Applicability of Information and Communication Technologies (ICTs) in a secondary hospital Pelvic Floor consultation. Final Study.

Cornet A1, López Á1, Allué N1, Sanjuán A1

Research Type

Clinical

Abstract Category

Health Services Delivery

Abstract 411
E-Poster 2
Scientific Open Discussion ePoster Session 18
Thursday 5th September 2019
13:35 - 13:40 (ePoster Station 12)
Exhibition Hall
Incontinence Pelvic Organ Prolapse Pelvic Floor Prolapse Symptoms Questionnaire
1.Hospital de Mollet
Presenter
A

Ariana Cornet

Links

Poster

Abstract

Hypothesis / aims of study
Information and Communication Technologies (ICTs) are implementing in the vast majority of fields, including health. There are reviews analyzing the impact that the use of ICTs may cause, such as centralizing patients’ health, improving health quality and increasing sanitary education, not only of patients but also of nursing and medical professionals (1). On the one side, the Gyneacology Department of our secondary hospital has no data of the regular ICT use of our patients. On the other hand, our Gynaecology Department does not currently use any ICTs tool. There is current bibliography validating web-based questionnaires (WBQ) comparing them to a questionnaire done at the first appointment (2) (3). We consider the use of this tool may bring advantages to our Pelvic Floor consultation and contribute to a more efficient and satisfactory first visit.
Firstly, we aim to have data about the use and level of confidence in ICTs among Gynaecology patients of our hospital, according to social variables (Study A). Secondly, we would like to assess the effects of an ICTs tool in a Gynaecological Pelvic Floor consultation, in terms of quality of first visit (satisfaction), efficiency (time for first visit) and level of knowledge on basic Pelvic Floor diseases (Study B).
Study design, materials and methods
Study A: cross-sectional descriptive study about the ICTs use among our patients. We designed a paper survey which was offered to patients attending Emergency Room for any gynaecological disease, patients attending Pelvic Floor or General Gynaecology consultation and Urodynamics office. We set a sample size of 400 surveys. A descriptive analysis of all items vas done. Study B: intervention quasi-experimental study with convenience sampling. 52 patients in the intervention group filled in a WBQ  and received basic Pelvic Floor information links before the first appointment. The WBQ was designed on the hospital website with our Systems Department support. 52 patients in the control group attended the regular first appointment without the on-line process. A paper survey about satisfaction and Pelvic Floor knowledge was designed, which was completed by each patient after the first face-to-face appointment. A prospective comparative study was done between intervention and control groups. To start with, we proceeded to a descriptive analysis of quantitative and qualitative variables. In the second place, we focused on the possible associations between quality of first visit (satisfaction), efficiency (time of first visit) and level of knowledge on basic Pelvic Floor diseases, comparing both groups. In both studies, data from surveys was collected by Google Forms and exported to Excel, with a final analysis by PASW Statistic v.19.
Results
At the present time, for Study A we have recruited 400 paper surveys about ICTs use among Gynaecology Department patients. The average age of our responders was 54 +/- 12,64 years. As for education, 29,2% had only Primary studies while 22,2 % had part of Secondary education.  About internet use, 52,6% used it daily and 8% more than 3 times per week. 25,3% never used internet. 54,4% did not use internet for improving their health while 43,6% did, basically to search health information (30 %after the appointment, 22% before) or to book electronic appointments. In general, the level of confidence the patients had on internet health information was low (75,8% gave scores from 0 to 3 out of 5). The most used ICT devices were smart phones (92,3%) and computer (43,3%). 5,3% never used any of them. 66,3% would consider it positive that their medical practitioner would give them useful internet health information but 83,8% of their doctors did not provide them with it.  Finally, the best scored ICT tools by patients in terms of usefulness were the use of video conferences or email communication.
As for the Study B, we have recruited 52 patients in the intervention group and 53 in the control group (1 was excluded for hearing impairment which may stretch on the first appointment). 
The mean age in the intervention group was 60,1 years +/- 12,7 and  64,5 years +/- 9,0 in the control group. The measured total mean time inside the consultation room was 19,36 minutes +/- 4,96 in the intervention group and 21,19 minutes +/- 4,96 in the control group, not significant. The perceived mean time in the consultation room was similar in both groups, 15,5 minutes +/-4. When comparing the results in terms of satisfaction after the first consultation, there were no significant differences between both groups. Instead, when comparing the results in terms of knowledge about pelvic organ prolapse or urinary incontinence, the intervention group got better results relating to organ prolapse and urinary incontinence definition and classification of urinary incontinence (0 0,04; 0,012; 0,008 respectively). In the multivariate analysis adjusted for age, level of studies and measured time inside the consultation, the three items about knowledge remained statistically different in favor of the intervention group ( p 0,03; and inferior to 0,01 respectively).
Interpretation of results
To start with, it is important to highlight the limitations of this study which make it unlikely to extrapolate our findings to the general population: method of randomization and sample size. We found that our patients had difficulty in handing themselves with internet use so a simple randomization process was proven difficult and we had to use sampling by convenience. Apart from that, the principal investigator works in Pelvic Floor consultation once every two weeks with an average of 4 first visits and 20 successive visits. Therefore, the number of recruited patients in one year time could not be very high. As for our results, it seems our WBQ may contribute in improving the first consultation in terms of patient knowledge. It is not clear that this tool can shorten the time of the appointment or patient satisfaction.
At a systematic level, this study helps to have an idea of what impact may cause a WBQ before the first Pelvic Floor appointment. Taking into consideration how easy is to design this tool, it would be important to consider its use among our practice. Other articles concluded that a WBQ contributed to a slightly more efficient use of the first consultation and a better registration of pelvic floor functioning (3).
Concluding message
Whether or not the results prove statistically significant and the benefits of web-base questionnaires remain unclear, it is important to consider the use of ICTs tools and introduce them in medical consultation. Further research should focus in the benefits of ICTs such as improving patient satisfaction and communication.
Figure 1 Web-based questionnaire format
Figure 2 Significant differences between control and intervention groups according to urinary incontinence definition
References
  1. Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA. Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews. J Med Internet Res. 2017 Apr 25;19(4).
  2. Egger MJ, Lukacz ES, Newhouse M, Wang J, Nygaard I. Web versus paper-based completion of the epidemiology of prolapse and incontinence questionnaire. Female Plevic Med Reconstr Surg. 2013 Jan-Feb;19(1):17-22.
  3. Selina Posthuma, J. Marinus van der Ploeg, Britt A. H. van Etten-deBruijn, David P. van der Ham. Time efficiency of a web-based questionnaire in urogynecology: a randomized study. Int Urogynecol J. 2016 Apr;27(4):621-7
Disclosures
Funding No funding Clinical Trial No Subjects Human Ethics Committee CEIC (Clinical Investigation Ethic Commitee) Hospital de Granollers Helsinki Yes Informed Consent Yes