title: Implementing Real-Time Video Consultation in Plastic Surgery.
abstract: BACKGROUND
  The Dutch government, hospitals, and health insurance companies have agreed on concentrating all specialist care in a few expert centers. This should lead to lower healthcare costs, but might also cause less accessible healthcare for patients living at a considerable distance from expert centers. A way to overcome less accessible healthcare, while maintaining reduced costs of medical care, is by using telemedicine between physician and patient.
  
  
  METHODS
  In a randomized controlled trial, follow-up consultation between the patient and physician via a secured real-time video connection 6 weeks after plastic surgery of the face was compared to traditional in-person consultation after the same time interval. After the consultation, patients received an invite to fill in an online survey, which consisted of questionnaires assessing patient satisfaction (PSQ-18, TSQ) and communication experiences (PEQ), as well as questions about the time spent on different aspects of the consultations.
  
  
  RESULTS
  Thirty-one patients participated. Overall satisfaction was equal for both groups, but a significant difference in the dimensions 'general satisfaction' (online consultation group more satisfied) and 'accessibility and convenience' (online consultation group less satisfied) was found. Patients reported significantly lower satisfaction in patient-physician communication in online consultation than in traditional in-person consultations. Patients were satisfied with the online consultation, and were willing to use the system again. Patients in the online consultation group experienced significantly less waiting time, and spent less time in total for the appointment.
  
  
  CONCLUSIONS
  Overall patients are equally satisfied with traditional consultation or real-time video consultation in plastic surgery. Online consultation is found to be a time-saving alternative to traditional consultation. However, online consultation is perceived by some patients as a negative influence on communication with the physician. Dedicated training for physicians in the use of online consultation is recommended to improve their online communicative skills.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, PO Box 7057, 1007, Amsterdam, MB, The Netherlands, iriswestra@hotmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Westra
authors.forename: F B
authors.initials: FB
authors.lastname: Niessen
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D000704:Analysis of Variance; D004954:Esthetics; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D009426:Netherlands; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018579:Patient Selection; D010817:Physician-Patient Relations; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration*; D018570:Risk Assessment; D013518:Surgery, Plastic / Q000379:methods*; D017216:Telemedicine / Q000379:methods; D016896:Treatment Outcome; D049269:Videoconferencing; D014945:Wound Healing / Q000502:physiology