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Obstetrics and gynaecology
Research
Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation
  1. Esther V A Bouwsma1,2,3,
  2. Judith A F Huirne1,3,
  3. Peter M van de Ven4,
  4. Antonie Vonk Noordegraaf5,
  5. Frederieke G Schaafsma2,3,
  6. Steven E Schraffordt Koops6,
  7. Paul J M van Kesteren7,
  8. Hans A M Brölmann1,
  9. Johannes R Anema2,3
  1. 1 Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
  3. 3 Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
  4. 4 Department of Epidemiology and Statistics, VU University Medical Center, Amsterdam, The Netherlands
  5. 5 Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands
  6. 6 Department of Obstetrics and Gynaecology, Meander Medical Center, Amersfoort, The Netherlands
  7. 7 Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  1. Correspondence to Dr Esther V A Bouwsma; ev.bouwsma{at}vumc.nl, Professor Judith A F Huirne; j.huirne{at}vumc.nl and Professor Johannes R Anema; h.anema{at}vumc.nl

Abstract

Objective To evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease.

Design Stepped-wedge cluster randomised controlled trial.

Setting Secondary care, nine hospitals in the Netherlands, 2011–2014.

Participants 433 employed women aged 18–65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery.

Interventions An internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice.

Main outcome measures The primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers.

Results Median time until RTW was 49 days (IQR 27–76) in the intervention group and 62 days (42–85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95% CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8%) and professional (81.7%).

Conclusions Implementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries.

Trial registration number NTR2933; Results.

  • telemedicine
  • minimally invasive surgery
  • organisation of health services
  • quality in healthcare

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-017781

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    Footnotes

    • Contributors All named authors made substantial contributions to this study and the article. EVAB, JAFH, AVN, FGS, HAMB and JRA participated in the design and/or execution of the study, the interpretation of data, and the drafting and/or revision of the article. PMvdV was involved in the statistical data analyses and interpretation of the data, and the revision of the article. SESK and PJMvK contributed to the execution of the study and to the revision of the article. All named authors approved the final version of the manuscript. EVAB and JRA are the study guarantors.

    • Funding This study is funded by the Netherlands Organisation for Scientific Research and Development (ZonMw grants 171102015 and 92003590).

    • Disclaimer ZonMw did not have any involvement in the study design, data collection, analysis or interpretation, or in writing the report and decision to submit for publication. The views expressed in this report are those of the authors and not necessarily of those of ZonMw.

    • Competing interests JRA reports a chair in insurance medicine paid by the Dutch Social Security Agency, and he is a stockholder of Evalua. JAFH reports grants from Samsung, Gideon Richter and Celonova, outside the submitted work. HAMB reports grants from Olympus and personal fees from Nordic Farma, during the conduct of the study. JRA and JAFH intend to set up a spin-off company concerning the implementation of a mobile application concerning the ikherstel intervention in the Netherlands. The remaining authors have nothing to disclose.

    • Patient consent Obtained.

    • Ethics approval The study protocol was approved by the Institutional Review Board of the VU University Medical Centre (16 May 2011, number 2011/142) and by the medical ethics committees of Onze Lieve Vrouwe Gasthuis Oost (Amsterdam), Meander Medical Center (Amersfoort), Amstelland Hospital (Amsterdam), Medical Center Alkmaar (Alkmaar), Diakonessenhuis (Utrecht), Spaarne Gasthuis (locations Haarlem and Hoofddorp) and Flevo Hospital (Almere).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available, though details on statistical analyses are available from the corresponding author on request.