What is the acceptance of video consultations among orthopedic and trauma outpatients? A multi-center survey in 780 outpatients

Open AccessPublished:February 23, 2021DOI:https://doi.org/10.1016/j.injury.2021.02.023

      Highlights

      • The majority of participants would be willing to conduct an online consultation and do own suitable devices.
      • Participants older than 55 years of age are 5-times less likely to conduct an online consultation.
      • Participants would use an online consultation most likely in order to discuss medical findings and for prescriptions rather than for initial presentation of traumatic problems and initial diagnostics.
      • According to this study, advantages of the online consultation are reduction of physical appointments and reduction of travelling.
      • Disadvantages were no physical examination and no incidental findings.

      Abstract

      Introduction

      The purpose of the present study was to assess orthopedic and orthopedic trauma patients’ willingness to perform hypothetical remote video consultations, possible advantages as well as concerns.

      Methods

      Between June 2019 and November 2019, a survey amongst consecutive regular orthopedic and orthopedic trauma patients at the outpatient clinics from three European level I trauma centers was conducted via paper-based questionnaires, composed of participants` demographics as well as five open and closed questions. Participation was voluntary and anonymity was granted.

      Results

      In total, 780 participants (female 302, 38.7%, male 478, 61.3%) with a mean age of 43.8 years (SD 17.1, range from 14 years to 94 years) were included. The majority of the participants (57,6%) were eager to use a remote consultation. Participants with an age of more than 55 years were significantly less likely to use a remote consultation than their younger counterparts (OR= 0.18, p=0.003. r2=0.141). Among the whole study population, 86.2% stated, that they had a device compatible with an online video consultation. The highest willingness to conduct a video consultation in respect of the participants` occupation was observed in “part-time”-jobs (70.6%), whereas the lowest disposition was seen in retired patients (37.1%) (p= 0.0001). The most stated reason why to conduct a video consultation was “communication of medical findings” (67.8%). The most stated advantage was the “reduction of physical consultations” (66.4%). “No physical examination” was the most frequently stated disadvantage (75.9%).

      Conclusion

      The majority of orthopedic and orthopedic trauma outpatients would use a video consultation, especially because of commuting and time issues and ideally to communicate medical findings, such as x-ray reports or lab values. Elderly patients appear to be less eager in regard to video consultations. These results may change for even better acceptance in view of a current pandemic situation, as experienced since early 2020. We feel that this assumption may warrant further investigation.

      Keywords

      Introduction

      The digital development in medicine is inevitably on the rise and may alter interactions between physicians and their patients. The WHO stresses the importance of using new technologies in order to make use of the full potential for information and communication [

      WHO ( 2016 ) Global strategy on human resources for health: workforce 2030.

      ]. Due to the high acceptance rate towards the use of digitalization, the medical community has to make more use of the available resources and/ or develop new strategies to use digital technologies in treating patients, especially in global burdens like the COVD-19 crisis. Worldwide, more and more elderly people are using smartphones. A study revealed, that 53 % of the over 65 year old people in the US own a smartphone, compared to the European Union, where 23% of people older than 64 years of age used a smartphone in 2016 [

      Pew Research Center (2019) Mobile fact sheet.

      ,

      European Commission (2017) Eurostat: individuals - devices used to access the internet.

      ]. In Germany, the smartphone usage in the group of the elderly seems to be higher compared to the overall usage in the European union. In 2019, 40% of people aged 65 years or older used a smartphone on a regular basis [

      Statistisches Bundesamt (Destatis) (2020).

      ].
      In a study conducted amongst 1604 smartphone users in the U.S,.58% of participants had downloaded a health-related app in 2015 [
      • Krebs P.
      • Duncan D.T.
      Health app use among US mobile phone owners: a national survey.
      ]. The right use of eHealth can be advantageous for both, the patient and the treating physician. The options are manifold, such as reduction in travel distance, waiting time and duration of consultation. In addition, health related costs can be lowered, and eHealth-systems can be easily used as follow-up instruments, which could decrease the common loss of follow-up in orthopedic trauma patients [
      • Sathiyakumar V.
      • Apfeld J.C.
      • Obremskey W.T.
      • Thakore R.V.
      • Sethi M.K.
      Prospective randomized controlled trial using telemedicine for follow-ups in an orthopedic trauma population: a pilot study.
      ,
      • Zelle B.A.
      • Buttacavoli F.A.
      • Shroff J.B.
      • Stirton J.B.
      Loss of follow-up in orthopaedic trauma: who is getting lost to follow-up?.
      ]. A study among US orthopedic surgeons assessed that the implementation of eHealth into the orthopedic follow-up process would be welcomed by 60% of the assessed surgeons [
      • Wongworawat M.D.
      • Capistrant G.
      • Stephenson J.M.
      The opportunity awaits to lead orthopaedic telehealth innovation: AOA critical issues.
      ]. Video consultations are already in use and show general acceptance in patients and treating physicians in different medical disciplines []. Online video consultations could be particularly used in traumatology and orthopedics for the judgement of wounds, visiting of patients currently undergoing rehabilitation, postoperative range of motion assessment and private doctor-patient related discussions [
      • Parks M.T.
      • Wang Z.
      • Siu K.C.
      Current low-cost video-based motion analysis options for clinical rehabilitation: a systematic review.
      ]. However, little is known, if patients who are currently in trauma or orthopedic treatment, would accept and make use of a video consultation.
      Thus, the aim of this study was to conduct a survey investigating the willingness of individuals who were currently treated by a trauma orthopedic trauma surgeon, to use live video consultation. The study also investigated patients’ concerns and appreciation about the mentioned hypothetical use of remote consultation.

      Materials and methods

       Patients and survey design

      A standardized questionnaire was handed out to patients in the outpatient clinics of the authors’ trauma and orthopedic departments in Switzerland and Germany. The survey was conducted between June 2019 to November 2019. The only inclusion criteria was being currently treated by an orthopedic or a trauma surgeon at one of those three institutions. Participation was voluntary and anonymity was granted. All participants received a written patient information explaining the aim of the study and processing of their data. No identifying data except for age, gender and occupation was collected. Hence, data can be assumed to be anonymous and the European data protection regulations do not apply. In addition, the local ethics committees of all participating centers have declared general waivers for surveys with anonymous data. By answering the questionnaire, participants gave consent to the use of the data that they had provided.

       Study questionnaire

      The questionnaire first explained the general process and the technical requirements for a successful hypothetical online video consultation. Furthermore, it was explained, that health insurances cover online video consultation at no additional costs. Additionally, the online video consultation would always be live, using certified and secured connections via notebook, smartphone, desktop computer or tablet. In the following, the participants’ baseline characteristics including age, sex and professional status (part-time, “9-to-5” (office hours, 9am to 5pm), self-employed, shiftwork, others (student, not willing to give information about the occupational status, jobless) and “retired”) were obtained. They were then asked, if they would use a video consultation in general and if they have the equipment for conducting a video consultation (yes, no, uncertain). In further three questions, patients were asked for what special reason they would use it and what advantages and disadvantages they see in a video consultation by choosing from a number of answers provided, including optional free text comments.

       Statistical analysis

      Further statistical analysis was done by the use of SPSS for Mac 25.0 (SPSS, Chicago, Illinois, USA). Data is presented as frequencies (n) and means with the standard deviation (SD). To assess differences between groups, a Chi-Square test was used for categorical data. A subgroup analysis was performed for age (group 1: < 30 years, group 2: 30 to 55 years, group 3: > 55 years, arbitrary selection of thresholds), gender and profession. The level of statistical significance was set at p < 0.05.
      Age (categorized), sex, and profession were assessed in a binary logistic regression as predictors for the use of a video consultation (yes or no).

      Results

       Demographics

      In total, 780 participants (female 302, 38.7%, male 478, 61.3%) with a mean age of 43.8 years (SD 17.1, range from 14 years to 94 years) were included. The group with patients up to 30 years of age counted 220 participants (35.5%) (group 1), whereas the group between 30 and 55 years of age consisted of 356 participants (45.6%) (group 2) and the patients older than 55 years counted 204 participants (26.2%) (group 3). [Table 1] Most of the participants were “9-to-5”-workers (32.9%) followed by “others” (22.8%), “retired” (16.3%), shift workers (16.3%), “part-time” (6.5%) and “self-employed” (4.5%).
      Table 1Distribution of participants by gender and age.
      Gender
      AgenMaleFemale
      all ages780478 (61,3%)302 (38,7%)
      </= 30220150 (68,2%)70 (31,8%)
      >30 - </= 55356231 (64,9%)125 (35,1%)
      >5520497 (47,5%)107 (52,5%)
      Question 1: Could you generally imagine using a video consultation?
      The majority of the study population would be willing to use a video consultation (57.6%), 21.2% were unsure and 21.3% would not. There was no significant difference between the assessed cities the study was conducted in. Males were significantly more likely to use a video consultation (61.3%) than female participants (51.7%) (p=0.027). The highest rate of willingness to conduct an online consultation was observed in age group 2 (64.3%), followed by group 1 (60.5%) and group 3 (42.6%). [Table 2] (p<0.0001).
      Table 2Could you generally imagine using a video consultation?
      NYESNOUNCERTAIN
      All ages780449 (57.6%)166 (21.3%)165 (21.2%)
      ≤ 30y220133 (60.5%)35 (15.9%)52 (23.6%)
      >30y - ≤ 55y356229 (64.3%)61 (17.1%)66 (18.6%)
      > 55y20487 (42.6%)70 (34.3%)47 (23.1%)
      Male478293 (61.3%)91 (19.0%)94 (19.7%)
      Female302156 (51.7%)75 (24.8%)71 (23.5%)
      The highest rate in favour for the video consultation in respect of the participants` occupation was observed in part-time (70.6%) followed by “9-to-5” (66.5%), self-employed (65.7%), shift work (59.1%), “others” (53.4%) and retired (37.1%) (p=0.0001).
      In a multivariate regression-analysis using “would you use a video consultation?” (yes/no) as dependent variable (outcome) and the parameters “age”, “occupation”, and “gender” as independent variables, only “age” was a significant predictor for the willingness to use a video consultation. Participants with an age of more than 55 years were 5 times less likely to use a remote consultation than their younger counterparts. (r2=0.141, OR= 0.18, CI 95%= 0.06 – 0.56, p=0.003).
      Question 2: Do you own a device suitable for a video consultation (e.g., smartphone, laptop with camera and microphone)?
      Overall, 86.2% of the participating patients stated that they had a smartphone and/or another device (laptop, tablet) with which a video consultation would be possible (camera, microphone, internet). Age group 2 showed the highest incidence of smartphones and/or other compatible devices with 94.1% followed by group 1 (93.6%) and group 3 with 64.2%. There was no significant difference between female and male participants (p=0.558).
      Question 3: For what specific situation could you imagine using the video consultation?
      The three most often stated reasons for the usage of the video consultation amongst the whole study population were “communication of medical findings” (67.8%), “prescriptions” (66.3%) and “personal questions” (61.4%). The most unlikely reason for using the online consultation was a preliminary consultation in a newly occurred disease or trauma (21.7%). [Table 3]
      Table 3For what specific situation could you imagine using a video consultation?
      All ages (n=780)≤ 30y (n=220)> 30y - ≤ 55y (n=356)> 55y (n=204)
      Communication of medial findings
      = p<0.05 between age groups
      529 (67.8%)152 (69.1%)269 (75.6%)108 (52.9%)
      Prescription
      = p<0.05 between age groups
      517 (66.3%)145 (65.9%)255 (71.6%)117 (57.4%)
      Personal Question
      = p<0.05 between age groups
      479 (61.4%)138 (62.7%)247 (69.4%)94 (46.1%)
      Referral letter
      = p<0.05 between age groups
      384 (49.2%)102 (46.4%)194 (54.4%)88 (43.1%)
      Certificate of incapacity for work
      = p<0.05 between age groups
      369 (47.3%)121 (55.0%)198 (55.6%)50 (24.5%)
      Stay abroad
      = p<0.05 between age groups
      357 (45.8%)109 (49.5%)191 (53.7%)57 (27.9%)
      Follow-up
      = p<0.05 between age groups
      291 (37.3%)75 (34.1%)156 (43.8%)60 (29.4%)
      Initial consultation in newly occurred illness169 (21.7%)41 (18.6%)87 (24.4%)41 (20.1%)
      low asterisk = p<0.05 between age groups
      Question 4: Which of the mentioned advantages do you see in the video consultation?
      The three most often stated suspected advantages of the online-video consultation were “reduction of consultations” (66.4%) followed by “contact to the doctor from home / no need of traveling” (65.4%) and “doctor is reachable from anywhere” (51.2%). [Table 4]
      Table 4Which of the mentioned advantages do you see in a video consultation?
      All ages (n=780)≤ 30y (n=220)> 30y - ≤ 55y (n=356)> 55y (n=204)
      Reduction of physical consultations
      = p<0.05 between age groups
      518 (66.4%)156 (70.9%)256 (71.9%)106 (52.0%)
      No travelling
      = p<0.05 between age groups
      510 (65.4%)159 (72.3 %)246 (69.1%)105 (51.1%)
      Availability from anywhere
      = p<0.05 between age groups
      399 (51.2%)128 (58.2%)200 (56.2%)71 (34.8%)
      No danger of infection
      = p<0.05 between age groups
      346 (44.4%)94 (42.7%)183 (51.4%)69 (33.8%)
      Availability at inconvenient times302 (38.7%)94 (42.7%)143 (40.2%)65 (31.9%)
      low asterisk = p<0.05 between age groups
      Question 5: Which of the mentioned disadvantages do you see in the video consultation?
      The three most frequently stated suspected disadvantages of the online-video consultation were “no physical examination” (75,9%) followed by “no incidental findings” (58,5%) and “no personal contact to the doctor in general” (49,1%). [Table 5]
      Table 5Which of the mentioned disadvantages do you see in a video consultation?
      All ages (n=780)≤ 30y (n=220)> 30y - ≤ 55y (n=356)> 55y (n=204)
      No physical examination
      = p<0.05 between age groups
      592 (75.9%)181 (82.3%)284 (79.8%)127 (62.3%)
      No incidental findings
      = p<0.05 between age groups
      456 (58.5%)142 (64.5%)222 (62.4%)92 (45.1%)
      No direct contact with the doctor383 (48.1%)101 (45.9%)172 (48.3%)110 (53.9%)
      Data security
      = p<0.05 between age groups
      223 (28.6%)73 (33.2%)113 (31.7%)37 (18.1%)
      Relationship to the doctor could change208 (26.7%)53 (24.1%)104 (29.2%)51 (25.0%)
      low asterisk = p<0.05 between age groups
      There were no additional free text comments which were not already covered by the questionnaire.

      Discussion

      The aim of the present study was to assess if orthopaedic trauma and orthopedic outpatients would be willing to perform a video consultation, whether they had the necessary equipment and which advantages and disadvantages they would connect with a potential consultation via the internet.
      In our study population, the vast majority had a smartphone and/or device which would suit to perform a video consultation. More than half of the over 55-year old participants stated that they have the required equipment, which is a higher rate than previous studies have shown [

      European Commission (2017) Eurostat: individuals - devices used to access the internet.

      ,

      Statistisches Bundesamt (Destatis) (2020).

      ]. Our study indicated that the majority of the participants would use a remote consultation for traumatic or orthopedic health problems, which reflects a higher rate of positive responds towards the use of telemedicine than in previous studies [
      • Eikelboom R.H.
      • Atlas M.D.
      Attitude to telemedicine, and willingness to use it, in audiology patients.
      ,
      • Sin D.Y.E.
      • Guo X.
      • Yong D.W.W.
      • Qiu T.Y.
      • Moey P.K.S.
      • Falk M.R.
      • Tan N.C.
      Assessment of willingness to Tele-monitoring interventions in patients with type 2 diabetes and/or hypertension in the public primary healthcare setting.
      ]. The willingness to participate in a telemedical consultation decreased with age, which might be consistent with elderly people`s reduced affinity towards the usage of electronical devices [
      • Rahimpour M.
      • Lovell N.H.
      • Celler B.G.
      • McCormick J.
      Patients' perceptions of a home telecare system.
      ,
      • Phang C.W.
      • Sutanto J.
      • Kankanhalli A.
      • Li Y.
      • Tan B.C.
      • Teo H.-H.
      Senior citizens’ acceptance of information systems: a study in the context of e-government services.
      ,
      • Peel N.M.
      • Russell T.G.
      • Gray L.C.
      Feasibility of using an in-home video conferencing system in geriatric rehabilitation.
      ,
      • Modahl M.
      • Meinke S.
      Telehealth index: 2015 consumer survey.
      ]. So called “computer anxiety” might be the most important factor for elderly people to disagree with the use of telemedicine [
      • Laguna K.
      • Babcock R.L.
      Computer anxiety in young and older adults: implications for human-computer interactions in older populations.
      ]. However, although willingness might be decreasing with age, other studies have found that age does not have significant influence on patients` willingness to conduct telemedical consultations, or online-video consultations in particular [
      • Roettl J.
      • Bidmon S.
      • Terlutter R.
      What predicts patients' willingness to undergo online treatment and pay for online treatment? Results from a web-based survey to investigate the changing patient-physician relationship.
      ,
      • Almathami H.K.Y.
      • Win K.T.
      • Vlahu-Gjorgievska E.
      Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients' homes: systematic literature review.
      ]. In the present study, interestingly, males were significantly more likely to use a video consultation than female participants, but in multivariate regression analysis, gender was not a significant predictor for the potential use of a video consultation. A survey of 1006 patients in Germany has found that gender has no influence on the willingness to undergo a video consultation [
      • Roettl J.
      • Bidmon S.
      • Terlutter R.
      What predicts patients' willingness to undergo online treatment and pay for online treatment? Results from a web-based survey to investigate the changing patient-physician relationship.
      ]. In respect of the participants` occupation, our survey showed that patients with part-time and “9-to-5” jobs would rather use the video consultation than self-employed and “shift-workers”. To our knowledge, there is no data on willingness to perform a video consultation in respect of participants` occupation available yet. Participants who were retired showed the smallest rate of willingness which can be seen as consistent with the decreasing rate of acceptance in elderly patients. The most often stated reasons for the use of an online consultation were communication of medical findings, prescriptions and personal questions which is in agreement with a survey conducted in the U.S. from 2019 [

      Harris Poll (2019) Telehealth index: 2019 consumer survey

      ]. Interestingly, the less frequently stated reason to conduct an online video consultation was a newly occurred disease. Other authors had previously promoted the video consultation as a good tool for judging newly occurred patients` problems in order to conduct a sufficient triage [
      • Vargas B.B.
      • Shepard M.
      • Hentz J.G.
      • Kutyreff C.
      • Hershey L.G.
      • Starling A.J.
      Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion.
      ].
      The three most often stated advantages of the video consultation in the presented study population were the reduction of consultations, reduction of travel and that the doctor is reachable from anywhere. This is consistent with findings of several previous studies [
      • Hickey S.
      • Gomez J.
      • Meller B.
      • Schneider J.C.
      • Cheney M.
      • Nejad S.
      • et al.
      Interactive home telehealth and burns: a pilot study.
      ,
      • Abdolahi A.
      • Bull M.T.
      • Darwin K.C.
      • Venkataraman V.
      • Grana M.J.
      • Dorsey E.R.
      • et al.
      A feasibility study of conducting the Montreal Cognitive Assessment remotely in individuals with movement disorders.
      ,
      • Demiris G.
      • Speedie S.M.
      • Finkelstein S.
      Change of patients' perceptions of TeleHomeCare.
      ]. Almost half of the participants stated that “no danger of an infection in the medical office” is an advantage of a video consultation. It can be assumed that in the current Covid-19 pandemic, patients would be more worried about infections and therefore would rather use a video consultation for the mentioned reason [
      • Greenhalgh T.
      • Wherton J.
      • Shaw S.
      • Morrison C.
      Video consultations for covid-19.
      ]. The most frequently stated disadvantages of the video consultation were that no physical examination would be possible, no incidental findings could occur and that there would be no direct contact with the treating physician in general, which is consistent with findings of various previous of other medical disciplines [
      • Eslami Jahromi M.
      • Ahmadian L.
      Evaluating satisfaction of patients with stutter regarding the tele-speech therapy method and infrastructure.
      ,
      • Ehlers D.K.
      • Huberty J.L.
      • de Vreede G.J.
      Can an evidence-based book club intervention delivered via a tablet computer improve physical activity in middle-aged women?.
      ]. The complaint about not having physical contact with the doctor was mostly stated in the group of the elderly patients, which is in agreement with findings of earlier projects [
      • Demiris G.
      • Speedie S.M.
      • Finkelstein S.
      Change of patients' perceptions of TeleHomeCare.
      ]. As major topic, data security is one of the biggest aspects in digital medicine [
      • Filkins B.L.
      • Kim J.Y.
      • Roberts B.
      • Armstrong W.
      • Miller M.A.
      • Hultner M.L.
      • Castillo A.P.
      • Ducom J.C.
      • Topol E.J.
      • Steinhubl S.R.
      Privacy and security in the era of digital health: what should translational researchers know and do about it?.
      ]. However, it seems that concerns about data security are less prevalent when it comes to video consultations [
      • Almathami H.K.Y.
      • Win K.T.
      • Vlahu-Gjorgievska E.
      Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients' homes: systematic literature review.
      ,
      • Green S.M.
      • Lockhart E.
      • Marhefka S.L.
      Advantages and disadvantages for receiving Internet-based HIV/AIDS interventions at home or at community-based organizations.
      ,
      • Harris M.A.
      • Freeman K.A.
      • Duke D.C.
      Seeing is believing: using skype to improve diabetes outcomes in youth.
      ]. Also in the presented survey, only almost a third of the participants had critical thoughts about data security. To our knowledge, there is no study published, addressing solely the willingness and opinions of orthopedic and oprthopedic trauma patients towards online video consultations. It is known that patients prefer the use of video consultations in routine care [
      • Werner P.
      • Karnieli E.
      A model of the willingness to use telemedicine for routine and specialized care.
      ,,
      • Brick J.E.
      • Bashshur R.L.
      • Brick J.F.
      • D'Alessandri R.M.
      Public knowledge, perception, and expressed choice of telemedicine in rural West Virginia.
      ]. However, several studies have found that minor trauma, orthopedic consultation in an out-patient setting, triage of trauma patients or follow-ups are suitable for video consultations [
      • Benger J.R.
      • Noble S.M.
      • Coast J.
      • Kendall J.M.
      The safety and effectiveness of minor injuries telemedicine.
      ,
      • Brennan J.A.
      • Kealy J.A.
      • Gerardi L.H.
      • Shih R.
      • Allegra J.
      • Sannipoli L.
      • Lutz D.
      Telemedicine in the emergency department: a randomized controlled trial.
      ,
      • Aarnio P.
      • Lamminen H.
      • Lepisto J.
      • Alho A.
      A prospective study of teleconferencing for orthopaedic consultations.
      ,
      • Lambrecht C.J.
      Telemedicine in trauma care: description of 100 trauma teleconsults.
      ]. In the presented study, patients were rather willing to perform a remote consultation for personal questions and prescriptions than follow-up or newly occurred trauma. A study from Norway has shown that patients` satisfaction is not impaired in video-assisted orthopedic consultations compared to standard consultations [
      • Buvik A.
      • Bugge E.
      • Knutsen G.
      • Smabrekke A.
      • Wilsgaard T.
      Patient reported outcomes with remote orthopaedic consultations by telemedicine: a randomised controlled trial.
      ]. Several other studies assessed that (orthopedic) surgeons are mainly satisfied with video consultations and that the patients` outcomes treated via video consultations are comparable to those treated conventionally [
      • Wan A.C.
      • Gul Y.
      • Darzi A.
      Realtime remote consultation in the outpatient clinic–experience at a teaching hospital.
      ,
      • Aarnio P.
      • Lamminen H.
      • Lepisto J.
      • Alho A.
      A prospective study of teleconferencing for orthopaedic consultations.
      ,
      • Aarnio P.
      • Rudenberg H.
      • Ellonen M.
      • Jaatinen P.
      User satisfaction with teleconsultations for surgery.
      ].
      This study has certain limitations. It is known that surveys have minor level of evidence. The outcome is directly linked to the participant`s understanding and rating of the questions. Also, due to the voluntariness of participation, patients with a critical attitude towards the topic of digitalization or video consultation might be under-represented. Furthermore, the patients in this study consulted the outpatient clinics due to already existing specific problems, which might have biased their opinion. Additionally, we did not assess the circumstances of visits of the individual participants (e.g. fracture type, follow-up, etc.), which could have biased their opinion on a video consultation and might have changed its feasibility.
      We feel that our data may be helpful in projecting requirements for online consultations in the near future. Also, patients who have difficulties travelling or making time for doctors’ appointments can benefit from remote consultations [
      • Darkins A.
      Patient safety considerations in developing large telehealth networks.
      ]. Further need may ensue given the current pandemic, where telemedicine may help reduce the risk of infections by prolonged exposure in waiting areas. The practical use of video consultations in diagnostics, for therapeutic or follow-up reasons, especially in orthopedics and traumatology, will have to be addressed in further studies. It may be advantageous to offer patients the opportunity to choose between physical consultations and video consultations.

      Conclusion

      The majority of the participants in this survey amongst orthopedic and orthopedic trauma outpatients appear to be willing to use a video consultation. Most participants would use the remote consultation for prescriptions and personal questions rather than for direct presentation of orthopedic or traumatic problems and initial diagnostics. Advantages of the video consultation according to the study participants were the reduction of physical appointments as well as the reduction of travelling. Most frequently stated disadvantages were no possible physical examination and no incidental findings. Data security was not a major concern for the participating patients. These results may be more favourable in view of the current pandemic.

      Funding

      All authors certify that no funding exists that needs to be reported.

      Declaration of Competing Interest

      All authors certify that no conflicts of interest exist that need to be reported.

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      3. European Commission (2017) Eurostat: individuals - devices used to access the internet.

      4. Statistisches Bundesamt (Destatis) (2020).

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