key: cord-0911230-qc8br6ix
authors: Schlottmann, Francisco; Dreifuss, Nicolas H.; Masrur, Mario A.
title: Telehealth: Increasing Access to Bariatric Surgery in Minority Populations
date: 2022-01-03
journal: Obes Surg
DOI: 10.1007/s11695-021-05876-y
sha: 517ea6767a79e05de3d3dc04bda9b696d9dec8d8
doc_id: 911230
cord_uid: qc8br6ix

nan

visit, and 85% of providers reported spending the same or less time as compared to in-person visits [4] .

The traditional model requires patients to travel to healthcare facilities in order to seek care. For bariatric surgery candidates, multiple appointments with different members of a multidisciplinary team are often needed during the process (surgeon, nutritionist, dietician, psychologist, etc.). Unfortunately, access to care can be threaten by long travel distances to the facility, lack of logistic resources (e.g., transportation), or socio-economic factors (e.g., inability/fear to obtain timeoff from work). In fact, previous research has shown that greater travel distance to the follow-up center was one of the main factors associated with attrition in bariatric aftercare [5] . The telemedicine approach is indeed attractive because it can potentially save time and money to patients while helping overcoming common barriers to care.

In April 2020, due to the COVID-19 pandemic, the University of Illinois at Chicago implemented the telehealth clinics service for patients seeking bariatric surgery. Healthcare providers were trained for obtaining competency in delivering care through this modality, and administrative support was available to coordinate and assist telehealth appointments. During April, May, and June, only telehealth visits were allowed. After that, a hybrid system with both telehealth and in-person visits was available. In our healthcare network, patients are usually referred to the bariatric surgery team by other providers (mainly primary care physicians). However, no-show rates for the first consultation have been historically relatively high. Interestingly, we noticed that the monthly no-show rates for the first visit considerably declined after the implementation of telehealth (from 39.3 to 16.6%) (Fig. 1) . While we are aware that several factors might have played a role in this decline, we strongly believe that the alternative of telehealth visit contributed to the higher show-up rates. For instance, we have noticed in many opportunities that patients were taking a brief break from the work duties or were taking care of their kids during consultations. Access to a computer or mobile device with internet connection and the knowledge needed to use the technology are potential barriers for the use of telehealth. A combination of telemedicine and in-person visit options is thereby a reasonable strategy. Remarkably, our patients' population is mostly represented by African Americans (50%) and Hispanics (20%) [6] , who often suffer from healthcare disparities [7] . Even among this vulnerable population, our telehealth platform was associated with increased show-up rates. A recent study on telehealth utilization among patients with obesity showed that older age was inversely associated with telemedicine use and non-Hispanic black were more likely to use telehealth compared to non-Hispanic white [8] . The young mean age of our patients (41.6 years) [6] might also be related to the high adherence to telemedicine.

Considering that less than 1% of the patients who are eligible for weight loss procedures undergo bariatric surgery, and around 50% of patients who initiate the process in a bariatric program do not undergo surgery [9] , strategies to improve access to bariatric surgery are much needed. The broad emergence of telemedicine during the COVID-19 pandemic is a great opportunity to explore how the adoption of newer technologies can facilitate access to care. Infrastructure support (building and implementing operational systems), telehealth training for providers, and constant analysis of potential patient-related barriers for the use of telemedicine seemed to be critical to obtain a successful telehealth practice [10] .

In our program, implementation of telehealth was associated with a remarkable decrease on the no-show rates of first bariatric surgery consultations. Telehealth is a powerful tool for delivering multidisciplinary and effective obesity care. Therefore, telemedicine visits should remain as a care option even when the pandemic subsides. Further research should be focused on how to effectively embrace, maintain, and enhance telehealth medicine in bariatric surgery.

Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was waived due to the retrospective nature of the study.

The authors declare no competing interests.

Prevalence of obesity and severe obesity among adults: United States

Monthly no-show rates for the first bariatric surgery consultation at the University of Illinois at Chicago 2

Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities

Patient and provider satisfaction with telemedicine in a comprehensive weight management program

Predictors of attrition in bariatric aftercare: a systematic review of the literature

Factors associated with weight loss after metabolic surgery in a multiethnic sample of 1012 patients

Association of race, health insurance status, and household income with location and outcomes of ambulatory surgery among adult patients in 2 US states

Telehealth utilization among multi-ethnic patients with obesity during the COVID-19 pandemic

Improving obesity treatment through telemedicine: increasing access to bariatric surgery

Practical considerations of developing and conducting a successful telehealth practice in response to COVID-19