow-up by a midlevel provider after laparoscopic inguinal hernia repair is feasible and effective and is well received by patients.
authors.affiliation: Department of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Eisenberg
authors.affiliation: Department of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hwa
authors.affiliation: Department of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA.
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017216:Telemedicine; D013689:Telephone
keywords: Follow-up; Inguinal hernia; Laparoscopy; Telehealth
references.citation: Int Urogynecol J. 2014 Mar;25(3):381-6
references.pmid: 24105409
references.citation: JAMA. 2014 Jul 16;312(3):240-8
references.pmid: 25027139
references.citation: Int Urogynecol J. 2014 Dec;25(12):1693-7
references.pmid: 24969025
references.citation: Arch Otolaryngol Head Neck Surg. 2000 Jun;126(6):718-21; discussion 722
references.pmid: 10864107
references.citation: JAMA Surg. 2013 Sep;148(9):823-7
references.pmid: 23842982
references.citation: Br J Urol. 1996 Sep;78(3):401-4
references.pmid: 8881950
references.citation: BMC Cancer. 2010;10:174
references.pmid: 20429948
references.citation: Ulster Med J. 2010 May;79(2):76-9
references.pmid: 21116423
references.citation: BMJ. 2003 May 3;326(7396):966-9
references.pmid: 12727771