Effect of Applying Telemedicine Follow-up versus Scheduled Clinic Follow-up on Renal-Transplanted Patients’ Satisfaction

Background: Kidney transplants are becoming common surgical procedures with high success rates. Although many specializations have effectively employed telemedicine, the practice -of kidney transplantation has lagged in its adoption. Aim: The present study’s objective was to evaluate the effect of applying telemedicine follow-up versus scheduled clinic follow-up on renal-transplanted patients’ satisfaction. Design: was quasi-experimental. Setting: The present study was conducted at the Menoufia University Hospital's Renal Surgeries follow-up outpatient clinic, Menoufia Governorate, Egypt. Subjects: A convenient sample of Forty-two adult renal-transplanted participants; half of them who underwent follow-up care via video and telephone calls interaction (telemedicine group) and the other half in scheduled follow-up clinic care (control group). Methods : patients who volunteered to participatewere evaluated for patients’ satisfaction and healthcare use by employing the Kidney Transplant Understanding Tool (K-TUT) , Telemedicine Satisfaction Questionnaire, and Health Utilization Questionnaire. Pairing by propensity was done through using one-way multiple regression of variances and one-way variation analysis to contrast the mean and SD of the ratings for the questionnaires. Results: In this investigation, there were 21 telemedicine participants that were confirmed and 21 other patients as the control group. The total average age (±SD) was 50 (±5.51) years for the telemedicine sample and 51 (±6.01) years for the control group, correspondingly. The two samples' levels of overall patients' satisfaction was comparable (p =0.78). While telemedicine participants' satisfaction with social interactions and communication was comparable to that of clinic patient populations', they had much shorter commute (p< 0.0001) and waiting durations (p< 0.0001). 85.7% (18/21) of telemedicine participants choose to utilize the services again due to the convenience of using it without sacrificing patients-nursing engagement. Conclusion : The use of telemedicine seemed to be a more convenient and affordable option than scheduling follow-up meetings. Telemedicine offers the potential to increase clinic efficiency, shorten patient wait durations, and lower expenses for those undergoing kidney transplants. Recommendations: To maximize healthcare use in our nation, greater research into the application of telemedicine in a wide range of clinical environments is therefore necessary . To shorten waiting lists and give patients more flexibility planning, crowded facilities across the country should seriously explore offering telemedicine services.


Introduction:
The kidneys function as the body's natural blood filter by filtering waste material through metabolism. If any health problem damaged the person's kidneys and led to a decreased Glomerular Filtration rate (GFR) less than 10 mL/min/1.73m, this condition is known as end stage renal disease

Operational definitions:
Telemedicine: Telemedicine also is called tele-health, which is the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient, and professional health-related education (Angell et al., 2021). In this study, telemedicine was used in the form of videoconferences and telephone calls. Where:  Z is the z score  N is calculated sample size  ξ is the margin of error and  p is the population incidence The sample size is calculated to be 42 participants.
In order to achieve the aim of the study the following criteria were taken into consideration when selecting the present study participants:

Scoring system
The overall score is 69 points, with 1 point (1) the level of the healthcare provided, (2) the resemblance to a face-to-face contact, and (3) impression of the connection.

Scoring system
A Likert scale with five-points ranging from, "Strongly Disagree" (1) to "Strongly Agree" (5), was used by the participants to register their answers. Adversely phrased items' ratings were inverted throughout assessment so that for every item. Hence, the total scores ranged between 14 and 70 with lower ratings consistently denoted poor telemedicine satisfaction and higher marks consistently denoted good telemedicine satisfaction, while the result for every topic was the average of all the items within that topic and had 9 items that evaluated specific elements of the expenditure of time and money by individuals to schedule follow-up appointments, whether they were made in clinic or via telemedicine.

Scoring system
A Likert scale with five-points ranging from, "Strongly Disagree" (1) to "Strongly Agree" (5), was used by participants to register their answers. Adversely phrased items' ratings were inverted throughout assessment so that for every item, lower ratings consistently showed poor experience and higher marks consistently showed positive experience as the total score ranged between 9 and 45, while the result for every topic was the average of all the items within that topic. Participants typically get a standardized discharge plan during these visits.    Results for the TSQ were presented as the average scores for each item and the standard deviations.

Results
General characteristics (Table 1) In the telemedicine group, most of participants are males (61.9%) aged between 35 and 60 years and the majority of them were married and highly educated (85.7%), while for the control group, more than half of participants were females (52.38%) aged between 35 and 60 years old and most of them were married (76.2%) and living alone (85.7%). There was no significant difference between the two groups according to complications.
There was no statistically significant difference between the telemedicine and controls according to the general characteristics (Table 1).  Contrarily, the TSQ item with the lowest average score indicated a need for support when utilizing the telemedicine platform, emphasizing the significance of fully educated participants before their first telemedicine session. In the last item, 42.8% (9/21) of the sample selected "strongly agree" compared to 38.09% (8/21 participants) who responded, "Agree" to a declaration of overall satisfaction with the telemedicine services. One participant from the remaining group said, "Uncertain" and another said, "disagreed" with the assertion.

Health Utilization Questionnaire (HUQ)
In this investigation, a one-way ANOVA testing was employed to compare the results for each HUQ issue between the two groups. Which could be interpreted as the telemedicine cohort considerably outperformed the controls in the following areas; (1) reduction for time taken off work to participate in follow-up visits as telemedicine's mean score was 4.56 ± 0.55 and controls was 3.08 ± 0.7, p< 0.0001. As well, reduced wait periods for their healthcare providers as telemedicine's mean score was 4.74 ± 0.15 and controls' was 2.72 ±1.01, p< 0.0001.
Also, less frequently did they need to request that a friend, family member, or caregiver take time off from work to join them in their follow-up appointments as telemedicine's mean score was 3.08 ± 0.59 and controls was 2.03 ± 0.61, p = 0.002.    What is more, this investigation was inevitably survey-based, which increased its susceptibility to some level of responses' bias.

Conclusions:
To conclude;  Telemedicine was a more convenient and affordable option than scheduling follow-up meetings in renally transplanted patients without sacrificing the nurse-patient interaction.
 The majority of participants in the current study thought that the telemedicine follow-up sessions' total medical background and patients-nurses relationship were just as beneficial as in-clinic appointments, and they would utilize the service once more in the future if given the chance.
 Telemedicine can greatly increase clinical efficiency, decrease patients' waiting lists, and save their money for transfer.

Recommendations:
 To maximize the use of healthcare in our nation, greater research into the application of telemedicine in a wide range of clinical environments is therefore necessary. Personalized immunosuppression after