Background: Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. Methods: A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriate- ness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. Results: Stakeholder median age was 53 years (interquartile range limits 40e60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappro- priate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. Conclusion: This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated

E-consensus on telemedicine in proctology: a RAND/UCLA-modified study / Gallo, Gaetano; Grossi, Ugo; Sturiale, Alessandro; Di Tanna, Gian Luca; Picciariello, Arcangelo; Pillon, Sergio; Mascagni, Domenico; Altomare, Donato Francesco; Naldini, Gabriele; Perinotti, Roberto; Bottini, Corrado; Bracchitta, Salvatore; Brusciano, Luigi; Caminati, Filippo; Cantarella, Francesco; Celentano, Valerio; Paola De Nardi, Gianpiero Cione; Ferrara, Francesco; Folliero, Cristina; Giamundo, Paolo; Giani, Iacopo; Giannini, Ivana; Giuffrida, Maria Carmela; Infantino, Aldo; La Torre, Marco; Lauretta, Andrea; Lisi, Giorgio; Losacco, Luigi; Maffioli, Anna; Mancini, Stefano; Marino, Fabio; Martellucci, Jacopo; Mascagni, Domenico; Meinero, Piercarlo; Milito, Giovanni; Mistrangelo, Massimiliano; Mori, Lorenzo; Orlandi, Simone; Pata, Francesco; Pessia, Beatrice; Picciariello, Arcangelo; Pietroletti, Renato; Pozzo, Mauro; Pucciani, Filippo; Ratto, Carlo; Romano, Lucia; Roveroni, Maurizio; Santoro, Giulio; Serventi, Alberto; Telesco, Davide; Testa, Alessandro; Tonello, Paolo; Tricomi, Nicola; Trompetto, Mario; Tutino, Roberta; Zaffaroni, Gloria; Mayol, Julio. - In: SURGERY. - ISSN 0039-6060. - 170:2(2021), pp. 405-411. [10.1016/j.surg.2021.01.049]

E-consensus on telemedicine in proctology: a RAND/UCLA-modified study

Gallo, Gaetano
Primo
;
Di Tanna, Gian Luca;Pillon, Sergio;Mascagni, Domenico;La Torre, Marco;Mancini, Stefano;Mascagni, Domenico;Orlandi, Simone;Pata, Francesco;Telesco, Davide;
2021

Abstract

Background: Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. Methods: A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriate- ness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. Results: Stakeholder median age was 53 years (interquartile range limits 40e60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappro- priate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. Conclusion: This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated
2021
telemedicine; e-consensus; proctology
01 Pubblicazione su rivista::01a Articolo in rivista
E-consensus on telemedicine in proctology: a RAND/UCLA-modified study / Gallo, Gaetano; Grossi, Ugo; Sturiale, Alessandro; Di Tanna, Gian Luca; Picciariello, Arcangelo; Pillon, Sergio; Mascagni, Domenico; Altomare, Donato Francesco; Naldini, Gabriele; Perinotti, Roberto; Bottini, Corrado; Bracchitta, Salvatore; Brusciano, Luigi; Caminati, Filippo; Cantarella, Francesco; Celentano, Valerio; Paola De Nardi, Gianpiero Cione; Ferrara, Francesco; Folliero, Cristina; Giamundo, Paolo; Giani, Iacopo; Giannini, Ivana; Giuffrida, Maria Carmela; Infantino, Aldo; La Torre, Marco; Lauretta, Andrea; Lisi, Giorgio; Losacco, Luigi; Maffioli, Anna; Mancini, Stefano; Marino, Fabio; Martellucci, Jacopo; Mascagni, Domenico; Meinero, Piercarlo; Milito, Giovanni; Mistrangelo, Massimiliano; Mori, Lorenzo; Orlandi, Simone; Pata, Francesco; Pessia, Beatrice; Picciariello, Arcangelo; Pietroletti, Renato; Pozzo, Mauro; Pucciani, Filippo; Ratto, Carlo; Romano, Lucia; Roveroni, Maurizio; Santoro, Giulio; Serventi, Alberto; Telesco, Davide; Testa, Alessandro; Tonello, Paolo; Tricomi, Nicola; Trompetto, Mario; Tutino, Roberta; Zaffaroni, Gloria; Mayol, Julio. - In: SURGERY. - ISSN 0039-6060. - 170:2(2021), pp. 405-411. [10.1016/j.surg.2021.01.049]
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