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Khera M, Bernie HL, Broderick G, Carrier S, Faraday M, Kohler T, Jenkins L, Watter D, Mulhall J, Raheem O, Ramasamy R, Rubin R, Spitz A, Yafi F, Sadeghi-Nejad H. Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper. J Sex Med 2024; 21:318-332. [PMID: 38430132 DOI: 10.1093/jsxmed/qdad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 03/03/2024]
Abstract
PURPOSE The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. LITERATURE SEARCH STRATEGY A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Gregory Broderick
- Department of Urology, Mayo Clinic Alix School of Medicine, Jacksonville, Florida 32224, United States
| | - Serge Carrier
- Surgical Department /Urology Division, McGill University, Montreal, Quebec, H4A 3J1, Canada
| | - Martha Faraday
- Four Oaks Consulting, Berryville, VA 22611, United States
| | - Tobias Kohler
- Department of Urology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lawrence Jenkins
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Daniel Watter
- Morris Psychological Group, P.A., Parsippany, NJ 07054, United States
| | - John Mulhall
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States
| | - Omer Raheem
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL 60637, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Rachel Rubin
- Department of Urology, Georgetown University, Washington, DC 20007, United States
| | - Aaron Spitz
- Orange County Urology Associates, Laguna Hills, California, CA 92653, United States
| | - Faysal Yafi
- Department of Urology, University of California Irvine, CA 92660, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology, NYU Langone Grossman School of Medicine, New York, NY 10017, United States
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Hamouche F, Hakam N, Unno R, Ahn J, Yang H, Bayne D, Stoller ML, Smith S, Finlayson E, Smith J, Chi T. Reimagining Ambulatory Care in Urology: Conversion of the Urology Clinic into a Procedure Center Improves Patient's Experience. Telemed J E Health 2024; 30:748-753. [PMID: 37862049 DOI: 10.1089/tmj.2023.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic made it necessary to practice social distancing and limited in-person encounters in health care. These restrictions created alternative opportunities to enhance patient access to care in the ambulatory setting. We hypothesized that by transforming clinics into centers that prioritize procedures and transitioning ambulatory appointments to telehealth, we could establish a secure, streamlined, and productive method for providing patient care. Methods: Clinic templates were restructured to allow the use of the physical space to perform procedure-based clinics exclusively, while switching to virtual telemedicine for all nonprocedural encounters. Staff members were given specific roles to support one of the patient care modalities for a given day (Procedures vs. Telehealth). Performance and patient satisfaction metrics were collected between two periods of time defined as P1 (February-June 2019) and P2 Post-COVID (February-June 2020) and compared. These served as proxies of periods when the clinic workflow and templates were structured in the traditional versus the emerging way. Statistical analysis was performed using bivariate analyses. Results: The percentage of procedures performed among all in-person visits were higher in P2 compared to P1 (45% vs. 29%, p < 0.001). Although total charges and relative value units were lower in P2, the overall revenue generated was higher compared to P1 ($4,597,846 vs. $4,517,427$, respectively). This increase in revenue was mainly driven by the higher relative income generated by procedures. Patient experience, reflected through patient-reported outcomes, was more favorable in P2 where patients seemed more likely to "Recommend this provider office" (90% vs. 85.7%, p = 0.01), report improved "Access overall" (56% vs. 49%, p = 0.02), and felt they were "Moving through your visit overall" (59% vs. 51%, p = 0.007). Conclusions: Our data suggest that reorganizing urology clinics into a space that is centered around outpatient procedures can represent a model that improves the patient's access to care and clinical experience, while simultaneously improving operational financial strength. This efficient care model could be considered for many practice settings and drive high-value outpatient care.
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Affiliation(s)
- Fadl Hamouche
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Nizar Hakam
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Rei Unno
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Justin Ahn
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Heiko Yang
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - David Bayne
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Marshall L Stoller
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Susan Smith
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Emily Finlayson
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - James Smith
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
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Patel V, Saikali S, Moschovas MC, Patel E, Satava R, Dasgupta P, Dohler M, Collins JW, Albala D, Marescaux J. Technical and ethical considerations in telesurgery. J Robot Surg 2024; 18:40. [PMID: 38231309 DOI: 10.1007/s11701-023-01797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
Telesurgery, a cutting-edge field at the intersection of medicine and technology, holds immense promise for enhancing surgical capabilities, extending medical care, and improving patient outcomes. In this scenario, this article explores the landscape of technical and ethical considerations that highlight the advancement and adoption of telesurgery. Network considerations are crucial for ensuring seamless and low-latency communication between remote surgeons and robotic systems, while technical challenges encompass system reliability, latency reduction, and the integration of emerging technologies like artificial intelligence and 5G networks. Therefore, this article also explores the critical role of network infrastructure, highlighting the necessity for low-latency, high-bandwidth, secure and private connections to ensure patient safety and surgical precision. Moreover, ethical considerations in telesurgery include patient consent, data security, and the potential for remote surgical interventions to distance surgeons from their patients. Legal and regulatory frameworks require refinement to accommodate the unique aspects of telesurgery, including liability, licensure, and reimbursement. Our article presents a comprehensive analysis of the current state of telesurgery technology and its potential while critically examining the challenges that must be navigated for its widespread adoption.
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Affiliation(s)
- Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Shady Saikali
- AdventHealth Global Robotics Institute, Celebration, FL, USA.
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Ela Patel
- Stanford University, Stanford, CA, 94305, USA
| | | | - Prokar Dasgupta
- MRC Centre for Transplantation, Department of Urology, King's Health Partners, King's College London, London, UK
| | - Mischa Dohler
- Advanced Technology Group, Ericsson Inc., Santa Clara, CA, 95054, USA
| | - Justin W Collins
- Division of Uro-Oncology, University College London Hospital, London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- CMR Surgical, Cambridge, UK
| | - David Albala
- Downstate Health Sciences University, Syracuse, NY, USA
- Department of Urology, Crouse Hospital, Syracuse, NY, USA
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
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Katz C, Robles N, Novillo-Ortiz D, Saigí-Rubió F. Selection of criteria for a telemedicine framework for designing, implementing, monitoring and evaluating telemedicine interventions: Validation using a modified Delphi process. Digit Health 2024; 10:20552076241251951. [PMID: 38726219 PMCID: PMC11080763 DOI: 10.1177/20552076241251951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives The call to scale up telemedicine services globally as part of the digital health transformation lacks an agreed-upon set of constructs to guide the implementation process. A lack of guidance hinders the development, consolidation, sustainability and optimisation of telemedicine services. The study aims to reach consensus among telemedicine experts on a set of implementation constructs to be developed into an evidence-based support tool. Methods A modified Delphi study was conducted to evaluate a set of evidence-informed telemedicine implementation constructs comprising cores, domains and items. The study evaluated the constructs consisting of five cores: Assessment of the Current Situation, Development of a Telemedicine Strategy, Development of Organisational Changes, Development of a Telemedicine Service, and Monitoring, Evaluation and Optimisation of Telemedicine Implementation; seven domains: Individual Readiness, Organisational Readiness, Clinical, Economic, Technological and Infrastructure, Regulation, and Monitoring, Evaluation and Optimisation; divided into 53 items. Global telemedicine specialists (n = 247) were invited to participate and evaluate 58 questions. Consensus was set at ≥70%. Results Forty-five experts completed the survey. Consensus was reached on 78% of the constructs evaluated. Regarding the core constructs, Monitoring, Evaluation and Optimisation of Telemedicine Implementation was determined to be the most important one, and Development of a Telemedicine Strategy the least. As for the domains, the Clinical one had the highest level of consensus, and the Economic one had the lowest. Conclusions This research advances the field of telemedicine, providing expert consensus on a set of implementation constructs. The findings also highlight considerable divergence in expert opinion on the constructs of reimbursement and incentive mechanisms, resistance to change, and telemedicine champions. The lack of agreement on these constructs warrants attention and may partly explain the barriers that telemedicine services continue to face in the implementation process.
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Affiliation(s)
- Che Katz
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Noemí Robles
- eHealth Centre, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Jericevic D, Brucker B. Telemedicine in Overactive Bladder Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:103-108. [PMID: 37193335 PMCID: PMC10015147 DOI: 10.1007/s11884-023-00689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 03/17/2023]
Abstract
Purpose of Review This review discusses the role and benefits of telemedicine as an integral component of the post-pandemic care paradigm in urological practice and, in particular, as part of the care of patients with overactive bladder (OAB). Recent Findings The COVID-19 pandemic accelerated the implementation of telemedicine across almost every medical specialty and (at least temporarily) swept away barriers including those regarding reimbursement and licensure. Telemedicine benefits patients and providers alike including savings on transportation costs, access to specialists or tertiary care from geographically remote locations, and minimized exposure to a contagious illness. Integration of telemedicine into clinical practice can reduce costs for office/exam space and staffing overhead, as well as facilitate greater scheduling efficiency. Many, if not most, aspects of care for the uncomplicated OAB patient can be as effectively managed remotely as with in-person encounters, across the treatment algorithm. Summary Telemedicine will almost certainly remain a key component in the care of OAB, general urology, and throughout all medical specialties.
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Affiliation(s)
- Dora Jericevic
- Departments of Urology and Obstetrics & Gynecology, New York University Langone Health, New York, NY USA
| | - Benjamin Brucker
- Departments of Urology and Obstetrics & Gynecology, New York University Langone Health, New York, NY USA
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Mirone V, Celentano G, Collà Ruvolo C, Cirillo L, Fusco GM, Abate M, Morra S, Di Bello F, Califano G, Mirone C, Cacace G, Morgera V, La Rocca R, Capece M, Longo N, Napolitano L, Creta M. Perceptions and attitudes toward the use of telemedicine for the postoperative outpatient urological care during the COVID-19 pandemic in an Academic Hospital in Southern Italy. Arch Ital Urol Androl 2022; 94:375-379. [PMID: 36576476 DOI: 10.4081/aiua.2022.4.375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Telemedicine is a most used tools in various medical and surgical scenarios. The aim of the present study was to explore attitudes and perceptions by urologic patients toward the use of telemedicine in the context of patient-physicians communication during the post-operative follow-up in a large academic tertiary urology referral department in Italy. MATERIALS AND METHODS An anonymous questionnaire consisting of 15 multiple choice questions was designed including three sections: respondents' demographics, attitudes, and perceptions towards the use of telemedicine. Invitations to participate to this anonymous questionnaire was given to outpatients attended at Urology Department, University of Naples Federico II. RESULTS In total 697 responses were received (participation rate 73%). The frequency of telemedicine use was described as frequently, occasional, rarely, and never by 41.6%, 30.4%, 15.1%, and 12.6% of respondents, respectively. WhatsApp messenger used by 59.5% of respondents and telephone call (34.3%) were the most common type of tools. Satisfaction in using telemedicine was reported as very satisfied, satisfied, neutral, dissatisfied, and very dissatisfied by 39.6%,41.4%,10%,7% and 2% of respondents respectively. Overall, 43.7%% of participants individuated limited interaction and risk of misdiagnosis as the major limit of telemedicine. CONCLUSIONS Telemedicine represents the future of medical practice due to several benefits as well as convenience, increased access to care and decreased healthcare costs.
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Affiliation(s)
- Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Luigi Cirillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Giovanni Maria Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Claudia Mirone
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania "Luigi Vanvitelli", Naples.
| | - Gianluigi Cacace
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Vincenzo Morgera
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
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Virtual Access to Subspecialty Care. Prim Care 2022; 49:557-573. [PMCID: PMC9581700 DOI: 10.1016/j.pop.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Paesano N, Carrion DM, Autrán Gomez AM. Telemedicine use in current urologic oncology clinical practice. Front Surg 2022; 9:885260. [PMID: 36338631 PMCID: PMC9629354 DOI: 10.3389/fsurg.2022.885260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the last fifteen years, there have been important technological advances in telehealth systems and urology, along with other specialties, has been a pioneer in the successful use of this medical care modality. Due to the COVID-19 pandemic, the use of telemedicine has been rapidly embraced by the urology community around the world. A review of the most relevant and updated articles on telemedicine and telehealth in urology has been carried out with the aim of better understanding how it has been implemented to date, as well as reviewing concepts, current regulations, health policies and recommendations for its implementation. METHODS A narrative review of the current literature published up to April 2022 on the use of telemedicine in urology was performed. From the search results, 42 publications were obtained for analysis. RESULTS Telemedicine in urology has been shown to be useful in a variety of clinical scenarios within urological practice, from benign diseases to advanced cancers. This is due to the positive impact on medical consultation times, lower patient mobility costs, less work absenteeism and greater protection for both the patient and the doctor. The main limitations for the use of telemedicine lie in the impossibility of a correct physical examination, which is essential in certain situations, as well as the lack of accessibility to technology in disadvantaged populations and in elderly patients who have not adapted to the use of technology, as well as the lack of development of health policies to establish their implementation in some countries. CONCLUSION Telemedicine is in full growth. There is much information in the current literature on the successful adoption of telemedicine for patients suffering from urological diseases. While the use and implementation of these new practices has been rapid in the urology community, more work is needed to bring more accessible specialty care to underserved and underdeveloped areas. Health policies must promote its development to reduce costs and increase access.
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Affiliation(s)
- Nahuel Paesano
- Department of Urology, Instituto Médico Tecnológico, Prostate Institute Barcelona, CIMA—SANITAS Hospital, Barcelona, Spain,Office of Residents and Young Urologists, Office of Residents and Young Urologists of the American Confederation of Urology (CAU), Barcelona, Spain,Correspondence: Nahuel Paesano
| | - Diego M. Carrion
- Department of Urology, Torrejon University Hospital, Madrid, Spain,Department of Urology, Instituto de Cirugía Urologica Avanzada (ICUA), Clínica CEMTRO, Madrid, Spain
| | - Ana María Autrán Gomez
- Department of Urology, Lyx Urology, Madrid, Spain,Office of Research, Office of Research of the American Confederation of Urology (CAU), Madrid, Spain
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Macharet DVDL, Mendes LN, Oliveira WCSD, Pereira GMV, Monteiro MVDC. Patient Acceptance of Telemedicine in Urogynecology Consultations - A Cross-Sectional Study Performed at a Brazilian Public Institution. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:755-760. [PMID: 35760361 PMCID: PMC10032051 DOI: 10.1055/s-0042-1748971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the acceptance of telemedicine and determine its associated factors in an urogynecology outpatient clinic of a public hospital in Brazil. METHODS The present was a cross-sectional study performed between June and November 2020. The included patients had their elective appointments postponed due to the coronavirus disease 2019 (COVID-19) pandemic. The variables considered regarding the acceptance of telemedicine were: urogynecologic diagnosis, age, level of schooling, place of residence, access to the internet, type of device used, frequency of internet use, and use of social media platforms. The categorical variables were described by their absolute and relative frequencies. The association among variables was evaluated through the Fisher exact test, and univariate and multivariate analyses, considering the acceptance of telemedicine as the dependent variable. RESULTS A total of 225 patients were listed, and 182 agreed to participate. The mean age was 59 years old, 81.3% of the patients had access to the internet, and 87.3% of them accepted telemedicine. There were statistically significant associations regarding the acceptance of telemedicine and high levels of schooling (p < 0.01), internet access (p < 0.01), daily use of the internet (p < 0.01), access through personal mobile phone (p < 0.01), and access through the participant's own residence (p < 0.01). In the univariate and multivariate analyses, only high levels of schooling were associated with the acceptance of telemedicine (Adjusted odds ratio: 4.82; 95% confidence interval = 1.59-14.65). CONCLUSION Most of the urogynecology patients of a public hospital in a developing country accepted telemedicine. Internet access and level of schooling were the factors associated with the acceptance of telemedicine in urogynecology.
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Affiliation(s)
| | - Leonardo Nogueira Mendes
- Division of Urology, Hospital das Clínicas of Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Bhanvadia RR, Carpinito G, Kavoussi M, Lotan Y, Margulis V, Bagrodia A, Roehrborn C, Gahan JC, Cadeddu JA, Woldu S. Safety and Feasibility of Telehealth Only Preoperative Evaluation Prior to Minimally Invasive Robotic Urologic Surgery. J Endourol 2022; 36:1070-1076. [PMID: 35596562 DOI: 10.1089/end.2021.0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Telehealth utilization has increased dramatically over the past few years due to improvement in technology and the COVID-19 pandemic. To date, no study has examined whether a telehealth visit alone for preoperative evaluation is safe and sufficient prior to surgery. We examined the safety and feasibility of preoperative telehealth visits alone prior to minimally invasive urologic surgery Materials & Methods Single institution retrospective review of robotic prostate, kidney, and cystectomy procedures between April - Dec 2020. Cases were dichotomized into those who underwent preoperative evaluation by telehealth-only versus traditional in-person visits. Outcomes included complications, blood loss, conversion to open surgery rates, and operative times. We assessed efficiency of care by measuring time from preoperative visit to surgery. Results 314 patients were included in the study, with 14% of cases (n = 45) being performed after a preoperative telehealth visit. The majority of cases included in analysis were robotic surgeries of the prostate (56.1% of all cases, n = 176) and the kidney (35.0% of all cases, n = 110). Patients seen via telehealth alone preoperatively had no significant differences in any grade of complications, perioperative outcomes, blood loss, operative time, and length of stay. There was no difference in change in anticipated procedure between groups, and there was no cases of conversion to open surgery in the telehealth only group. Time from preoperative visit to surgery was significantly shorter for the telehealth group by 13 days. Conclusion Our study is the first to analyze the safety of telehealth-only preoperative visits prior to minimally invasive urologic surgery. We found no difference in perioperative outcomes including conversion to open surgery or change in planned procedure. Further, telehealth preoperative visits appeared to facilitate shorter time to surgery. This study has important implications for expediting patient care and medico-legal considerations.
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Affiliation(s)
- Raj Ramnik Bhanvadia
- University of Texas Southwestern Medical Center at Dallas, 12334, 2001 Inwood Road, 4th Floor, WBCE3, Dallas, Texas, United States, 75390;
| | | | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Blvd. J8.112, Dallas, Texas, United States, 75390;
| | - Vitaly Margulis
- UT Southwestern Medical, Urology, 5339 harry hines blvd, Dallas, Texas, United States, 75390;
| | - Aditya Bagrodia
- UT Southwestern, 12334, Urology, Dallas, Texas, United States;
| | - Claus Roehrborn
- UT Southwestern Medical Center, Urology, 5323 Harry Hines Blvd, J8 142, Dallas, Texas, United States, 75390-9110;
| | - Jeffrey C Gahan
- UT Southwestern medical center, Urology, 5323 Harry Hines Blvd., J8.106, Dallas, Texas, United States, 75390;
| | - Jeffrey A Cadeddu
- UT Southwestern Medical Center, Urology, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390-9110;
| | - Solomon Woldu
- University of Texas Southwestern Medical Center at Dallas, 12334, Urology, Dallas, Texas, United States, 75390;
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Naik N, Hameed BMZ, Nayak SG, Gera A, Nandyal SR, Shetty DK, Shah M, Ibrahim S, Naik A, Kamath N, Mahdaviamiri D, D'costa KK, Rai BP, Chlosta P, Somani BK. Telemedicine and Telehealth in Urology-What Do the 'Patients' Think About It? Front Surg 2022; 9:863576. [PMID: 35495745 PMCID: PMC9051070 DOI: 10.3389/fsurg.2022.863576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023] Open
Abstract
Telemedicine is the delivery of healthcare to patients who are not in the same location as the physician. The practice of telemedicine has a large number of advantages, including cost savings, low chances of nosocomial infection, and fewer hospital visits. Teleclinics have been reported to be successful in the post-surgery and post-cancer therapy follow-up, and in offering consulting services for urolithiasis patients. This review focuses on identifying the outcomes of the recent studies related to the usage of video consulting in urology centers for hematuria referrals and follow-up appointments for a variety of illnesses, including benign prostatic hyperplasia (BPH), kidney stone disease (KSD), and urinary tract infections (UTIs) and found that they are highly acceptable and satisfied. Certain medical disorders can cause embarrassment, social exclusion, and also poor self-esteem, all of which can negatively impair health-related quality-of-life. Telemedicine has proven beneficial in such patients and is a reliable, cost-effective patient-care tool, and it has been successfully implemented in various healthcare settings and specialties.
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Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
| | - B. M. Zeeshan Hameed
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, Father Muller Medical College, Mangalore, India
| | - Sanjana Ganesh Nayak
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Anshita Gera
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | | | - Dasharathraj K. Shetty
- Department of Humanities and Management, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Milap Shah
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Robotics and Urooncology, Max Hospital and Max Institute of Cancer Care, New Delhi, India
| | - Sufyan Ibrahim
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Aniket Naik
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Nagaraj Kamath
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Delaram Mahdaviamiri
- Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kenisha Kevin D'costa
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Bhavan Prasad Rai
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University in Krakow, Kraków, Poland
| | - Bhaskar K. Somani
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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12
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Payne T, Kevric J, Stelmach W, To H. The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review. JMIR Perioper Med 2022; 5:e34661. [PMID: 35436223 PMCID: PMC9052035 DOI: 10.2196/34661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/20/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. Objective We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. Methods We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. Results A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. Conclusions The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research.
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Affiliation(s)
- Thomas Payne
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Jasmina Kevric
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Wanda Stelmach
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Henry To
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
- Department of Surgery, Werribee Mercy Hospital, Melbourne, Australia
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13
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Telemedicine: The New "Virtual Reality" of Female Pelvic Medicine and Reconstructive Surgery? Female Pelvic Med Reconstr Surg 2022; 28:e80-e87. [PMID: 35272338 PMCID: PMC8919843 DOI: 10.1097/spv.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Understanding women's acceptance of telemedicine as a model of care for pelvic floor disorders (PFDs) allows for a more patient-centered approach to widespread implementation in female pelvic medicine and reconstructive surgery. OBJECTIVES The pandemic sparked rapid and widespread implementation of telemedicine. Our goal was to assess acceptance, satisfaction, and desire for future use of telemedicine among women seeking care for PFDs. STUDY DESIGN We performed a structured telephone survey of new patients who underwent video visits, and established patients who underwent video or telephone visits, when nonurgent, in-person visits were suspended. Our survey assessed the following domains: satisfaction, future use of telemedicine, level of comfort, perceived utility, and access and comfort with technology. RESULTS Between April and July 2020, we conducted telemedicine visits with 221 patients, 131 (63% of eligible patients) of whom agreed to participate in our survey (63 (74%) telephone and 68 (56%) video, including 35 established and 33 new patients). Overall, most participants (96.3%) described being "very" or "somewhat satisfied" with telemedicine in addressing their needs and "comfortable" sharing personal information with providers in a telemedicine visit (94.7%). However, video participants (both new and established) were more likely to view telemedicine as valuable (P = 0.02) than telephone participants. Furthermore, established video participants perceived greater quality care of care (P = 0.01) than telephone participants. CONCLUSIONS Video telemedicine is a well-accepted adjunct model of care with the potential to expand the reach of quality subspecialty care of value to women with PFDs.
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14
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Ayoub CH, El-Asmar JM, Abdulfattah S, El-Hajj A. Telemedicine and Telementoring in Urology: A Glimpse of the Past and a Leap Into the Future. Front Surg 2022; 9:811749. [PMID: 35273996 PMCID: PMC8901873 DOI: 10.3389/fsurg.2022.811749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
Telemedicine is the process of utilizing telecommunications and digital relay to perform, teach, or share medical knowledge. The digital era eased the incorporation of telemedicine to different areas of medical care, including the surgical care of Urologic patient mainly through telementoring, telesurgery, and telerobotics. Over the years, Telemedicine has played an integral part in a physicians' ability to provide high quality medical care to remote patients, as well as serve as an educational tool for trainee physicians, in the form of telementoring. During the COVID-19 pandemic, telemedicine has played a vital role in combatting the health implications of confinements. Challenges of telemedicine implementation include cost, ethical considerations, security, bandwidth, latency, legal, and licensure difficulties. Nevertheless, the future of telemedicine, specifically telementoring, promises several improvements and innovative advancements that aim to bridge the gap in technological divides of urologic care. In this review, we build on what is already known about telemedicine focusing specifically on aspects related to telementoring, telestration, and telesurgery. Furthermore, we discuss its historical role in healthcare with a special emphasis on current and future use in urology.
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Affiliation(s)
- Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jose M. El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Albert El-Hajj
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15
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Kuo AC, Geleris B, Arnhym A. TeleBBD: Telehealth management of bladder bowel dysfunction - A provider survey of benefits and limitations. J Pediatr Urol 2021; 17:792.e1-792.e7. [PMID: 34656434 DOI: 10.1016/j.jpurol.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/03/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bladder bowel dysfunction (BBD), defined by the International Children's Continence Society (ICCS) as a spectrum of lower urinary tract and bowel symptoms, represents to up to 40% of pediatric urology consults. Management of BBD involves strict behavioral management with frequent follow ups by urology advanced practice providers (APPs). If left untreated, patients may develop secondary comorbidities that impact their renal and/or bladder function, bowel function, and psychosocial well-being. Previous studies have reported feasibility for virtual post-operative visits and prenatal consultations, however, telehealth management of BBD, or TeleBBD, has not yet been studied. The goal of this study is to survey APPs in pediatric urology to understand how TeleBBD compares to in-person visits, and identify benefits and limitations of TeleBBD. STUDY DESIGN An online survey via Qualtrics was designed based on current practice guidelines for BBD management and telehealth considerations. Survey was distributed in September 2020 via the Pediatric Urology Nurses & Specialists listserv. Group qualitative coding was completed by the authors to generate themes that emerged from the results. RESULTS/DISCUSSION A total of 53 APPs from across 21 states in the US completed the online survey, with 49 (92%) APPs reporting currently providing TeleBBD. Those who did not provide TeleBBD typically do not manage BBD patients. Summary Table shows the comparison of TeleBBD with in-person visits, with many elements of TeleBBD better or the same as in-person visits. APPs reported that TeleBBD has been most beneficial in increasing access and overall improvement in follow up which is significant for management of this chronic condition. Barriers include access to technology/internet and inability to perform full physical exams via televisit. Limitations of the study include lack of validated survey and small sample size. Overall increased access and improved patient adherence and resolution from BBD is significant for this patient population for prevention of secondary comorbidities. CONCLUSION This is the first study to survey APPs across the US specifically exploring indication of TeleBBD as well as comparison of TeleBBD with in-person visits. The perception of improved access to care and less no-show rates is significant especially during the pandemic in providing continuity of care and prevent secondary comorbidities. Additionally, TeleBBD was felt to be just as effective as in-person visits for patient adherence to treatment, and other components of care, with the exception of ability to provide physical exams. Providers leveraged the benefits of TeleBBD and shared strategies for best practices.
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Affiliation(s)
- Angel Chen Kuo
- University of California San Francisco School of Nursing, Dept of Family Health Care Nursing, 2 Koret Way, Room N411Y, San Francisco, CA, 94143, USA.
| | - Bethany Geleris
- University of California, San Francisco, Department of Pediatric Urology, 744 52nd Street, 4th Floor, Oakland, CA, 94609, USA.
| | - Anne Arnhym
- University of California, San Francisco, Department of Pediatric Urology, 1825 4th Street, 5th Floor, San Francisco, CA, 94143, USA.
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16
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Alpert JM, Taylor G, Hampton CN, Paige S, Markham MJ, Bylund CL. Clinicians’ perceptions of the benefits and challenges of teleoncology as experienced through the COVID-19 pandemic: A qualitative study (Preprint). JMIR Cancer 2021; 8:e34895. [PMID: 35142622 PMCID: PMC8914732 DOI: 10.2196/34895] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 01/29/2023] Open
Affiliation(s)
- Jordan M Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Greenberry Taylor
- Department of Communication, Flagler College, Saint Augustine, FL, United States
| | - Chelsea N Hampton
- College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Samantha Paige
- College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Merry Jennifer Markham
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Carma L Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
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17
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Adopting Telehealth During The COVID-19 Era: The Urologist's Perspective. Urology 2021; 156:289-295. [PMID: 34052257 PMCID: PMC8830601 DOI: 10.1016/j.urology.2021.03.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the urology providers' (through a range of training levels) experience utilizing telemedicine given the rapid nationwide implementation of telemedicine in urology practices due to COVID-19. Several studies focusing on the patient's perspective have illustrated that telemedicine is comparable to traditional office visits in terms of cost, communication, and overall satisfaction. However, there is sparse data on the provider's experience. METHODS With IRB approval, we assessed provider satisfaction with telemedicine at Urology programs in the U.S. through an electronic survey. The 25-question survey was based on the Patient Assessment of Communication of Telehealth which is a validated 33 question instrument that has been utilized to assess the quality of patient-provider communication in telemedicine. Experience with telemedicine was assessed in 2 categories: technical aspects and communication with patients. Variables were rated using a 5-point Likert Scale. RESULTS There were 144 responses to the survey. 50% of providers reported not receiving any formal training in using telemedicine. This differed significantly by training level with 55% of attendings having had received training vs 20% of residents. Providers felt they would most benefit from training in billing (52%) rather than equipment use (33%) or communication (28%). 87% of providers felt comfortable discussing sensitive topics while only 55% felt comfortable using telehealth to schedule surgery (P < .001). CONCLUSION Urology providers are generally satisfied with their experience communicating with patients via telemedicine and the majority would opt to continue utilizing telemedicine. Nevertheless, many providers are hesitant to schedule surgery via telemedicine. Providers would benefit from formal training in telemedicine.
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18
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Shin C, Allen AZ, Zhu D, Tellechea L, Watts KL, Abraham NE. Patient satisfaction and savings, and clinical outcomes of televisits in female pelvic medicine and reconstructive surgery at an urban academic center. Neurourol Urodyn 2021; 40:1834-1844. [PMID: 34342368 DOI: 10.1002/nau.24759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/03/2021] [Accepted: 07/15/2021] [Indexed: 12/19/2022]
Abstract
AIM To evaluate patient satisfaction and savings, and compare visit outcomes based on chief complaint (CC) of women presenting for a televisit to a female pelvic medicine and reconstructive surgery (FPMRS) clinic at an urban academic center. METHODS A cross-sectional study of women completing a televisit with an FPMRS specialist at our institution from June 19, 2020 to July 17, 2020 was conducted. A telephone questionnaire was administered to patients to assess satisfaction and savings (travel costs/time avoided). Electronic medical records were reviewed to collect patient demographics and comorbidities, CC, and televisit outcomes (e.g., face-to-face (F2F) exam scheduled, orders placed). Logistic regression was used to analyze predictors of satisfaction and need for F2F follow-up. RESULTS One hundred eighty-seven of 290 (64.5%) women called completed the survey, of whom 168 (89.8%) were satisfied with their televisit. Eighty-eight (48.1%) saved at least an hour and 54 (28.9%) saved more than $25 on transportation. There were no significant associations between patient characteristics, CC, or televisit outcomes and satisfaction. Ninety-nine (52.9%) televisits resulted in F2F follow-up, with CC of prolapse (odds ratio [OR] = 4.2 (1.7-10.3); p = 0.002), new patient (OR = 2.2 (1.2-4.2); p = 0.01), and Hispanic ethnicity (OR = 3.9 (1.2-13.6); p=.03) as significant predictors. CONCLUSION Most patients were satisfied with FPMRS televisits at our urban academic center. Televisits resulted in patient travel time and cost savings. Women presenting with prolapse and for new patient visits would likely benefit from initial F2F visits instead of televisits. Televisits are an important mode of health care and in some cases can replace F2F visits.
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Affiliation(s)
- Christina Shin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ariel Z Allen
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laura Tellechea
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
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19
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Woodmass M, Ramshaw K, Lakshmanan P. Utility of telephone consultations during COVID-19 and beyond: a study of orthopaedic spinal patients. Minerva Surg 2021; 77:360-367. [PMID: 34338464 DOI: 10.23736/s2724-5691.21.08963-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Due to the COVID-19 pandemic, hospital clinic lists have abruptly shifted towards remote appointments via telephone. This study investigated the views and experiences of telephone consultations in a population of orthopaedic spinal patients. METHODS A 10-item telephone questionnaire was completed by 202 orthopaedic spinal patients. Questions addressed patient perceptions towards: confidence in telephone consultations; their impact on treatment outcome; their advantages and limitations and how satisfied they were with their telephone consultation. RESULTS 94% of patients were confident in their doctor providing effective care via telephone consultation. 81% of patients were confident that their treatment outcome would not have changed with a face-to-face appointment and 75% would consider choosing a telephone consultation in the post-pandemic era. Key benefits of telephone consultations for patients are the convenience of not travelling and avoiding travel-related expenses. The most commonly reported limitation is the lack of a clinical examination. Satisfaction scores were consistently high with no significant differences between different treatment groups. CONCLUSIONS This study demonstrates that telephone calls are a favourable method of consultation for patients requiring orthopaedic spinal care. Satisfaction levels are consistently high, patient confidence in their clinician is nearly unanimous and a majority of patients would consider choosing this method for future follow-up appointments. Issues with telephone consultations appear to chiefly concern the lack of physical examination, difficulties with the communication and retention of clinical information, and brevity of the appointment. However, consistent satisfaction scores suggest broad utility across a comprehensive range of treatment outcomes for orthopaedic spinal patients.
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Affiliation(s)
- Michael Woodmass
- Department of Trauma and Orthopaedics, Sunderland Royal Hospital, Sunderland, UK -
| | - Kathryn Ramshaw
- Department of Trauma and Orthopaedics, Sunderland Royal Hospital, Sunderland, UK
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Suarez-Ibarrola R, Miernik A. Prospects and Challenges of Artificial Intelligence and Computer Science for the Future of Urology. World J Urol 2021; 38:2325-2327. [PMID: 32910230 PMCID: PMC7508738 DOI: 10.1007/s00345-020-03428-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Center, Freiburg, Germany.
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Center, Freiburg, Germany
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21
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Bergroth R, Matikainen M, Rannikko A. Mobile PSA: A Novel Telehealth Tool for Prostate Cancer Follow-Up. EUR UROL SUPPL 2021; 28:43-46. [PMID: 34337524 PMCID: PMC8317875 DOI: 10.1016/j.euros.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
The prevalence of prostate cancer (PCa) is increasing. As the prognosis of PCa continues to improve, the increasing follow-up requirements after radical prostatectomy or radiotherapy puts significant pressure on health care systems. Follow-up is typically conducted by treating urologists, specialized nurses, or general practitioners. Despite the increase in patient numbers, resources are not likely to increase in proportion. Furthermore, the ongoing COVID-19 pandemic has led to a paradigm shift in our thinking towards telehealth solutions, primarily to avoid or limit physical contact and to spare resources. Here we report our novel telehealth solution for PCa follow-up, called Mobile PSA. Currently, more than 4500 PCa patients have been using Mobile PSA follow-up in our center. Mobile PSA can increase follow-up accuracy, as all biochemical relapses will be detected in a timely manner, can significantly reduce delays in reporting prostate-specific antigen results to patients, and can significantly reduce costs. Patient summary We assessed a new telehealth information system for prostate cancer follow-up that does not use an app. More than 4500 prostate cancer patients in our center have used this system, called Mobile PSA, for follow-up. The system significantly reduces delays in reporting prostate-specific antigen (PSA) test results to patients, increases the accuracy of detecting recurrence of elevated PSA, and reduces costs.
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Affiliation(s)
- Robin Bergroth
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Corresponding author. Department of Urology, Helsinki University Hospital, P.O. Box 900, FI-00029 HUS, Finland. Tel. +358 9 4711; Fax: +358 9 47166684.
| | - Mika Matikainen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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22
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El-Asmar JM, Labban M, El-Hajj A. Integration of aquablation through telemetry: an alternative to onsite proctoring? World J Urol 2021; 39:3473-3479. [PMID: 33547926 PMCID: PMC7866960 DOI: 10.1007/s00345-021-03603-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/15/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the feasibility of telementoring for aquablation by comparing the outcomes of onsite versus telemetry proctoring. METHODS The telemetry device of choice was Proximie, an innovative digital platform that uses live video stream with an augmented reality technology. Our study retrospectively reviewed outcomes from our IRB approved prospective Aquablation database from March 2018 till October 2019. Procedures were guided by a proctor either onsite or remotely through telemetry. One-way ANOVA or Chi-square was used to compare perioperative parameters and mixed model ANOVA was used to compare functional outcomes. RESULTS Our data included 59 patients who underwent a proctored-based Aquablation of which 21 were telementor guided and 38 were onsite guided. The initial ten procedures were done with the latter approach. There was no statistical difference in age, comorbidities, prostate size, and baseline serum markers amongst the two groups. In contrast, telementor guidance was associated with increased general anaesthesia use (76.2% vs. 21.1%) and haemostatic cauterization (81.0% versus 47.4%) with a p value < 0.00001 and 0.004 respectively. However, the main procedure outcomes: operative time, time to Foley catheter removal, haemoglobin drop, urinary retention, and adverse events were statistically insignificant (p value > 0.05). CONCLUSION Following an initial phase of onsite proctoring, telementoring can be safely used in the adoption phase of a new robotic technology. This approach allowed more flexibility in patient scheduling and reduced travel costs with similar surgical outcomes.
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Affiliation(s)
- Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Muhieddine Labban
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Albert El-Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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23
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Amato M, Eissa A, Puliatti S, Secchi C, Ferraguti F, Minelli M, Meneghini A, Landi I, Guarino G, Sighinolfi MC, Rocco B, Bianchi G, Micali S. Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study. World J Urol 2021; 39:3465-3471. [PMID: 33538866 PMCID: PMC7859466 DOI: 10.1007/s00345-021-03594-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/08/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients’ safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03594-9.
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Affiliation(s)
- Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Cristian Secchi
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Federica Ferraguti
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Marco Minelli
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Isotta Landi
- Department of Psychology and Cognitive Sciences, University of Trento, Royereto, Italy
| | - Giulio Guarino
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
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Liu X, Goldenthal S, Li M, Nassiri S, Steppe E, Ellimoottil C. Comparison of Telemedicine Versus In-Person Visits on Impact of Downstream Utilization of Care. Telemed J E Health 2021; 27:1099-1104. [PMID: 33513056 DOI: 10.1089/tmj.2020.0286] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Telemedicine use has expanded substantially in recent years. Studies evaluating the impact of telemedicine modalities on downstream office visits have demonstrated mixed results. Introduction: We evaluated insurance claims of a large commercial payer, Blue Cross Blue Shield of Michigan (BCBSM), to assess the frequency of follow-up visits following encounters initiated via telemedicine versus in-person. Materials and Methods: We used the BCBSM claim-level data set (2011-2017) to assess encounters in the following places of service: hospital outpatient, doctor's office, patient's home, or psychiatric daycare facility. We identified the primary diagnostic category for 30-day episodes of care using clinical classifications software (CCS) and multilevel clinical classifications software (ML-CCS). Our intervention group consisted of episodes initiated via telemedicine; our control group consisted of episodes initiated in-person. Our primary outcome was the percentage of 30-day episodes with a related visit (encounters occurring within the same period and CCS categories) across CCS categories. Our secondary outcome was the mean related visit rate. Results: The final data set included 4,982,456 patients and 68,148,070 claims, of which 53,853 were telemedicine related. Many episodes did not have related visits (the mean related visit rate was 16%). Telemedicine visits had a higher frequency of related visits across all CCS categories. Discussion: Episodes of care initiated via telemedicine more frequently generate related visits within a 30-day period. This increased health care utilization could represent excessive care or could reflect expanded access to care. Conclusion: Further research should explore the cause of this increased utilization and potential unintended consequences.
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Affiliation(s)
- Xiang Liu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Steven Goldenthal
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Manqi Li
- Department of Technology and Operations, Michigan Ross, Ann Arbor, Michigan, USA
| | - Shima Nassiri
- Department of Technology and Operations, Michigan Ross, Ann Arbor, Michigan, USA
| | - Emma Steppe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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25
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Berg WT, Goldstein M, Melnick AP, Rosenwaks Z. Clinical implications of telemedicine for providers and patients. Fertil Steril 2020; 114:1129-1134. [PMID: 33280717 PMCID: PMC8024108 DOI: 10.1016/j.fertnstert.2020.10.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in paradigm shifts in the delivery of health care. Lockdowns, quarantines, and local mandates forced many physician practices around the United States to move to remote patient visits and adoption of telemedicine. This has several long-term implications in the future practice of medicine. In this review we outline different models of integrating telemedicine into both male and female fertility practices and recommendations on performing video physical examinations. Moving forward we foresee two general models of integration: one conservative, where initial intake and follow-up is performed remotely, and a second model where most visits are performed via video and patients are only seen preoperatively if necessary. We also discuss the impact THAT telemedicine has on coding and billing and our experience with patient satisfaction.
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Affiliation(s)
- William T Berg
- Department of Urology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Alexis P Melnick
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Zev Rosenwaks
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
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26
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Rodriguez Socarrás M, Loeb S, Teoh JYC, Ribal MJ, Bloemberg J, Catto J, N’Dow J, Van Poppel H, Gómez Rivas J. Telemedicine and Smart Working: Recommendations of the European Association of Urology. Eur Urol 2020; 78:812-819. [PMID: 32654801 PMCID: PMC7347487 DOI: 10.1016/j.eururo.2020.06.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
CONTEXT Telemedicine provides remote clinical support using technological tools. It may facilitate health care delivery while reducing unnecessary visits to the clinic. The coronavirus disease 2019 (COVID-19) outbreak has caused an abrupt change in our daily urological practice, converting many of us to be reliant on telehealth. OBJECTIVE To provide practical recommendations for effective use of technological tools in telemedicine. EVIDENCE ACQUISITION A Medline-based and gray literature search was conducted through April 2020. We selected the most relevant articles related to "telemedicine" and "smart working" that could provide important information. EVIDENCE SYNTHESIS Telemedicine refers to the use of electronic information and telecommunications tools to provide remote clinical health care support. Smart working is a model of work that uses new or existing technologies to improve performance. Telemedicine is becoming a useful invaluable tool during and even beyond the COVID-19 pandemic. It is time for us to formalize the place of telemedicine in routine urological practice, and it is our responsibility to adapt and learn about all the tools and possible strategies for their optimal implementation during the pandemic to ensure that the quality of care received by patients and the outcomes of patients and their families are of the highest standard. CONCLUSIONS Telemedicine facilitates specialized urological clinical support at a distance, solves problems of limitations in mobility, reduces unnecessary visits to clinics, and is useful for reducing the risk of viral transmission in the current COVID-19 outbreak. Furthermore, both personal and societal considerations may favor continued use of telemedicine, even beyond the COVID-19 pandemic. PATIENT SUMMARY Telemedicine in urology offers specialized remote clinical support to patients, similar to face-to-face visits. It is very useful for reducing unnecessary visits to the clinic, as well as reducing the risk of contagion in the current coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Maria J. Ribal
- Uro-oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - James N’Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain; Young Academic Urologist-Urotechnology Working Party (ESUT-YAU), European Association of Urology, Arnhem, The Netherlands.
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27
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Gómez Rivas J, Rodríguez-Serrano A, Loeb S, Yuen-Chun Teoh J, Ribal M, Bloemberg J, Catto J, ŃDow J, van Poppel H, González J, Esteban M, Rodriguez Socarrás M. Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations. Actas Urol Esp 2020; 44:644-652. [PMID: 33012592 PMCID: PMC7486047 DOI: 10.1016/j.acuro.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/22/2020] [Indexed: 01/16/2023]
Abstract
Introducción La telemedicina ofrece un soporte clínico remoto utilizando herramientas tecnológicas. Puede facilitar la atención médica al tiempo que reduce las visitas innecesarias a la consulta. La pandemia COVID-19 ha provocado un cambio brusco en nuestra práctica urológica diaria convirtiéndose en algo muy necesario el acto de la teleconsulta. Objetivo Proporcionar recomendaciones prácticas para el uso efectivo de herramientas tecnológicas en telemedicina. Materiales y métodos Se realizó una búsqueda en la literatura en la plataforma Medline hasta abril de 2020; seleccionamos los artículos más relevantes relacionados con «telemedicina» y «trabajo inteligente» que podrían proporcionar información útil. Resultados La telemedicina se refiere al uso de la información electrónica y a las herramientas de telecomunicaciones para proporcionar apoyo clínico remoto a la atención médica. El trabajo inteligente es un modelo de trabajo que utiliza tecnologías nuevas o existentes para mejorar el rendimiento. La telemedicina se está convirtiendo en una herramienta útil y necesaria durante la pandemia COVID-19 e incluso más allá de la misma. Es hora de que formalicemos y demos el lugar que se merece a la telemedicina en nuestra práctica clínica y es nuestra responsabilidad adaptar y conocer todas las herramientas y posibles estrategias para su implementación de una manera óptima, garantizar una atención de calidad a los pacientes y que dicha atención sea percibida por pacientes y familiares como de alto nivel. Conclusiones La telemedicina facilita la atención clínica urológica especializada a distancia y resuelve problemas como las limitaciones en la movilidad o el traslado de los pacientes, reduce las visitas innecesarias a las clínicas y es útil para reducir el riesgo de transmisión viral de la COVID-19.
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28
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Dubin JM, Wyant WA, Balaji NC, Ong WL, Kettache RH, Haffaf M, Zouari S, Santillan D, Autrán Gómez AM, Sadeghi-Nejad H, Loeb S, Borin JF, Gomez Rivas J, Grummet J, Ramasamy R, Teoh JYC. Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study. J Med Internet Res 2020; 22:e21875. [PMID: 33031047 PMCID: PMC7647472 DOI: 10.2196/21875] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/06/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. OBJECTIVE The aim of this study was to investigate current telemedicine usage by urologists, urologists' perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. METHODS We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists' perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. RESULTS A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients' lack of technological comprehension, patients' lack of access to the required technology, and reimbursement concerns. CONCLUSIONS This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists' usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.
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Affiliation(s)
- Justin M Dubin
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - W Austin Wyant
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Navin C Balaji
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - William Lk Ong
- Department of Urology, Penang General Hospital, Penang, Malaysia
| | - Reda H Kettache
- Department of Urology, Bachir Bennacer - Biskra Hospital, Biskra, Algeria
| | - Malik Haffaf
- Department of Urology, EHU 1er Novembre, Oran, Algeria
| | - Skander Zouari
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Diego Santillan
- Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ana Maria Autrán Gómez
- Department of Urology, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
- Research Office of Confederacion Americana de Urologia, Buenos Aires, Argentina
| | - Hossein Sadeghi-Nejad
- Department of Urology, Rutgers New Jersey Medical School, Newark, NJ, United States
- Department of Urology, Hackensack Meridian Health, Hackensack, NJ, United States
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs Medical Center, New York City, NY, United States
| | - James F Borin
- Department of Urology, New York University, New York City, NY, United States
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
- Department of Urology, Autonomous University of Madrid, Madrid, Spain
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jeremy Y C Teoh
- SH Ho Urology Centre, Prince of Wales Hospital, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future. Eur Urol 2020; 78:731-742. [PMID: 32893062 PMCID: PMC7471715 DOI: 10.1016/j.eururo.2020.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. OBJECTIVE To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. EVIDENCE ACQUISITION A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. EVIDENCE SYNTHESIS Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. CONCLUSIONS The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. PATIENT SUMMARY The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.
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Sarmah PB, Broadley GA, Khwaja S, Delves GH. Clinical Safety and Cost-Effectiveness of Follow-up Virtual Clinic for Bladder Outflow Obstruction Surgery. J Endourol 2020; 34:1161-1166. [PMID: 32668986 DOI: 10.1089/end.2020.0319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Bladder outflow obstruction (BOO) surgery is among the most commonly performed urologic procedures. Postoperative assessment consists of physical measurement of uroflowmetry and post-void residual volume, but health systems worldwide have experienced pressures in demand, leading to exploration of greater efficiency in organizing clinic protocols. International Prostate Symptom Score (IPSS) questionnaire measurement has been identified as a tool to predict change in postoperative management. Our institution established a nurse-led follow-up virtual clinic (VC) for patients undergoing BOO surgery based on IPSS measurement. We present the clinical and economic outcomes of this new service. Materials and Methods: Patients with a successful postoperative trial without catheter were contacted by telephone via VC and discharged by a Urology Clinical Nurse Specialist (UCNS) if IPSS was <8. Data were analyzed for IPSS, arrangement of subsequent clinic visits, and numbers discharged. Primary outcome was the proportion of patients discharged after VC consultation. Secondary outcomes were overall discharge rate following subsequent face-to-face (FTF) appointment; and the proportion of patients re-referred from Primary Care within 3 months of discharge from VC. Cost savings were calculated based on tariffs of £135 for first attendance with UCNS, £199 for uroflowmetry, and £47.84 for VC appointment. Results: The first 50 patients to be recipients of the new VC were included. The median IPSS and quality-of-life score were 13 (interquartile range [IQR] 5) and 3 (IQR 1), respectively. Thirty-nine (78%) patients were discharged from VC; 36 (72%) had IPSS <8. Overall discharge rate following subsequent FTF appointment was 88%. Two patients discharged from VC (5.1%) were subsequently re-referred, neither of whom required additional treatment. Total cost savings with VC amounted to £10,634. Conclusion: Telephone follow-up for BOO surgery based on IPSS is clinically safe and cost-effective, providing greater efficiency for clinic protocols.
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Affiliation(s)
| | | | - Sikandar Khwaja
- Department of Urology, Queen's Hospital Burton, Burton-on-Trent, United Kingdom
| | - George Henry Delves
- Department of Urology, Queen's Hospital Burton, Burton-on-Trent, United Kingdom
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31
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Hughes T, Pietropaolo A, Archer M, Davis T, Tear L, Somani BK. Lessons Learnt (Clinical Outcomes and Cost Savings) from Virtual Stone Clinic and Their Application in the Era Post-COVID-19: Prospective Outcomes over a 6-Year Period from a University Teaching Hospital. J Endourol 2020; 35:200-205. [PMID: 32731751 DOI: 10.1089/end.2020.0708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6 ± 1.0 per patient), with a mean age of 57.0 ± 15.8 years (range: 17-92) and a men-women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0 ± 2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2 per patient (93% reduction), equating to a total saving of £12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Matthew Archer
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Tania Davis
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Loretta Tear
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
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Haider Z, Aweid B, Subramanian P, Iranpour F. Telemedicine in orthopaedics and its potential applications during COVID-19 and beyond: A systematic review. J Telemed Telecare 2020; 28:391-403. [PMID: 32762270 PMCID: PMC9124641 DOI: 10.1177/1357633x20938241] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Telemedicine is the delivery of healthcare across a distance using some form of communication technology. The COVID-19 pandemic has led to increased adoption of telemedicine with national orthopaedic governing bodies advocating its use, as evidence suggests that social distancing maybe necessary until 2022. This systematic review aims to explore evidence for telemedicine in orthopaedics to determine its advantages, validity, effectiveness and utilisation. Methods Databases of PubMed, Web of Science, Scopus and CINAHL were systematically searched and articles were included if they involved any form of telephone or video consultation in an orthopaedic population. Findings were synthesised into four themes: patient/clinician satisfaction, accuracy and validity of examination, safety and patient outcomes and cost effectiveness. Quality assessment was undertaken using Cochrane and Joanna Briggs Institute appraisal tools. Results Twenty-one studies were included consisting of nine randomised controlled trials (RCTs). Studies revealed high patient satisfaction with telemedicine for convenience, less waiting and travelling time. Telemedicine was cost effective particularly if patients had to travel long distances, required hospital transport or time off work. No clinically significant differences were found in patient examination nor measurement of patient-reported outcome measures. Telemedicine was reported to be a safe method of consultation. Discussion Evidence suggests that telemedicine in orthopaedics can be safe, cost effective, valid in clinical assessment and with high patient/clinician satisfaction. However, more high-quality RCTs are required to elucidate long-term outcomes. This systematic review presents up-to-date evidence on the use of telemedicine and provides data for organisations considering its use during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Zakir Haider
- Trauma & Orthopaedics, Royal Free London NHS Foundation Trust, Barnet Hospital, London, UK
| | | | | | - Farhad Iranpour
- Trauma & Orthopaedics, Royal Free London NHS Foundation Trust, Barnet Hospital, London, UK
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Baldwin-Medsker A, Holland J, Rodriguez E. Access to Care: Using eHealth to Limit Location-Based Barriers for Patients With Cancer. Clin J Oncol Nurs 2020; 24:16-23. [DOI: 10.1188/20.cjon.s1.16-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gadzinski AJ, Andino JJ, Odisho AY, Watts KL, Gore JL, Ellimoottil C. Telemedicine and eConsults for Hospitalized Patients During COVID-19. Urology 2020; 141:12-14. [PMID: 32330533 PMCID: PMC7172813 DOI: 10.1016/j.urology.2020.04.061] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Juan J Andino
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anobel Y Odisho
- Department of Urology and Center for Digital Health Innovation, University of California, San Francisco, CA
| | - Kara L Watts
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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35
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Kappa SF, McClain C, Wallace K, Cinquina P, Lawson D, Smith MM, Walz E, Edwards B, Kirsh GM. Implementation of a Centralized, Cost-effective Call Center in a Large Urology Community Practice. Rev Urol 2020; 22:67-74. [PMID: 32760230 PMCID: PMC7393684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Call centers provide front-line care and service to patients. This study compared call-answering efficiency and costs between the implementation of an internal, centralized call center (January to July 2019) and previously outsourced call-center services (January to July 2018) for a large urology community practice. Retrospective review of call metrics and cost data was performed. Internal call-center leadership, training, and culture was examined through survey of staff and management. A total of 299,028 calls with an average of 5751 calls per week were answered during the study periods. The Average Speed of Answer (ASA) was 1:42 (min:s) for the outsourced call center and 0:14 for the internal call center (P < 0.001), with 70% of outsourced calls answered under 2 minutes compared with 99% of calls for the internal call center (P < 0.001). The Average Handle Time (AHT) for each outsourced call was 5:32 versus 3:41 for the internal call center (P < 0.001). The total operating expenses were 7.7% lower for the internal call center. Surveys revealed the importance of engaged leadership and staff training with feedback, simplified work algorithms, and expanded clinical roles. We found that internal, centralized call centers may provide a call-answering solution with greater efficiency and lower total operating expense versus an outsourced call center for large surgical practices. A culture that emphasizes continuous improvement and empowers call-center staff with expanded clinical roles may ultimately enhance patient communication and service.
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