1
|
Lim C, Wu W, La J, Chan V, Schubach KM, Duns G, Lantsberg D, Katz DJ. Direct-to-Consumer Telemedicine Practices in the Health and Fertility of Men: A Systematic Review of the Literature. World J Mens Health 2024; 42:148-156. [PMID: 37652657 PMCID: PMC10782129 DOI: 10.5534/wjmh.230057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE Men are increasingly turning toward online direct-to-consumer (DTC) men's health platforms to fulfill their health needs. Research surrounding these platforms is lacking and the motivations and predictors underlying this online health-seeking behavior is largely unknown. This review scopes the existing literature concerning DTC men's health and identifies factors influencing engagement, as well as health outcomes of this platform. MATERIALS AND METHODS A structured search was performed following PRISMA guidelines. CINAHL via EBSCO, Embase, MEDLINE via Ovid, PsycINFO, PubMed and Web of Science were searched. RESULTS Peer-reviewed quantitative and qualitative studies with a focus on demographics and characteristics of those using DTC men's health platforms, as well as studies related to patient outcomes using such platforms, were included. Ten of the 3,003 studies identified met the inclusion and exclusion criteria. Four cross-sectional descriptive studies evaluated the motivations behind men's engagement with DTC platforms. Convenience, embarrassment and health motivation were identified as predominant factors associated with DTC platform use. The review identified a lack of qualitative studies, and major limitations were noted in the quantitative studies that impacted the accuracy of findings. Six further quantitative studies explored the quality of care provided by DTC platforms. DTC platforms were found to have a varying level of adherence to established clinical guidelines, but appeared to provide satisfactory patient outcomes with low levels of patient-reported side effects and adverse events. CONCLUSIONS There is a lack of research within the DTC men's health space given the infancy of the field. Important predictors and motivations underlying men's choices in accessing these platforms have been noted across several studies. However, further studies need to be conducted to investigate the psychosocial underpinnings of this behavior. Studies across a wider variety of male health conditions treated by these platforms will also help to provide insights to guide patient-centered care within the DTC landscape.
Collapse
Affiliation(s)
- Christopher Lim
- Department of Urology, Western Health, St Albans, Australia.
| | - Winston Wu
- Department of Urology, Western Health, St Albans, Australia
| | - Justin La
- Department of Urology, Kaiser Permanente San Rafael Medical Center, San Rafael, CA, USA
| | | | | | - Glenn Duns
- Men's Health Melbourne, Melbourne, Australia
| | - Daniel Lantsberg
- Men's Health Melbourne, Melbourne, Australia
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Australia
- Melbourne IVF, East Melbourne, Australia
| | - Darren J Katz
- Department of Urology, Western Health, St Albans, Australia
- Men's Health Melbourne, Melbourne, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Parkville, Australia
| |
Collapse
|
2
|
Wexler A, Dubinskaya A, Suyama J, Komisaruk BR, Anger J, Eilber K. Does MDMA have treatment potential in sexual dysfunction? A systematic review of outcomes across the female and male sexual response cycles. Sex Med Rev 2023; 12:26-34. [PMID: 37888490 DOI: 10.1093/sxmrev/qead046] [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: 08/07/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Sexual health, an integral component of overall well-being, is frequently compromised by common yet underdiagnosed sexual dysfunctions. Traditional interventions encompass pharmaceutical and psychological treatments. Unconventional therapies, like MDMA, offer hope for sexual dysfunction. This review delves into MDMA's effects on sexual responsiveness and its potential role in treating sexual dysfunction. OBJECTIVES The purpose of this review is to elucidate effects of MDMA on different domains of the female and male sexual response cycles. METHODS We conducted a systematic review on the effects of MDMA on each domain of the female and male sexual response cycles. PubMed, MEDLINE, and EMBASE were queried, and results were screened using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms utilized were "MDMA" or "ecstasy" in combination with "desire," "arousal," "lubrication," "orgasm," "pleasure," "libido," "erection," and "ejaculation." Inclusion criteria for this review were MDMA use by study subjects and sexual outcomes in at least 1 domain of the female and/or male sexual response cycles were described and measured. Randomized controlled trials, cohort studies (both prospective and retrospective), surveys, and literature reviews published between January 2000 and June 2022 were included. Case reports and studies that did not address conditions of interest were excluded from analysis. Duplicated search results were screened out. The remaining studies were then read in full text to ensure they met inclusion and exclusion criteria for analysis. RESULTS We identified 181 studies, of which 6 met criteria for assessment of the female sexual response cycle and 8 met criteria for assessment of the male sexual response cycle. Four of 6 studies reported increased sexual desire with MDMA use among women. Arousal and lubrication were improved with MDMA use in 3 of 4 studies, but they were not affected in 1 randomized control study. In men, 7 studies evaluated the effects of MDMA on desire and/or arousal, 5 studies measured impact on erection, 3 on orgasm, and 2 on ejaculation. Sixty percent of interview-based studies reported increased sexual desire in men, while 40% reported mixed or no effect. Two studies reported impairment of erection, 2 reported mixed effects, and 1 reported fear of erection impairment. In both men and women, all studies evaluating orgasm reported delay in achieving orgasm but increased intensity and pleasure if achieved. Primary outcome measures were variable and largely qualitative. CONCLUSION Our findings suggest that MDMA generally increases sexual desire and intensifies orgasm when achieved. While producing conflicting evidence on sexual arousal in both sexes, MDMA may impair erectile and ejaculatory function in men.
Collapse
Affiliation(s)
- Ava Wexler
- The Hebrew University- Hadassah Medical School, Jerusalem, 9112001, Israel
| | - Alexandra Dubinskaya
- Los Angeles Institute for Pelvic and Sexual Medicine, Beverly Hills, CA, 90210, United States
| | - Julie Suyama
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, 90213, United States
| | - Barry R Komisaruk
- Psychology Department, Rutgers University, Newark, NJ, 07102, United States
| | - Jennifer Anger
- Division of Gender Affirming Surgery, Urologic Reconstruction, and Female Pelvic Medicine, Department of Urology, University of California San Diego, La Jolla, CA, 92093, United States
| | - Karyn Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Beverly Hills, 90048, CA, United States
| |
Collapse
|
3
|
Abeck F, Kött J, Bertlich M, Wiesenhütter I, Schröder F, Hansen I, Schneider SW, von Büren J. Direct-to-Consumer Teledermatology in Germany: A Retrospective Analysis of 1,999 Teleconsultations Suggests Positive Impact on Patient Care. Telemed J E Health 2023; 29:1484-1491. [PMID: 36862525 DOI: 10.1089/tmj.2022.0472] [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] [Indexed: 03/03/2023] Open
Abstract
Background: There is a high demand for dermatological care in Germany. As use of teledermatology has increased significantly, this study aimed to investigate the impact of teledermatology on patient care. Methods: This retrospective cross-sectional study used data from a direct-to-consumer teledermatology platform using store-and-forward technology available in Germany between July 2021 and April 2022. Additional patient characteristics were collected using a voluntary follow-up questionnaire, 28 days after teleconsultation. Results: Data of 1,999 enrolled patients were evaluated. Patients had a mean age of 36 years, and 61.2% (1,223/1,999) lived in a rural residence. The most common diagnoses included eczema (36.0%, 701/1,946), fungal diseases (15.4%, 299/1,946), and acne (12.5%, 243/1,946). The follow-up questionnaire was answered by 166 patients (8.3%, 166/1,999). In total, 42.8% (71/166) of patients had undergone no previous medical consultation. The most frequent reason for using teledermatology was the waiting time for a dermatology outpatient appointment (62.0%, 103/166). A total of 62.0% (103/166) participants rated the treatment success as good or very good, while 86.1% (143/166) rated the quality of telemedical care as equal or better to that of an outpatient visit. Conclusion: This study showed that patients often use teledermatology because of functional barriers (waiting times). In this cohort, the diagnoses strongly corresponded to reasons for outpatient presentation. Most patients rated the quality of teledermatology service as at least equivalent to that of outpatient physician visits and reported treatment success. Thus, teledermatology can relieve the burden of outpatient care while providing high benefits from the patient's perspective.
Collapse
Affiliation(s)
- Finn Abeck
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Kött
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mattis Bertlich
- Department of Dermatology and Allergology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Isabell Wiesenhütter
- Munich University Institute for Psychotherapy Training (MUNIP), Munich, Germany
- Wellster Healthtech Group, Munich, Germany
| | | | - Inga Hansen
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
4
|
von Büren M, Wülfing C, Brookman-May SD, Gratzke C, von Büren J. Reply to Eugenio Ventimiglia, Andrea Salonia, and Francesco Montorsi's Letter to the Editor re: Moritz von Büren, Severin Rodler, Isabell Wiesenhütter, et al. Digital Real-world Data Suggest Patient Preference for Tadalafil over Sildenafil in Patients with Erectile Dysfunction. Eur Urol Focus 2022;8:794-802. Eur Urol Focus 2023; 9:846-847. [PMID: 37061364 DOI: 10.1016/j.euf.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Moritz von Büren
- Department of Urology, University of Freiburg, Freiburg, Germany.
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany; Wellster Healthtech Group, Munich, Germany
| | - Sabine D Brookman-May
- Wellster Healthtech Group, Munich, Germany; Janssen Research and Development, LLC, Spring House, PA, USA; Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | |
Collapse
|
5
|
Brink SM, Iarajuli T, Shin D. Characteristics of direct-to-consumer platforms offering erectile dysfunction treatment. Sex Med 2023; 11:qfad038. [PMID: 37547870 PMCID: PMC10397420 DOI: 10.1093/sexmed/qfad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023] Open
Abstract
Background Due to the sensitivity and potential embarrassment of discussing erectile dysfunction (ED) in person, men are seeking treatment online. Aims We sought to compare offerings of direct-to-consumer (DTC) platforms for ED treatment with respect to consultation, pricing, services, and privacy policy. Methods Google was queried to identify DTC platforms offering ED treatment with the keywords: "telehealth erectile dysfunction," "telemedicine erectile dysfunction," and "online erectile dysfunction." Inclusion criteria were as follows: serving a majority of U.S. states, existing online only, providing both the consultation and prescription for phosphodiesterase type 5 inhibitors, and delivering the prescription to the patient. Results Fifteen DTC platforms met criteria. Ten provided free consultations; 4 bundled the consultation fee with the first month of the prescription, with 1 of these functioning as a subscription service. Fourteen (93%) relied on online intake forms and 10 (67%) advertised review by the prescriber within 2 business days. Only 4 (27%) platforms explicitly advertised physician-only consults. Direct contact with the prescriber would only occur if needed or if required by state law at 8 (53%) platforms. Purchasing sildenafil and tadalafil was advertised on all platforms. Minimum prices of sildenafil ranged from $0.50 to $35/pill (mean $5.16/pill, median $2.65/pill); tadalafil ranged from $0.50 to $9.80/pill (mean $4.70/pill, median $3.21/pill). In addition to ED therapy, 13 (86%) platforms offered treatment for other men's health issues. All platforms included a website privacy policy, but only 10 (67%) mentioned Health Insurance Portability and Accountability Act compliance, with 2 of these claiming to not be covered entities. Conclusion Although DTC platforms are transparent with phosphodiesterase type 5 inhibitor medication and subscription pricing information, few offer direct contact with a physician to further discuss issues related to ED after completion of the online intake form. For comprehensive evaluation of ED in Health Insurance Portability and Accountability Act-compliant settings, in-person or telemedicine visits should be arranged with men's physicians.
Collapse
Affiliation(s)
- Sarah M Brink
- Department of Urology, Hackensack University Medical Center, 360 Essex Street, Suite 403, Hackensack, NJ 07601, United States
| | - Teona Iarajuli
- Department of Urology, Hackensack Meridian School of Medicine, 123 Metro Boulevard, Suite 4100, Nutley, NJ 07110, United States
| | - David Shin
- Corresponding author: HUMG Department of Urology, 360 Essex Street, Suite 403, Hackensack, NJ 07601, United States.
| |
Collapse
|
6
|
Huber J, Borgmann H, Miller K, Merseburger AS, Krege S, Gratzke C. [Urology 2030: Why it is key to promote digitisation in urology today to maintain medical care in the future - an expert consensus]. Aktuelle Urol 2023; 54:213-219. [PMID: 37224859 DOI: 10.1055/a-2071-4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Due to demographic change associated with an increase in patient numbers as well as the existing shortage of medical personnel, the German healthcare system will face a major challenge in patient care. In order to maintain high-quality patient care at a high level, the digitisation of urology should be driven forward promptly and forcefully as digital applications such as online appointment scheduling, video consultations, digital health applications (DiGAs) and others could significantly improve treatment efficiency. The long-planned introduction of the electronic patient record (ePA) will hopefully accelerate this process, and medical online platforms could also become a permanent part of new treatment methods, which could emerge from the urgently needed structural change towards more digital medicine, including questionnaire-based telemedicine. This transformation, which, already today, is urgently needed in the healthcare system, must be demanded and promoted by service providers, but also by policymakers and administration, in order to achieve the positive development of digitisation in (urological) medicine.
Collapse
Affiliation(s)
- Johannes Huber
- Klinik für Urologie, Philipps-Universität Marburg, Marburg, Germany
| | - Hendrik Borgmann
- Klinik und Poliklinik für Urologie, Johannes Gutenberg Universitat Universitatsmedizin, Mainz, Germany
| | - Kurt Miller
- Urologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Axel S Merseburger
- Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Susanne Krege
- Klinik für Urologie, Kinderurologie & Urologische Onkologie, Evang. Kliniken Essen-Mitte Evang. Huyssens-Stiftung Essen-Huttrop, Essen, Germany
| | - Christian Gratzke
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Germany
| |
Collapse
|
7
|
Amin R, Cato M, Rahavi S, Tran K, Lee K, Lobo E, Mill D, Page A, Salter S. Is It Safe to Buy Medications from an App? Evaluation of Medication Prescribing Applications Available in Australia. PHARMACY 2023; 11:49. [PMID: 36961027 PMCID: PMC10037640 DOI: 10.3390/pharmacy11020049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
Prescription request applications (apps) have changed the way consumers can obtain prescription-only medications. However, there is a lack of research surrounding such apps and their potential risks to consumers. We conducted an Australian study to (1) identify and characterise prescription request apps available in Australia and (2) assess whether prescription request apps in Australia adhere to guidelines for safe prescribing. Three online platforms (iOS App Store, Google Play store and Google search engine) were searched using 14 different search terms. Prescription request apps were identified based on pre-defined inclusion criteria. To determine whether the prescription request apps adhere to a safe prescribing framework, five medications were selected, and their corresponding consultation questionnaires were assessed against the Australian National Prescribing Service MedicineWise 12 core competencies for safe prescribing. A total of seven prescription request apps were identified. Assessment of the prescription request apps revealed that none of the apps provided prescribers with sufficient information to meet all the competencies required for safe prescribing; rather, they inconsistently adhered to the safe prescribing framework. Thus, consumers and healthcare professionals should consider the implications and safety concerns of obtaining medications via prescription request apps.
Collapse
Affiliation(s)
- Riya Amin
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| | - Melissa Cato
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| | - Sasha Rahavi
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| | - Kristin Tran
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| | - Elton Lobo
- Department of General Practice, The University of Melbourne, Melbourne, VIC 3010, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC 3220, Australia
| | - Deanna Mill
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| | - Amy Page
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| | - Sandra Salter
- School of Allied Health, The University of Western Australia, Crawley, WA 6009, Australia (K.L.)
| |
Collapse
|
8
|
Lafortune D, Girard M, Dussault É, Philibert M, Hébert M, Boislard MA, Goyette M, Godbout N. Who seeks sex therapy? Sexual dysfunction prevalence and correlates, and help-seeking among clinical and community samples. PLoS One 2023; 18:e0282618. [PMID: 36877709 PMCID: PMC9987801 DOI: 10.1371/journal.pone.0282618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/20/2023] [Indexed: 03/07/2023] Open
Abstract
Sexual dysfunctions (SD; e.g., female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, genito-pelvic pain/penetration disorder, etc.) affect up to a third of individuals, impairing sexuality, intimate relationships, and mental health. This study aimed to compare the prevalence of SDs and their sexual, relational, and psychological correlates between a sample of adults consulting in sex therapy (n = 963) and a community-based sample (n = 1,891), as well as examine barriers to sexual health services for SD and the characteristics of individuals seeking such services. Participants completed an online survey. Analyses showed that participants in the clinical sample reported lower levels of sexual functioning and sexual satisfaction and higher levels of psychological distress than participants in the community-based sample. Moreover, higher SD rates were related to lower relational satisfaction and higher psychological distress in the community sample, and to lower sexual satisfaction in both samples. Among participants in the community sample who sought professional services for SD, 39.6% reported that they were unable to access services, and 58.7% reported at least one barrier to receiving help. This study provides important data regarding the prevalence of SD and the link between SD and psychosexual health in clinical and nonclinical samples, as well as barriers to treatment access.
Collapse
Affiliation(s)
- David Lafortune
- Department of Sexology, Université du Québec à Montréal, Québec, Canada
- * E-mail:
| | - Marianne Girard
- Department of Sexology, Université du Québec à Montréal, Québec, Canada
| | - Éliane Dussault
- Department of Sexology, Université du Québec à Montréal, Québec, Canada
| | - Mathieu Philibert
- Department of Sexology, Université du Québec à Montréal, Québec, Canada
| | - Martine Hébert
- Department of Sexology, Université du Québec à Montréal, Québec, Canada
| | | | - Mathieu Goyette
- Department of Sexology, Université du Québec à Montréal, Québec, Canada
| | - Natacha Godbout
- Department of Sexology, Université du Québec à Montréal, Québec, Canada
| |
Collapse
|
9
|
von Büren M, Rodler S, Wiesenhütter I, Schröder F, Buchner A, Stief C, Gratzke C, Wülfing C, von Büren J. Digital Real-world Data Suggest Patient Preference for Tadalafil over Sildenafil in Patients with Erectile Dysfunction. Eur Urol Focus 2022; 8:794-802. [PMID: 34006491 DOI: 10.1016/j.euf.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is a major care problem worldwide. Tadalafil and sildenafil are the two most common phosphodiesterase-5 inhibitors (PDE5is) used to treat ED. OBJECTIVE This study aimed to evaluate patient data of a large online prescription platform (OPP), specifically analyzing preference for tadalafil over sildenafil. DESIGN, SETTING, AND PARTICIPANTS Data from a prospectively collected German OPP were retrospectively analyzed. This dataset included patients with a history of taking one or both substances (n = 26 821). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS ED patient baseline characteristics were derived from medical questionnaires for PDE5i prescriptions between May 2019 and May 2020. Order behavior was analyzed in patients who ordered both substances over time. We applied Kruskal-Wallis tests, χ² tests, and fisher's exact tests for statistical analysis. RESULTS AND LIMITATIONS Baseline characteristics were comparable for both PDE5is in patients with a median age of 49 yr (sildenafil [interquartile range {IQR} 38-57]; tadalafil [IQR 39-56]), a median body mass index (BMI) of 26 kg/m² (sildenafil [IQR 24.54-29.03]; tadalafil [IQR 24.49-28.69]), ED onset time of >12 mo (sildenafil [87%]; tadalafil [88%]), and the presence of morning erections (sildenafil [62%]; tadalafil [61%]). Tadalafil prescriptions increased significantly from 30% (first order) to 80% (last order) in patients who had already tested both drugs. Patients with age ≤40 yr, BMI ≤25 kg/m², and sustained morning erections preferred tadalafil to sildenafil. CONCLUSIONS Using database information from an OPP, preference for tadalafil was shown for patients who had tested both PDE5is. This preference was particularly pronounced in patients with age ≤40 yr, BMI ≤25 kg/m², and sustained morning erections. A well-managed OPP can be used for research on more complex health services. PATIENT SUMMARY Analysis of large online prescription platforms provide the benefit of identifying young treatment-naïve patients with early-stage disease, which is highlighted by the fact that about two-thirds of our patients analyzed still maintained spontaneous morning erections. Patients who had tested tadalafil once developed preference for this drug.
Collapse
Affiliation(s)
- Moritz von Büren
- Department of Urology, University of Freiburg, Freiburg, Germany.
| | - Severin Rodler
- Department of Urology, University of Munich, Munich, Germany
| | - Isabell Wiesenhütter
- Munich University Institute for Psychological Psychotherapy Training (MUNIP), Munich, Germany
| | | | | | - Christian Stief
- Department of Urology, University of Munich, Munich, Germany
| | | | | | | |
Collapse
|
10
|
Contemporary cost-analysis comparison of direct-to-consumer vs. traditional prescriptions of phosphodiesterase-5 inhibitors. Int J Impot Res 2022:10.1038/s41443-022-00567-3. [PMID: 35397646 PMCID: PMC8994416 DOI: 10.1038/s41443-022-00567-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/21/2022] [Accepted: 03/17/2022] [Indexed: 02/08/2023]
Abstract
After a focused telehealth visit, patients can now access phosphodiesterase-5 inhibitor (PDE5 inhibitor) prescriptions through online direct-to-consumer (DTC) healthcare companies. This study seeks to quantify the cost of DTC PDE5 inhibitor treatment compared to a traditional physician visit and local pharmacy prescription. Two DTC companies, two compounding pharmacies with national reach, three online Canadian pharmacies, and sixteen American pharmacy chains were queried for prices of 90-day regimens of common PDE5 inhibitors. Prices for chains were determined using their publicly available price on GoodRx® with coupon. Cost of physician visit was determined using 2020 Center for Medicare and Medicaid Services reimbursement for a level 3 new patient visit. For sildenafil 20 mg, a physician visit and local prescription cost a low of $125.45 compared to $144.35 for compounding, $169.34 for Canadian, and $195.00 for DTC. For sildenafil 100 mg, a physician visit and local prescription cost a low of $137.16 compared to $289.35 for compounding, $200.36 for Canadian, and $900.00 for DTC. For tadalafil 5 mg, a physician visit and local prescription cost a low of $125.80 compared to $169.35 for compounding, $195.34 for Canadian, and $720.00 for DTC. For tadalafil 20 mg, a physician visit and local prescription cost a low of $161.00 compared to $289.35 for compounding, $229.00 for Canadian, and $2880.00 for DTC. Thus, local pharmacies, in conjunction with online coupons, consistently provide a markedly less-expensive option for fulfillment of PDE5 inhibitor prescriptions than online DTC services.
Collapse
|
11
|
[Opportunities and risks of telemedicine in urology]. Urologe A 2022; 61:117-124. [PMID: 35129625 PMCID: PMC8831261 DOI: 10.1007/s00120-022-01759-x] [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: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Die Telemedizin in Deutschland ist auf dem Vormarsch. Die gesetzlichen Rahmenbedingungen für die Telemedizin sind seit 2018 sehr vorangetrieben worden. Neben dem Terminservice- und Versorgungsgesetz (TSVG) traten das Digitale-Versorgung-Gesetz (DVG) und das Patientendaten-Schutz-Gesetz (PDSG) sowie das Krankenhauszukunftsgesetz (KHZG) in Kraft. Auf der Anbieterseite kommen nun besonders die digitalen Gesundheitsanwendungen (DiGA), die zukünftig als „App auf Rezept“ verfügbar und von den Kostenträgern erstattbar sein werden, in den Markt (inklusive urologischer Anwendungen). Ebenso ist die Videosprechstunde nicht zuletzt durch die Coronapandemie sehr vorangekommen und dabei, sich weiter zu etablieren. Auch die elektronische Patientenakte (ePA) wird hoffentlich in hoher Geschwindigkeit umfassend verfügbar sein und genutzt werden, weil hierdurch ein starker Effizienzschub in der täglichen Arbeit eintreten wird. Dieses wird ergänzt durch das E‑Rezept und weitere Innovationen im Bereich der Medikamentenversorgung und -zustellung, die diese Entwicklung unterstützen werden. Als Herausforderungen im Umsetzungsprozess der Telemedizin bleiben v. a. die sehr wichtigen Aspekte des Datenschutzes, der Datensicherheit und die Problematik der Interoperabilität erhalten, werden hoffentlich aber den Fortschritt, der dringend benötigt wird, nicht sonderlich abbremsen. Urologinnen und Urologen werden durch die Fortschritte in der Digitalisierung der Medizin und der Urologie einen erheblichen Effizienzgewinn in der täglichen Arbeit erreichen.
Collapse
|
12
|
Patel PM, Slovacek H, Pahouja G, Patel HD, Cao D, Emerson J, Kansal J, Prebay Z, Medairos R, Doolittle J, Bresler L, Levine LA, Guise A, Bajic P. Socioeconomic Disparities and Risk Factors in Patients Presenting With Ischemic Priapism: A Multi-Institutional Study. Urology 2021; 163:50-55. [PMID: 34293374 DOI: 10.1016/j.urology.2021.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/20/2021] [Accepted: 03/05/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate contemporary clinical presentations of priapism, their association with socioeconomic characteristics, and the role of prescribing providers in priapism episodes in a large cohort of patients managed at 3 major academic health systems. METHODS We identified all consecutive patients presenting with ischemic priapism to the emergency departments of three major academic health systems (2014 -2019). Demographic characteristics, priapism etiologies, and clinical management were evaluated. Univariable and multivariable analyses were used to assess the contribution of socioeconomic characteristics and the role of prescribing providers in priapism episodes. RESULTS We identified 102 individuals with a total of 181 priapism encounters. Hispanic race, lower income quartile, sickle-cell disease, and illicit drug use were associated with increased risk of recurrent episodes. Of ICI users, 57% received their prescriptions from non-urological medical professionals (NUMPs); the proportion with recurrent episodes was higher for NUMPs compared to urologists (24% vs 0%, P = 0.06) with no demographic differences identified between patients treated by either group. CONCLUSION Socioeconomic disparities exist among patients presenting with recurrent episodes of priapism, potentially highlighting systemic issues with access to care and patient education. With most patients who developed ischemic priapism from ICI being prescribed these medications by NUMPs, further investigation is required to elucidate the prescribing and counseling patterns of these providers. Increased awareness of disparities and complications may improve patient safety.
Collapse
Affiliation(s)
- Parth M Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Hannah Slovacek
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Gaurav Pahouja
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - David Cao
- Division of Urology, Rush University Medical Center, Chicago, Illinois
| | - Jacob Emerson
- Division of Urology, Rush University Medical Center, Chicago, Illinois
| | - Jagan Kansal
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zachary Prebay
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Medairos
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Larissa Bresler
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, Illinois
| | - Amy Guise
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
13
|
Rabinowitz MJ, Kohn TP, Ellimoottil C, Alam R, Liu JL, Herati AS. The Impact of Telemedicine on Sexual Medicine at a Major Academic Center During the COVID-19 Pandemic. Sex Med 2021; 9:100366. [PMID: 34049265 PMCID: PMC8240353 DOI: 10.1016/j.esxm.2021.100366] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Telemedicine has the potential to improve access to care; however, its utility in the field of sexual medicine remains in question. AIM To examine the importance of video visits for the treatment of male sexual medicine at our academic center during the period of peak telemedicine use in April 2020. METHODS We collected and compared deidentified data from all nonprocedure, adult outpatient encounters conducted as either office visits in April 2019 (n = 1,949) or video visits in April 2020 (n = 608). The primary International Classification of Diseases codes (ICD-10) labeled as diagnoses from all encounters were collected, with most encounters linked to several disease codes (n = 4,584). Demographic data were also collected. We performed comparative analyses on Stata (College Station, TX, USA) with significance set at α = .05. MAIN OUTCOME MEASURES Disease codes were categorized based on their use and classification in urological care and the proportion that each category made up within the outpatient practice was calculated. RESULTS In comparison to the office visits, which took place in April 2019, male sexual medicine visits in April 2020, during the peak of telemedicine use, made up a significantly larger overall share of our practice (P = .012), defined by relative rises in encounters pertaining to male hypogonadism, infertility, penile abnormalities, and testicular abnormalities. Outpatients seen over video visits were also younger than outpatients seen during the previous year over office visits (58.9 vs 60.8, P = .008). Further, race and ethnicity characteristics in the outpatient population were unaffected during the period of telemedicine use. CONCLUSIONS During the period of historically high telemedicine use following the SARS-CoV-2 outbreak, encounters associated with male sexual medicine made up a significantly larger portion of our outpatient practice. Although the full influence of the COVID-19 pandemic cannot be delineated, our findings suggest telemedicine use is compatible with the field of sexual medicine. Rabinowitz MJ, Kohn TP, Ellimoottil C, et al. The Impact of Telemedicine on Sexual Medicine at a Major Academic Center During the COVID-19 Pandemic. Sex Med 2021;9:100366.
Collapse
Affiliation(s)
- Matthew J Rabinowitz
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chad Ellimoottil
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James L Liu
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amin S Herati
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
14
|
Brimley S, Natale C, Dick B, Pastuszak A, Khera M, Baum N, Raheem OA. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021; 9:289-295. [PMID: 33752994 PMCID: PMC9585225 DOI: 10.1016/j.sxmr.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 01/23/2023]
Abstract
Introduction Although telemedicine (TM) has been available for several decades, the recent increase in its acceptance due to the COVID-19 pandemic has emerged as a valuable solution for the delivery of health care that provides easy, affordable, and convenient communication with urologic patients. Objectives The objective of this study was to highlight limiting factors and provide successful practical solutions to assist urologists in incorporating and maintaining TM in their practices. Methods A thorough literature review was conducted utilizing PubMed, Cochrane library, clinicaltrials.gov, Google Scholar, and Web of Science. Search terms and keywords included “telemedicine” and “urology.” Only articles written or translated into the English language were included. Results A total of 12 peer-reviewed articles were identified that discussed barriers for incorporation of TM in urology. Articles exclusive to the use of TM during the COVID-19 pandemic were also included, as well as American Urological Association and European Urological Association guidelines and Centers for Medicare & Medicaid Services statements and policies regarding TM pertinent to urological practice. Conclusion TM is currently a viable option and fills an unmet need for most practicing urologists, especially during the COVID-19 pandemic, offering insight to the relative ease of transition to online clinical practice. OA Raheem, S Brimley, C Natale, et al. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021;9:289–295.
Collapse
Affiliation(s)
- Scott Brimley
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Caleb Natale
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Brian Dick
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Neil Baum
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA, USA.
| |
Collapse
|