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Karabulut I, Demirdogen SO, Ramazanoglu MA, Sam E, Cinislioglu AE, Al S, Altay MS, Yilmazel FK, Bicaklioglu F, Aydin HR, Adanur S. Desires and attitudes of outpatients and physicians regarding the use of teleurology during the pandemic: a prospective survey study. Aktuelle Urol 2024; 55:430-438. [PMID: 35172348 DOI: 10.1055/a-1648-2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It is not known to date how many patients admitted to urology outpatient clinics are willing to use telemedicine. We aimed to investigate knowledge levels and attitudes concerning the utilization of teleurology by patients applying to urology outpatient clinics. METHODS This prospective multicentre survey study included 334 patients aged 18-65 years who applied to an urology outpatient clinics. The patients were asked questions about their attitudes and expectations regarding teleurology. Diseases were divided into seven subgroups due to the broad spectrum of diagnoses. Physicians' and patients' opinions on whether it was possible to manage the current medical condition via teleurology were recorded. RESULTS 69.5% of patients stated that they had sufficient technical skills to use teleurology by themselves for medical examination. 55.4% of patients and 78.4% of physicians responded that the existing complaints were suitable for teleurology. Both patients and physicians deemed genital system diseases and urinary tract infections suitable for teleurology (p<0.001, p<0.001 for physicians, and p<0.001, p<0.001 for patients), whereas urine transport, storage and emptying disorders (p=0.003) and benign prostatic hyperplasia (p=0.029) were deemed to be suitable for teleurology only by the physicians. CONCLUSION Our study shows that (i) the majority of our patient population has a telecommunications infrastructure suitable for teleurology, (ii) teleurology has aroused interest among patients, particularly during the pandemic period, and (iii) physicians and patients have high expectations that the problem can be solved with teleurology in suitable patients.
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Affiliation(s)
- Ibrahim Karabulut
- Urology, University of Health Sciences, Regional Training and Research Hospital, Erzurum, Turkey
| | - Saban Oguz Demirdogen
- Urology, University of Health Sciences, Regional Training and Research Hospital, Erzurum, Turkey
| | - Mehmet Akif Ramazanoglu
- Urology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Emre Sam
- Urology, University of Health Sciences, Regional Training and Research Hospital, Erzurum, Turkey
| | - Ahmet Emre Cinislioglu
- Urology, University of Health Sciences, Regional Training and Research Hospital, Erzurum, Turkey
| | - Salih Al
- Urology, Ataturk University Faculty of Medicine, Ezurum, Turkey
| | - Mehmet Sefa Altay
- Urology, University of Health Sciences, Regional Training and Research Hospital, Erzurum, Turkey
| | - Fatih Kursat Yilmazel
- Urology, University of Health Sciences, Regional Training and Research Hospital, Erzurum, Turkey
| | - Fatih Bicaklioglu
- Urology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Hasan Riza Aydin
- Urology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Senol Adanur
- Urology, Ataturk University Faculty of Medicine, Ezurum, Turkey
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Heneka N, Chambers SK, Schaefer I, Carmont K, Parcell M, Wallis S, Walker S, Tuffaha H, Steele M, Dunn J. Acceptability of a virtual prostate cancer survivorship care model in rural Australia: A multi-methods, single-centre feasibility pilot. Aust J Rural Health 2024; 32:815-826. [PMID: 38853378 DOI: 10.1111/ajr.13149] [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: 10/08/2023] [Revised: 04/22/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024] Open
Abstract
DESIGN A multi-methods, single-centre pilot comprising a quasi-experimental pre-/post-test design and an exploratory qualitative study. SETTING A rural Australian hospital and health service. PARTICIPANTS Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. INTERVENTION The intervention comprised a 12-week virtual care program delivered via teleconference by a specialist nurse, using a pre-existing connected care platform. The program was tailored to the post-operative recovery journey targeting post-operative care, psychoeducation, problem-solving and goal setting. MAIN OUTCOME MEASURES Primary outcome: program acceptability. SECONDARY OUTCOMES quality of life; prostate cancer-related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post-intervention (T2); and 12 weeks post-intervention (T3). RESULTS Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. CONCLUSIONS This pilot has shown that a tailored nurse-led virtual care program, incorporating post-surgical follow-up and integrated low-intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes.
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Affiliation(s)
- Nicole Heneka
- University of Southern Queensland, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne K Chambers
- Australian Catholic University, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Isabelle Schaefer
- University of Southern Queensland, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | | | - Michael Steele
- Australian Catholic University, Sydney, New South Wales, Australia
| | - Jeff Dunn
- University of Southern Queensland, Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
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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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Schultis K, Ostdiek-Wille G, Deibert CM. Patient Portal Engagement Affects Postvasectomy Semen Analysis Completion. Urology 2024; 185:137-141. [PMID: 38367713 DOI: 10.1016/j.urology.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To identify factors that affect completion of postvasectomy semen analysis (PVSA) in men receiving telehealth prevasectomy counseling. Telehealth visits have become increasingly common for prevasectomy consultations. Prior studies have shown that men prefer telehealth vasectomy consultations over in-person options. Postvasectomy semen testing should be completed to confirm sterilization. METHODS Three hundred and seventy-one men aged 19 and older who saw a single physician for a telehealth prevasectomy consultation and completed an in-office vasectomy were included in the study. Demographic information such as age, patient relationship status, and distance from the clinic were accessed via electronic medical record. Patients were assessed based on their engagement with electronic preprocedure instructions, and the primary outcome measured was completion of PVSA. RESULTS 45.6% of men completed a PVSA. There was no significant difference in completion of the PVSA between those who opened their electronic instructions before their vasectomy and those who did not (46.1% vs 44.4%, P = .77). Of those who messaged the clinic for any reason at least once after their consultation, 62% completed their PVSA; 41% who did not contact the clinic completed the PVSA (P = .0009). CONCLUSION While there was no difference in completion of PVSA in patients who opened their instructions vs those who did not, patients with a higher level of engagement with the patient portals were more likely to complete their semen test. By understanding factors influencing patient compliance with postvasectomy semen testing, healthcare professionals can develop targeted interventions to ensure safe and successful outcomes.
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Affiliation(s)
- Kaitlyn Schultis
- College of Medicine; University of Nebraska Medical Center, Omaha, NE
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Ungerer GN, Winoker JS, Healy KA, Shah O, Koo K. Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review. Actas Urol Esp 2024; 48:25-41. [PMID: 37364768 DOI: 10.1016/j.acuroe.2023.06.010] [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: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD. METHODS We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies. RESULTS A total of 37 articles were included for analysis. Primary domains of evidence included: 1) "smart" water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes. CONCLUSIONS Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines.
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Affiliation(s)
- G N Ungerer
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - J S Winoker
- Smith Institute for Urology at Lenox Hill, Northwell Health, New York, NY, USA
| | - K A Healy
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - O Shah
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - K Koo
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
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Heneka N, Chambers SK, Schaefer I, Dunn J. Acceptability of a virtual prostate cancer survivorship care model in regional Australia: A qualitative exploratory study. Psychooncology 2023; 32:569-580. [PMID: 36694302 PMCID: PMC10947005 DOI: 10.1002/pon.6101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess the acceptability of a nurse-led prostate cancer survivorship intervention adapted for virtual delivery and tailored to post-surgical care, in a regional Australian hospital and health service. METHODS A qualitative exploratory study using the Theoretical Framework of Acceptability (TFA). RESULTS Twenty-two participants took part in a semistructured interview comprising men who had completed the program (n = 16) and health professionals/service stakeholders involved in program delivery (n = 6). Acceptability of this virtual prostate cancer survivorship care program was very high across all constructs of the TFA, from the perspectives of both program recipients and those delivering the program. The quality of care received was seen as superior to what men had experienced previously (burden, opportunity costs). The time afforded by the regularly scheduled video-consultations allowed men to come to terms with the recovery process in their own time (self-efficacy), and provided an ongoing sense of support and access to care outside the consultation (ethicality). Clinically, the program improved care co-ordination, expedited identification of survivorship care needs, and met service priorities of providing quality care close to home (burden, perceived effectiveness). CONCLUSIONS Findings from this study suggest virtual post-surgical care delivered via videoconferencing is highly acceptable to prostate cancer survivors in a regional setting. Future research exploring virtual program implementation at scale and long-term patient and service outcomes is warranted.
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Affiliation(s)
- Nicole Heneka
- University of Technology SydneyBroadwayNew South WalesAustralia
- University of Southern QueenslandSpringfieldQueenslandAustralia
- Australian Catholic UniversityBrisbaneQueenslandAustralia
| | - Suzanne K. Chambers
- University of Technology SydneyBroadwayNew South WalesAustralia
- Australian Catholic UniversityBrisbaneQueenslandAustralia
| | | | - Jeff Dunn
- University of Southern QueenslandSpringfieldQueenslandAustralia
- Prostate Cancer Foundation of AustraliaSydneyNew South WalesAustralia
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7
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Symeonidis EN, Veneziano D, Borgmann H, Zapała Ł, Zachariou A, Brenneis H, Haensel SM, Haas H, Dimitriadis F. Telemedicine in Urology: Where Have We Been and Where Are We Heading? EUR UROL SUPPL 2023; 50:106-112. [PMID: 36910337 PMCID: PMC9999165 DOI: 10.1016/j.euros.2023.02.005] [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: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Context Humanity is facing significant challenges, and in 2019, a new coronavirus caused an unprecedented global disease outbreak. The coronavirus disease 2019 (COVID-19) pandemic vastly impacted health care delivery, generating devastating economic, social, and public health disruption. Although previously underutilized, it was not until recently that telemedicine emerged and amassed tremendous popularity. Objective To examine and assess telemedicine's past, present, and future roles in urology. Evidence acquisition We queried relevant literature investigating the role of telemedicine in urology using the electronic PubMed database and mainly focused on English-language studies of any design. Evidence synthesis Growing attention has been paid to the widespread adoption of novel telehealth technologies for managing various diseases. Meanwhile, solid evidence supports the meaningful use of telemedicine for most urological diagnoses. Existing literature delineates telemedicine as a viable, safe, and convenient alternative to in-person clinical visits. Conclusions The present article overviews the evolution of telemedicine in urology, and discusses its application in outpatient and physician's office settings. In addition, it highlights the technical, legal, ethical, and financial aspects of telemedicine while providing valuable insights and practical considerations for the future of telehealth in urology. Patient summary Urologists must adopt telemedicine carefully in daily practice, always adhering to predefined regulatory frameworks.
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Affiliation(s)
- Evangelos N Symeonidis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | | | - Hendrik Borgmann
- Department of Urology, University Hospital Medical School Brandenburg, Brandenburg an der Havel, Germany
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | | | - Horst Brenneis
- Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan M Haensel
- Department of Urology, Franciscus Hospital, Rotterdam, The Netherlands
| | | | - Fotios Dimitriadis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Korman A, Ramanathan S, Shen N, Gerndt ZA, Luke N, Wang D, Zhao H, Huang S, Dewar R, Wojno K, Sirls L, Balaraman S, Korman H. The Diagnosis of Urinary Tract Infections Using a Novel At-home Testing Protocol to Enhance Telemedicine: A Retrospective Analysis. Urology 2023; 173:26-31. [PMID: 36638970 DOI: 10.1016/j.urology.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To retrospectively analyze a novel courier-based home urine collection strategy for patients with symptoms of urinary tract infections (UTIs). This model was developed to provide patient care using telehealth during the coronavirus 2019 pandemic. METHODS We analyzed data from 2206 patients with symptomatic UTIs to investigate the efficacy of a home urine collection protocol. The primary outcome was the impact of home versus office collection. RESULTS We analyzed the results of 1112 patient samples collected in-office and 1084 patient samples collected at home. There was no difference in the rate of bacterial identification between females in the office and home collection groups. However, males in the office collection group had a higher rate of bacterial identification (p = .002). The turnaround time was significantly faster in the home collection group than the office collection group (4.08 hours shorter, p < 0.0014). Antibiotic use prior to sample collection was significantly higher in the home collection group for both males (p = .0004) and females (p = .004). Changes in antibiotics were significantly higher in the home collection group than in the office collection group for both males (p = .0009) and females (p = .0006). CONCLUSION Our home collection protocol is a viable method to provide prompt and reliable outpatient care to urology patients suffering from UTIs. Furthermore, this approach resulted in adequate management and quicker turnaround times. Our findings demonstrate the clinical viability of a decentralized healthcare model to treat UTIs.
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Affiliation(s)
- Andrew Korman
- Urology private practice, Comprehensive Urology, Royal Oak, MI, USA.
| | - Siddharth Ramanathan
- Urology private practice, Comprehensive Urology, Royal Oak, MI, USA; Medical school, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nathan Shen
- Urology private practice, Comprehensive Urology, Royal Oak, MI, USA
| | - Zachary A Gerndt
- Urology private practice, Comprehensive Urology, Royal Oak, MI, USA
| | - Natalie Luke
- Medical Research, Education & Outcomes, Pathnostics, Irvine, CA, USA
| | | | | | | | - Rajan Dewar
- Urology private practice, Comprehensive Urology, Royal Oak, MI, USA
| | - Kirk Wojno
- Urology private practice, Comprehensive Urology, Royal Oak, MI, USA
| | - Larry Sirls
- Medical school, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Savitha Balaraman
- Divison of Clinical Hematology & Medical Oncology, Michigan Healthcare Professionals, Farmington, MI, USA
| | - Howard Korman
- Urology private practice, Comprehensive Urology, Royal Oak, MI, USA; Medical school, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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A Randomized Controlled Trial Comparing Telemedicine Versus In-Person Office Visits for the Follow-Up of Overactive Bladder. Female Pelvic Med Reconstr Surg 2022; 28:819-824. [PMID: 35830578 DOI: 10.1097/spv.0000000000001231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Overactive bladder is a condition that may be ideally suited for the use of telemedicine because initial treatment options are behavioral modification and pharmacotherapy. OBJECTIVE We sought to evaluate if there was an overall difference in patient follow-up rates between telemedicine and in-person visits. STUDY DESIGN New patients presenting with overactive bladder from July 2020 to March 2021 were randomized into telemedicine and in-person visits groups. A prospective database was maintained to compare follow-up rates, satisfaction rates, and time commitment. RESULTS Forty-eight patients were randomized, 23 to the telemedicine group and 25 to the in-person visits group. There was no significant difference in follow-up rates between the telemedicine and in-person follow-up groups at 30 days (39% vs 28%, P = 0.41), 60-days (65% vs 56% P = 0.51) or 90 days (78% vs 60%, P = 0.17). There was no significant difference in satisfaction rates between the 2 groups. There was a significant difference between the average telemedicine visit time and in-person visit time (12.1 ± 6.9 minutes vs 22.8 ± 17.1 minutes; P = 0.02). For in-person visits, the average travel time was 49 minutes (interquartile range, 10-90 minutes) and average miles traveled was 22.1 miles (interquartile range, 10-70 miles). CONCLUSIONS There was no significant difference in follow-up or satisfaction rates between telemedicine and in-person visits. Telemedicine visits took half the length of time compared with in-person visits. On average, patients in the telemedicine group saved approximately 1 hour per follow-up visit. Telemedicine visits save both the health care provider and patient significant amounts of time without sacrificing patient satisfaction and follow-up rates.
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Caruso AM, Lin G, Malkowicz SB. Telehealth: An Effective Model of Care for Renal Cancer Surveillance. J Nurse Pract 2022; 18:1086-1090. [PMID: 36267334 PMCID: PMC9561463 DOI: 10.1016/j.nurpra.2022.09.002] [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] [Indexed: 11/03/2022]
Abstract
The coronavirus disease 2019 pandemic presented challenges for urology patients to receive care in the format of a traditional clinic visit. For renal cancer patients, active surveillance and postintervention surveillance are the standard components of management. Telehealth, which was defined as a televideo encounter via the BlueJeans (Verizon) platform (a telehealth platform), was used to ensure continuity of care. Telehealth using the televideo modality was shown to be an effective model of care delivery to provide an optimal patient experience with ease of use.
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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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Leszczynski R, Norori N, Allen S, Persad R, Page T, Cross W, Craske E, Lovett H, Stalbow K. Remote consultations: experiences of UK patients with prostate cancer during the COVID-19 pandemic. Future Oncol 2022; 18:3713-3726. [PMID: 36250591 DOI: 10.2217/fon-2022-0613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: Explore UK prostate cancer patients' experiences and preferences for in-person and remote consultations. Materials & methods: In January-March 2021, patients completed a survey of consultation format preferences. Results: Of 971 patients, most preferred in-person consultations when receiving diagnosis and results (92.3 and 66.5%, respectively) and discussing first and further treatment options (92.0 and 84.0%, respectively). Fewer patients considered follow-up (40.9%) or side effect consultations (47.7%) should be in person. Patients with longer travel preferred telephone consultations for receiving test results post-treatment. Patients over 55 preferred in-person consultations for discussing first treatment. Conclusion: To optimize prostate cancer care in the wake of COVID-19, we recommend patients have the option of consultation format, although key decisions should be made in person.
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Affiliation(s)
| | | | - Steve Allen
- Tackle Prostate Cancer, London, EC1V 2NX, UK
| | - Raj Persad
- North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Toby Page
- Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | | | | | - Henry Lovett
- Formerly of Prostate Cancer UK, London, SE1 2QN, UK
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Patient Satisfaction, Provider Productivity, and Efficacy of a Standardized Preparatory Toolkit With Broad Telemedicine Adaptation in an Outpatient Urology Clinic. Female Pelvic Med Reconstr Surg 2022; 28:567-573. [PMID: 35703263 DOI: 10.1097/spv.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE The COVID-19 pandemic prompted telemedicine adoption. In March 2020, we developed an implementation toolkit with a nursing protocol for patient preparation before tertiary care urology clinic visits. OBJECTIVES Our primary objective was to determine patient satisfaction after implementation of a telemedicine toolkit. Our secondary objective was to assess downstream productivity generated from telehealth visits. STUDY DESIGN We prospectively conducted a postvisit survey that included the Telehealth Usability Questionnaire, a validated survey assessing patient satisfaction, for all patients with documented completion of the nursing protocol to assess patient experience and satisfaction. We then performed a retrospective chart review of all telemedicine visits to determine downstream outcomes, including imaging and procedure scheduling. RESULTS Between April and May 2020, 1,422 visits were completed, of which 265 had complete nursing protocol documentation. Eighteen of 265 (6.8%) reported setup assistance. Four (1.8%) were unsuccessful and converted to a nonvisual phone visit. Overall, 186 (70.1%) completed the Telehealth Usability Questionnaire with a mean score of 118.31 ± 23.44. High satisfaction was reported regardless of race, marital status, income, education, employment status, or travel distance. Younger age ( P = 0.017) and female sex ( P = 0.017) were associated with greater satisfaction. Of 1,422 total visits, imaging was ordered in 29%, office procedures scheduled in 14%, and surgery scheduled in 14%. New visits were more likely to result in procedure and surgery scheduling than returns ( P < 0.0001). CONCLUSIONS Our telemedicine toolkit designed to maximize patient engagement was successful in achieving patient-provider connectivity in 98% of patients with high satisfaction. Telemedicine visits are effective to provide comprehensive urologic care with implications beyond the pandemic.
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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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15
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Chen AJ, Yeh SL, Delfin D, Hoal G, Barron N, Riedinger T, Kashanijou N, Lieland J, Bickel K, O'Connell JB, Ulloa JG. Telemedicine and Vascular Surgery: Expanding Access and Providing Care Through the COVID-19 Pandemic. Am Surg 2022; 88:2561-2564. [PMID: 35722888 PMCID: PMC9209855 DOI: 10.1177/00031348221109464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Access to surgical service is limited by provider availability and geographic
barriers. Telemedicine ensures that patients can access medical care. Objective The objective is to describe our use of telemedicine in delivering vascular
surgery services to remote locations before and during the COVID-19
pandemic. Methods We conducted a retrospective chart review analyzing care delivered at six
vascular surgery telemedicine clinics over a 22-month period. We examined
vascular diagnoses, recommended interventions, referrals placed, and
emergency department visits within 30 days of evaluation. We calculated
travel distance saved for patients between their local clinic and our main
hospital. Results We identified 94 patients and 144 telemedicine visits, with an average of 1.5
visits per patient (SD = 0.73). The most common referrals were for
peripheral artery disease (20.2%) and abdominal aortic aneurysm (14.9%).
Three patients were immediately referred to the emergency department due to
concern for acute limb ischemia (2) or questionable symptomatic AAA (1).
Telemedicine visit recommendations were distributed between no intervention
(n = 30, 31.9%), medical management (n = 41, 43.6%), and surgical
intervention (n = 23, 24.5%). The surgical intervention cohort was most commonly referred to arterial
revascularization (n = 4), venous ablation (n = 4), and arteriovenous
fistula procedures (n = 4). Fourteen patients came to our main hospital for
surgery and four to local providers. Average travel distance saved per
telemedicine visit was 104 miles (SD = 43.7). Conclusions Telemedicine provided safe, efficient care during the COVID-19 pandemic and
saved patients an average of 104 travel miles per visit.
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Affiliation(s)
- Alina J Chen
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Savannah L Yeh
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Diana Delfin
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Graciela Hoal
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Natalie Barron
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Toby Riedinger
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nika Kashanijou
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jessica Lieland
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Katherine Bickel
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jessica B O'Connell
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jesus G Ulloa
- Surgical & Perioperative Careline, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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16
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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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17
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Abstract
PURPOSE OF REVIEW The purpose of this review article is to discuss the impact of Coronavirus Disease 2019 (COVID-19) on the evolution of telemedicine use for urology office visits. RECENT FINDINGS The COVID-19 pandemic has caused a dramatic change in the delivery of healthcare. Fraught with numerous barriers previously, the need for healthcare delivery during a time of social distancing and increased healthcare requirements drove the adoption of telemedicine forward. This 'trial period' over the last year has allowed us to appreciate the potential utility of telehealth-associated services in practice and consider its role even after the pandemic. Multiple studies equating its utility to in-person visits whereas simultaneously providing added convenience and cost-related savings have been published in the urologic literature. Permanent regulatory changes will need to be implemented to allow us the flexibility to use telehealth in the future. SUMMARY It is clear that telemedicine is an effective strategy for delivery of healthcare under the right circumstances. Although it initially started to fill a need out of necessity, it can help us effectively deliver healthcare as long as the regulations surrounding telemedicine allow us to continue to use it. This period has been challenging for healthcare delivery and led to policy changes that served as a catalyst to help us better understand this previously underutilized resource.
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Affiliation(s)
- Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
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18
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Testosterone replacement therapy in the era of telemedicine. Int J Impot Res 2022; 34:663-668. [PMID: 34799712 PMCID: PMC8604198 DOI: 10.1038/s41443-021-00498-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
The events of the 2019 SARS-CoV2 virus pandemic have all but ensured that telemedicine will remain an important aspect of patient care delivery. As health technologies evolve, so must physician practices. Currently, there is limited data on the management of testosterone replacement therapy (TRT) in the era of telemedicine. This review aims to explore the potential benefits and pitfalls of TRT management via telemedicine. We also propose a theoretical framework for TRT management via telemedicine. Telemedicine provides patients and physicians with a new mechanism for American Urological Association guideline-concordant TRT management that can increase patient access to care and provide a safe space for men who may otherwise not have been comfortable with in-person evaluation. However, there are significant limitations to the use of telemedicine for the management of TRT, including the inability to perform a physical exam, inability to administer specific medications, technological barriers, data security, and medical-legal considerations, and both patients and providers should engage in shared decision making before pursuing this approach. Understanding and acknowledging the potential pitfalls of telemedicine for TRT management will enable both patients and providers to achieve optimal outcomes and satisfaction.
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19
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Funk LM, Alagoz E, Jolles SA, Shea GE, Gunter RL, Raffa SD, Voils CI. A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration. Ann Surg 2022; 275:e181-e188. [PMID: 32886462 PMCID: PMC7674184 DOI: 10.1097/sla.0000000000003982] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers. SUMMARY OF BACKGROUND DATA Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration. METHODS We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or "contextual" barriers within Andersen Behavioral Model of Health Services Use. RESULTS Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time. CONCLUSIONS Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.
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Affiliation(s)
- Luke M. Funk
- William S. Middleton VA Memorial Hospital, Madison, WI
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sally A. Jolles
- William S. Middleton VA Memorial Hospital, Madison, WI
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Grace E. Shea
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Rebecca L. Gunter
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Susan D. Raffa
- Department of Veterans Affairs, National Center for Health Promotion and Disease Prevention, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Corrine I. Voils
- William S. Middleton VA Memorial Hospital, Madison, WI
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
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20
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Talal AH, Markatou M, Sofikitou EM, Brown LS, Perumalswami P, Dinani A, Tobin JN. Patient-centered HCV care via telemedicine for individuals on medication for opioid use disorder: Telemedicine for Evaluation, Adherence and Medication for Hepatitis C (TEAM-C). Contemp Clin Trials 2021; 112:106632. [PMID: 34813962 DOI: 10.1016/j.cct.2021.106632] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Telemedicine has the potential to increase healthcare access especially for vulnerable populations. Telemedicine for Evaluation, Adherence, and Medication for Hepatitis C (TEAM-C) is comparing telemedicine access to specialty medical care to usual care for management of hepatitis C virus (HCV) infection among persons with opioid use disorder (PWOUD). PWOUD have the highest hepatitis C virus (HCV) prevalence and incidence, yet they infrequently receive HCV care. The study objectives are to compare access to specialty care via telemedicine to offsite specialty referral (usual care) on 1) treatment initiation, completion, and sustained virological response, 2) patient satisfaction with health care delivery, and 3) HCV reinfection after successful HCV cure. METHODS TEAM-C is a multi-site, non-blinded, randomized pragmatic clinical trial conducted at 12 opioid treatment programs (OTP) throughout New York State that utilizes the stepped-wedge design. The unit of randomization is the OTP with a total sample size of 624 participants. HCV-infected PWOUD were treated via telemedicine or referral. Telemedicine encounters are conducted onsite in the OTP with co-administration of direct acting antivirals for HCV with medications for opioid use disorder. The primary outcome is undetectable HCV RNA obtained 12 weeks post-treatment cessation. We also follow participants for two years to assess for reinfection. CONCLUSIONS The study utilizes a rigorous study design to evaluate the effectiveness and implementation of virtual treatment for HCV integrated into behavioral treatment. We demonstrate the feasibility, engagement principles and lessons learned from the initial prospective randomized trial of telemedicine targeted to a vulnerable population.
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Affiliation(s)
- Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicot Street, Suite 6090, Buffalo, NY 14203, USA.
| | - Marianthi Markatou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Elisavet M Sofikitou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Lawrence S Brown
- START Treatment & Recovery Centers, 22 Chapel Street, Brooklyn, NY 11201, USA.
| | - Ponni Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY, USA; The Rockefeller University, 5 West 37th Street, 10(th) floor, New York, NY 10018, USA.
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21
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Desai C, Pearce I, Modgil V. Performing Sensitive Clinical Examinations During Urological Telemedicine Visits: How to Avoid Pitfalls? Res Rep Urol 2021; 13:739-744. [PMID: 34616694 PMCID: PMC8488042 DOI: 10.2147/rru.s313881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS The impact of coronavirus disease 2019 presented an unprecedented challenge to urological service globally. In many countries, outpatient clinics were cancelled, and the use of telemedicine visits was increased. For urological complaints, the need to perform a sensitive clinical examination via telemedicine posed an unfamiliar environment. Our aim is to explore the clinical and ethical factors involved in performing remote sensitive clinical examinations. METHODS A comprehensive review of literature and guidance from various medical bodies internationally was conducted using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar, and Research Gate in the first week of March 2021 including "COVID-19," "telemedicine," "urology," and "sensitive examinations." RESULTS Telemedicine reduced unnecessary visits to medical facilities and was useful for reducing the risk of transmission during the COVID-19 pandemic. We propose that in order to perform a sensitive clinical examination via telemedicine, the following four steps must be considered: assessment of the clinical need, obtaining informed consent, use of a chaperone, and thorough documentation. CONCLUSION Telemedicine will play a pivotal role in the future of urological practice beyond this present pandemic. However, sensitive clinical examinations using such technology must be performed in appropriate settings and situations. Suitable training, enhanced documentation, communication, and observing information governance guidance will aid in avoiding clinical and ethical pitfalls.
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Affiliation(s)
- Chaitya Desai
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Pearce
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
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22
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Nourian A, Smith N, Kleinman L, Boxer R, Shelton JB. A 5-Year Single-Institution Experience Integrating Telehealth Into Urologic Care Delivery. Telemed J E Health 2021; 27:997-1002. [DOI: 10.1089/tmj.2020.0267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alex Nourian
- Department of Urology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicholas Smith
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
| | - Leonard Kleinman
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Richard Boxer
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jeremy B. Shelton
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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23
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Kornelsen J, Khowaja AR, Av-Gay G, Sullivan E, Parajulee A, Dunnebacke M, Egan D, Balas M, Williamson P. The rural tax: comprehensive out-of-pocket costs associated with patient travel in British Columbia. BMC Health Serv Res 2021; 21:854. [PMID: 34419025 PMCID: PMC8380105 DOI: 10.1186/s12913-021-06833-2] [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: 10/30/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant concern for rural patients is the cost of travel outside of their community for specialist and diagnostic care. Often, these costs are transferred to patients and their families, who also experience stress associated with traveling for care. We sought to examine the rural patient experience by (1) estimating and categorizing the various out of pocket costs associated with traveling for healthcare and (2) describing and measuring patient stress and other experiences associated with traveling to seek care, specifically in relation to household income. METHODS We have designed and administered an online, retrospective, cross-sectional survey seeking to estimate the out-of-pocket (OOP) costs and personal experiences of rural patients associated with traveling to access health care in British Columbia. Respondents were surveyed across five categories: Distance Traveled and Transportation Costs, Accommodation Costs, Co-Traveler Costs, Lost Wages, and Patient Stress. Bivariate relationships between respondent household income and other numerical findings were investigated using one-way ANOVA. RESULTS On average, costs for respondents were $856 and $674 for transport and accommodation, respectively. Strong relationships were found to exist between the distance traveled and total transport costs, as well as between a patient's stress and their household income. Patient perspectives obtained from this survey expressed several related issues, including the physical and psychosocial impacts of travel as well as delayed or diminished care seeking. CONCLUSIONS These key findings highlight the existing inequities between rural and urban patient access to health care and how these inequities are exacerbated by a patient's overall travel-distance and financial status. This study can directly inform policy related efforts towards mitigating the rural-urban gap in access to health care.
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Affiliation(s)
- Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.
| | - Asif Raza Khowaja
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.,Faculty of Applied Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Gal Av-Gay
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Eva Sullivan
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Anshu Parajulee
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Marjorie Dunnebacke
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Dorothy Egan
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Mickey Balas
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Peggy Williamson
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
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24
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Dick H, Doth S, Ernst C, Fischer S, Holderried M. [Current developments on digitalization : Analysis of quality and economics in healthcare]. Urologe A 2021; 60:1141-1149. [PMID: 34347134 PMCID: PMC8335973 DOI: 10.1007/s00120-021-01606-5] [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: 07/07/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Im deutschen Gesundheitssystem und damit auch im Fachgebiet der Urologie gewinnen ökonomische Rahmenbedingungen zunehmend an Bedeutung und parallel dazu werden digitale Anwendungen vermehrt eingesetzt. Fragestellung Die Fragestellung betrifft die gesundheitsökonomische Auseinandersetzung mit den Rahmenbedingungen der Digitalisierung im deutschen Gesundheitssystem sowie ausgewählter Anwendungsbereiche in der Urologie. Material und Methoden Das Gutachten des Sachverständigenrates zur Begutachtung der Entwicklung im Gesundheitswesen (SVR) wird analysiert und eine systematische Literaturanalyse zum Einsatz der strukturierten Befundung und Analyse ausgewählter Literatur zu telemedizinischen Anwendungen in der Urologie unter gesundheitsökonomischen Gesichtspunkten durchgeführt. Ergebnisse Als zentrale Hemmnisse bei der Digitalisierung des deutschen Gesundheitswesens identifiziert der SVR dessen Regulierung und Komplexität sowie den Umgang mit Datenschutz und -sicherheit. Der Einsatz strukturierter Befundung kann Qualität, Effektivität und Effizienz der Befundung in der Urologie steigern. Im Hinblick auf die Kosten können signifikante Einsparungen mit zunehmender Digitalisierung in der Medizin realisiert werden. Schlussfolgerungen Aus medizinischer und gesundheitsökonomischer Perspektive besteht bei der Ausgestaltung von Rahmenbedingungen für digitale Anwendungen im deutschen Gesundheitssystem hinsichtlich der Informationssicherheit und des Datenschutzes weiterer Gestaltungsbedarf. Bei zielgerichtetem Einsatz von digitalen Anwendungen wie der strukturierten Befundung und der Telemedizin können optimale Voraussetzungen für den zunehmenden Einsatz von künstlicher Intelligenz im Fachgebiet der Urologie geschaffen werden.
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Affiliation(s)
- H Dick
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland
| | - S Doth
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland
| | - C Ernst
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland.
| | - S Fischer
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland
| | - M Holderried
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland.,Zentralbereich Medizin: Struktur‑, Prozess- und Qualitätsmanagement, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 6, 72076, Tübingen, Deutschland
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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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26
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Andino J, Zhu A, Chopra Z, Daignault-Newton S, Ellimoottil C, Dupree JM. Video Visits are Practical for the Follow-up and Management of Established Male Infertility Patients. Urology 2021; 154:158-163. [PMID: 34022261 PMCID: PMC9752825 DOI: 10.1016/j.urology.2021.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/31/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the use of video visits for male infertility care prior to the COVID-19 pandemic METHODS: We reviewed video visits for male infertility patients completed at a tertiary academic center in southeast Michigan. These patients had follow-up after an initial in-person evaluation. We designed this retrospective case series to describe the diagnostic categories seen through telehealth, management steps completed during video visits, and to understand whether additional in-person care was required within 90 days of video visits. In addition, we estimated time and cost savings for patients attributed to video visits. RESULTS Most men seen during video visits had an endocrinologic (29%) or anatomic (21%) cause for their infertility. 73% of video visits involved reviewing results; 30% included counseling regarding assistive reproductive technologies; and 25% of video visits resulted in prescribing hormonally active medications. The two patients (3%) who were seen in clinic after their video visit underwent a varicocelectomy in the interim. No patients required an unplanned in-person visit. From a patient perspective, video visits were estimated to save a median of 97 minutes (IQR 64-250) of travel per visit. Median cost savings per patient- by avoiding travel and taking time off work for a clinic visit-were estimated to range from $149 (half day off) to $252 (full day off). CONCLUSION Video visits for established male infertility patients were used to manage different causes of infertility while saving patients time and money. Telehealth for established patients did not trigger additional in-person evaluations.
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Affiliation(s)
- Juan Andino
- Michigan Medicine Department of Urology, Ann Arbor, MI.
| | - Alex Zhu
- Michigan Medicine Department of Urology, Ann Arbor, MI
| | - Zoey Chopra
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Chad Ellimoottil
- Michigan Medicine Department of Urology, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - James M Dupree
- Michigan Medicine Department of Urology, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
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27
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Allen AZ, Zhu D, Shin C, Glassman DT, Abraham N, Watts KL. Patient Satisfaction with Telephone Versus Video-Televisits: A Cross-Sectional Survey of an Urban, Multiethnic Population. Urology 2021; 156:110-116. [PMID: 34333039 DOI: 10.1016/j.urology.2021.05.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice. METHODS A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders. RESULTS A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P = .03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P = .05], labs ordered [OR:2.74 (1.12-6.70); P = .03] and female patient gender [OR:2.28 (1.03-5.03); P = .04] were significantly associated with satisfaction. CONCLUSION Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.
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Affiliation(s)
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Nitya Abraham
- Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Montefiore Medical Center, Bronx, NY; Department of Gynecology, Urogynecology Division, Montefiore Medical Center, Bronx, NY
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Montefiore Medical Center, Bronx, NY.
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28
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The role of technology in the perioperative management of bladder cancer patients. Urol Oncol 2021; 40:466-473. [PMID: 34154900 DOI: 10.1016/j.urolonc.2021.04.020] [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: 08/05/2020] [Revised: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Consumer technology in the form of personal computers, mobile devices, and wearable technology, despite current underutilization, has the potential to greatly enhance the practice of urologic oncology and the surgical care of bladder cancer patients, particularly through the dissemination of educational videos, telemedicine, and the use of wearable technology for patient monitoring. A comprehensive healthcare application can unite all of these features, providing curated educational videos at different timepoints in surgical care, facilitating communication between the patient and the care team, and interfacing with wearable technology and other peripherals to allow for nonintrusive patient monitoring to help facilitate early identification of complications and to follow post-operative patient progress. Here we seek to review the available literature on this topic, discuss our institutional experience, and provide future perspectives in the perioperative management of bladder cancer patients.
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29
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Margolin EJ, Pina Martina LA, Miles CH, Wenske S, McKiernan JM, DeCastro GJ, Hyams ES, Drake CG, Lim EA, Stein MN, Deutsch I, Anderson CB. Telemedicine in management of genitourinary malignancies: Patient and physician perspectives. Urol Oncol 2021; 39:480-486. [PMID: 34092480 DOI: 10.1016/j.urolonc.2021.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The rapid expansion of telemedicine has presented a challenge for the care of patients with genitourinary malignancies. We sought to assess patient and physician perspectives on the use of telemedicine for genitourinary cancer care. METHODS We conducted a prospective cross-sectional study of patients who had telemedicine visits with urology, medical oncology, or radiation oncology for management of genitourinary malignancies from July-August 2020. Patients and physicians each received a questionnaire regarding the telemedicine experience. Responses were scored on a 5-point Likert scale. The primary outcomes of the study were patient and physician satisfaction. RESULTS Of the 115 patients who enrolled, we received 96 patient responses and 46 physician responses. Overall, 77% of patients and 70% of physicians reported being "extremely satisfied" with the telemedicine encounter. Satisfaction was high among all components of the encounter including patient-physician communication, counseling, shared decision making, time spent, timeliness and efficiency, and convenience. Additionally, 78% of patients and 85% of physicians "strongly agreed" that they were able to discuss sensitive topics about cancer care as well as they could at an in-person visit. Nine telemedicine visits (9%) encountered technological barriers. Technological barriers were associated with lower overall satisfaction scores among both patients and physicians (p ≤ 0.01). CONCLUSION We observed high levels of patient and physician satisfaction for telemedicine visits for management of genitourinary malignancies. Technological barriers were encountered by 9% of patients and were associated with decreased satisfaction.
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Affiliation(s)
- Ezra J Margolin
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Luis A Pina Martina
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Caleb H Miles
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Sven Wenske
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - James M McKiernan
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - G Joel DeCastro
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Elias S Hyams
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Charles G Drake
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Emerson A Lim
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Mark N Stein
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Israel Deutsch
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
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30
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Chung E, Jiann BP, Nagao K, Hakim L, Huang W, Lee J, Lin H, Mai DBT, Nguyen Q, Park HJ, Sato Y, Tantiwongse K, Yuan Y, Park K. COVID Pandemic Impact on Healthcare Provision and Patient Psychosocial Distress: A Multi-National Cross-Sectional Survey among Asia-Pacific Countries. World J Mens Health 2021; 39:797-803. [PMID: 34169677 PMCID: PMC8444000 DOI: 10.5534/wjmh.210033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose COVID pandemic significantly affected the delivery and maintenance of healthcare system, resulting in greater utilization of digital health interventions. Materials and Methods This multi-national cross-sectional survey was administered to clinicians working in major Asia-Pacific cities during the mandatory social lockdown period in June 2020. Clinical demographics and professional data, delivery of Andrology-related healthcare services, and patient distress based on validated questionnaires such as Depression and Anxiety Stress Scales (DASS) and Decisional Engagement Scale (DES) were collected. Results Telehealth medicine was instituted in all the centres with the majority of centres (92.9%) reported a 50% or more reduction in out-patient related services. The numbers of phone calls, emails correspondence and educational webinars have significantly increased. Despite the provision of reasons for changes in healthcare service and delay in surgery, more than half of the patients (57.1%) rated 2 on the DASS score for the item on patients over-react to situations, while a third of the patients (35.7%) scored a 2 for DASS item on patients being more demanding or unreasonable. The DES scores were more positive with most patients reported a score above 7 out of 10 in terms of items on accepting current arrangement (85.7%), confident in clinician decision-making about treatment (92.9%) and comfortable that the decision is consistent with their preferences (71.4%). Most patients (85.7%) indicated their preferences for more detailed information on healthcare provision. Conclusions Our study showed telehealth services were integrated early and successfully during the COVID pandemic and patients were generally receptive with minimal psychosocial distress.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, University of Queensland, Brisbane, QLD, Australia.,AndroUrology Centre, Macquarie University Hospital, Sydney, NSW, Australia.
| | - Bang Ping Jiann
- Department of Urology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Koichi Nagao
- Department of Urology, Toho University, Tokyo, Japan
| | - Lukman Hakim
- Department of Urology, Airlangga University, Dr Soetomo Hospital, Surabaya, Indonesia
| | - William Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | - Haocheng Lin
- Department of Urology and Andrology, Peking University Third Hospital, Beijing, China
| | - Dung Ba Tien Mai
- Department of Urology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Quang Nguyen
- Centre of Andrology, Department of Urology, Viet Duc University Hospital, Hanoi, Vietnam
| | - Hyun Jun Park
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | | | - Yiming Yuan
- Andrology Centre, Peking University First Hospital, Peking University, Beijing, China
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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31
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Solomon DL, Dirlikov B, Shem KL, Elliott CS. The Time Burden of Specialty Clinic Visits in Persons With Neurologic Disease: A Case for Universal Telemedicine Coverage. Front Neurol 2021; 12:559024. [PMID: 34017297 PMCID: PMC8130896 DOI: 10.3389/fneur.2021.559024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/31/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: Those with chronic neurologic disorders are often burdened not only by the condition itself but also an increased need for subspecialty medical care. This may require long distance travel, while even small distances can be a hardship secondary to impaired mobility and transportation. We sought to examine the burden of time associated with clinical visits for those with chronic neurologic disorders and their family/caregivers. These topics are discussed as an argument to support universal coverage for telemedicine in this population. Design: Cohort Study. Setting: Specialty clinic at community hospital. Participants: 208 unique patients with chronic neurologic disability at physical medicine and rehabilitation or neurourology clinic over a 3-month period. Main Outcome Measures: Patient survey on commute distance, time, difficulties, and need for caregiver assistance to attend visits. Results: Approximately 40% of patients were covered by Medicare. Many patients (42%) perceived it difficult to attend their clinic visit with transportation difficulties, commute time, and changes to their daily schedule being the most commonly cited reasons. Most patients (75%) lived within 25 miles of our clinics and experienced an average commute time of 79.4 min, though 10% required 3 h or more. Additional family/caregiver assistance was required for 76% of patients, which resulted in an inclusive average commute time of 138.2 min per patient. Conclusion: Chronically neurologically-disabled patients and their caregivers may be burdened by the commute to outpatient appointments. To minimize this burden, increased emphasis on telemedicine coverage for those with chronic neurologic disability should be considered by all payors.
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Affiliation(s)
- Daniel L Solomon
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Kazuko L Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Christopher S Elliott
- Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, United States.,Department of Urology, Stanford University School of Medicine, Stanford, CA, United States
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32
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Pham Q, Hearn J, Bender JL, Berlin A, Brown I, Bryant-Lukosius D, Feifer AH, Finelli A, Gotto G, Hamilton R, Rendon R, Cafazzo JA. Virtual care for prostate cancer survivorship: protocol for an evaluation of a nurse-led algorithm-enhanced virtual clinic implemented at five cancer centres across Canada. BMJ Open 2021; 11:e045806. [PMID: 33883153 PMCID: PMC8061848 DOI: 10.1136/bmjopen-2020-045806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Prostate cancer (PCa) is the most common cancer in Canadian men. Current models of survivorship care are no longer adequate to address the chronic and complex survivorship needs of patients today. Virtual care models for cancer survivorship have recently been associated with comparable clinical outcomes and lower costs to traditional follow-up care, with patients favouring off-site and on-demand visits. Building on their viability, our research group conceived the Ned Clinic-a virtual PCa survivorship model that provides patients with access to lab results, collects patient-reported outcomes, alerts clinicians to emerging issues, and promotes patient self-care. Despite the promise of the Ned Clinic, the model remains limited by its dependence on oncology specialists, lack of an autonomous triage algorithm, and has only been implemented among PCa survivors living in Ontario. METHODS AND ANALYSIS Our programme of research comprises two main research objectives: (1) to evaluate the process and cost of implementing and sustaining five nurse-led virtual PCa survivorship clinics in three provinces across Canada and identify barriers and facilitators to implementation success and (2) to assess the impact of these virtual clinics on implementation and effectiveness outcomes of enrolled PCa survivors. The design phase will involve developing an autonomous triage algorithm and redesigning the Ned Clinic towards a nurse-led service model. Site-specific implementation plans will be developed to deploy a localised nurse-led virtual clinic at each centre. Effectiveness will be evaluated using a historical control study comparing the survivorship outcomes of 300 PCa survivors enrolled in the Ned Clinic with 300 PCa survivors receiving traditional follow-up care. ETHICS AND DISSEMINATION Appropriate site-specific ethics approval will be secured prior to each research phase. Knowledge translation efforts will include diffusion, dissemination, and application approaches to ensure that knowledge is translated to both academic and lay audiences.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jacqueline L Bender
- ELLICSR Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alejando Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ian Brown
- Division of Urology, Niagara Health System, Saint Catharines, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Denise Bryant-Lukosius
- Faculty of Health Sciences, School of Nursing and Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrew H Feifer
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Geoffrey Gotto
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hamilton
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Abstract
The future supply of urologists is not on pace to account for future demands of urologic care. This impending urologic shortage sits on a backdrop of multiple other workforce issues. In this review, we take an in-depth look at several pressing issues facing the urologic workforce, including the impending urology shortage, gender and diversity concerns, growing levels of burnout, and the effects of the coronavirus pandemic. In doing so, we highlight specific areas of clinical practice that may need to be addressed from a health care policy standpoint.
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Affiliation(s)
- Ryan Dornbier
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.
| | - Christopher M Gonzalez
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA
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34
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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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35
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Uustal M, Blackmon L. Telemedicine technology and implications for reproductive office operations. Fertil Steril 2020; 114:1126-1128. [PMID: 33280716 PMCID: PMC9490785 DOI: 10.1016/j.fertnstert.2020.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/06/2022]
Abstract
Telemedicine had been very slowly making inroads into standard clinical practice. The onset of the COVID-19 pandemic resulted in the rapid implementation of telemedicine across most practices. The efficiency and permanence of telemedicine services depends on a multitude of factors including technologic choices, governmental and insurance regulations, reimbursement policies, and staff and patient education and acceptance. Although challenges remain and the extent of implementation is still evolving, it is clear that telemedicine is here to stay and that all those involved in health care need to be familiar with its opportunities and challenges.
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Affiliation(s)
- Matt Uustal
- Brown Urology, Inc., Providence, Rhode Island
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36
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Andino JJ, Lingaya MA, Daignault-Newton S, Shah PK, Ellimoottil C. Video Visits as a Substitute for Urological Clinic Visits. Urology 2020; 144:46-51. [PMID: 32619595 PMCID: PMC7834609 DOI: 10.1016/j.urology.2020.05.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether video visits were being used as substitutes to clinic visits prior to COVID-19 at our institution's outpatient urology centers. METHODS We reviewed 600 established patient video visits completed by 13 urology providers at a tertiary academic center in southeast Michigan. We compared these visits to a random, stratified sample of established patient clinic visits. We assessed baseline demographics and visit characteristics for both groups. We defined our primary outcome ("revisit rate") as the proportion of additional healthcare evaluation (ie, office, emergency room, hospitalization) by a urology provider within 30 days of the initial encounter. RESULTS Patients seen by video visit tended to be younger (51 vs 61 years, P <.001), would have to travel further for a clinic appointment (82 vs 68 miles, P <.001), and were more likely to be female (36 vs 28%, P = .001). The most common diagnostic groups evaluated through video visits were nephrolithiasis (40%), oncology (18%) and andrology (14.3%). While the 30-day revisit rates were higher for clinic visits (4.3% vs 7.5%, P = .01) primarily due to previously scheduled appointments, revisits due to medical concerns were similar across both groups (0.5% vs 0.67%; P = .60). CONCLUSIONS Video visits can be used to deliver care across a broad range of urologic diagnoses and can serve as a substitute for clinic visits.
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Affiliation(s)
- Juan J Andino
- Department of Urology, Michigan Medicine, Ann Arbor, MI.
| | | | | | - Parth K Shah
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Chad Ellimoottil
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Pinar U, Anract J, Perrot O, Tabourin T, Chartier-Kastler E, Parra J, Vaessen C, de La Taille A, Roupret M. Preliminary assessment of patient and physician satisfaction with the use of teleconsultation in urology during the COVID-19 pandemic. World J Urol 2020; 39:1991-1996. [PMID: 32909174 PMCID: PMC7480659 DOI: 10.1007/s00345-020-03432-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Lockdown during the COVID-19 pandemic compelled urologists to change access to healthcare, especially for oncology patients. Teleconsultation is a safe way to receive medical advice without a risk of infection, and was implemented urgently in our academic centres. Our purpose was to evaluate patient and physician satisfaction with teleconsultation set up during the COVID-19 pandemic. METHODS From March 16th 2020, all face-to-face consultations were cancelled in France, except for emergencies. Teleconsultation was started immediately by five senior urologists in two academic hospitals. All patients received an email survey including the validated Teleconsultation Satisfaction Questionnaire (TSQ) and demographic questions. Data were collected prospectively. Physicians also responded to the TSQ. Patient satisfaction was measured objectively with the validated 14-item TSQ. Each item was scored on a 5-point Likert scale. Factors associated with positive satisfaction with teleconsultation were assessed by multivariable logistic regression. RESULTS Overall, 105 patients replied to the survey (91.3%). Median age was 66 years (IQR: 55‒71) and 95 were men (90.5%). Median overall TSQ score was 67 (IQR: 60‒69); teleconsultation was judged to be a good experience by 88 patients (83.8%) and four physicians (80%). Patients who met their surgeon for the first time were more likely to have a good experience (OR = 1.2 [95% CI 1.1‒1.5], p = 0.03). CONCLUSION Introduced rapidly during the COVID-19 lockdown, urology teleconsultation attained a high level of satisfaction among both patients and physicians. A major change in telemedicine use is foreseen in the post COVID-19 era.
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Affiliation(s)
- Ugo Pinar
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France
| | - Julien Anract
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France
| | - Ophélie Perrot
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France
| | - Thomas Tabourin
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France
| | - Emmanuel Chartier-Kastler
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France
| | - Jerome Parra
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France
| | - Christophe Vaessen
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France
| | - Alexandre de La Taille
- APHP, Henri Mondor Hôpital, Urology, Hôpitaux Universitaires Henri Mondor, 94010, Creteil, France
| | - Morgan Roupret
- Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013, Paris, France.
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Demaerschalk BM, Cassivi SD, Blegen RN, Borah B, Moriarty J, Gullerud R, TerKonda SP. Health Economic Analysis of Postoperative Video Telemedicine Visits to Patients' Homes. Telemed J E Health 2020; 27:635-640. [PMID: 32907513 DOI: 10.1089/tmj.2020.0257] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract Importance: A postoperative video telemedicine follow-up program was introduced by the Mayo Clinic. An attempt was made to understand the potential cost savings to patients before contemplating full-scale expansion across all potentially eligible surgical patients and practices. Objective: The primary purpose was to estimate potential cost savings to patients with video telemedicine follow-up to home compared with face-to-face follow-up in a standard clinic setting. Design: The research was designed collaboratively by the Center for Connected Care and the surgical practice to address the question of estimated cost savings of postoperative video telemedicine visits. The intervention arm is the postoperative video telemedicine follow-up visit to home setting and the comparator is the face-to-face visit at Mayo Clinic. Setting: Large, integrated, academic multispecialty practice supporting patient care delivery, research, and education. Participants: The population under study comprised routine uncomplicated postoperative patients who underwent video telemedicine or face-to-face follow-up visits that fell within the 90-day global period across multiple (general, neurosurgery, plastic, thoracic, transplant, and urology) surgical specialties. Main Outcome(s) and Measure(s): Economic outcomes were cost of travel, accommodations, meals, and missed work. Additional outcomes included time expenditure and patient satisfaction. Cost/benefit analysis unit was US dollars (USD). All costs were inflated to 2018 USD, using the Gross Domestic Product Implicit price deflator. Results: Patients who utilized video telemedicine rather than face-to-face clinic visit for postoperative follow-up were estimated to save $888 per visit on average. More specifically, patients residing more than 1,635 miles round trip from clinic saved an estimated $1,501 per visit and patients not needing accommodation still saved an estimated $256 per visit. Patient satisfaction over video telemedicine postoperative follow-up visits remained high over the 6-year period of study. Conclusions and Relevance: The use of video telemedicine for routine uncomplicated postoperative follow-up visits to replace face-to-face follow-up visits has the potential to be financially advantageous for patients. Key points Question: For postoperative patients, what are the health economic outcomes associated with video telemedicine follow-up to home compared with face-to-face follow-up in a standard clinic setting? Findings: Video telemedicine offers a cost benefit for patients through avoidance of travel costs and missed work. Meaning: For uncomplicated routine postoperative follow-up visits, video telemedicine is a less costly alternative for most patients.
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Affiliation(s)
- Bart M Demaerschalk
- Center for Connected Care, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA.,Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA.,Clinical Neurological Sciences, Neurology & Neurosurgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Stephen D Cassivi
- Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca N Blegen
- Center for Connected Care, Mayo Clinic, Rochester, Minnesota, USA.,Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Bijan Borah
- Healthcare and Policy Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James Moriarty
- Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Gullerud
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarvam P TerKonda
- Center for Connected Care, Mayo Clinic, Rochester, Minnesota, USA.,Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA.,Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Pham Q, Hearn J, Gao B, Brown I, Hamilton RJ, Berlin A, Cafazzo JA, Feifer A. Virtual care models for cancer survivorship. NPJ Digit Med 2020; 3:113. [PMID: 32923690 PMCID: PMC7468136 DOI: 10.1038/s41746-020-00321-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Virtual care models for cancer survivorship are needed to support patients living with the chronic effects of cancer treatment, while increasing health system capacity. Characteristics that may be critical to their success have not been adequately studied. This scoping review summarizes previous efforts to virtualize survivorship care to inform future innovations in the field. Four databases were searched for articles published before January 2020, and 24 articles that met selection criteria were included in this analysis. Rationale for pursuing virtual models of care shared two common objectives: (1) the need for sustainable survivorship care, and (2) the opportunity to improve survivorship outcomes. Breast cancer (N = 10) and prostate cancer (N = 4) were the most targeted cancers for virtual survivorship care. The implemented technologies included web platforms (N = 15), telephone calls (N = 12), and smartphone or tablet applications (N = 5). A variety of healthcare professionals were effectively involved in the provision of virtual care. Future virtual care models may benefit from integrating with existing health systems and services, repurposing common technologies, involving allied health professionals, and engaging patients and caregivers from diverse communities in the design of virtual services.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Ian Brown
- Division of Urology, Niagara Health, Niagara, ON Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
- Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON Canada
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Andrew Feifer
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON Canada
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Smith WR, Atala AJ, Terlecki RP, Kelly EE, Matthews CA. Implementation Guide for Rapid Integration of an Outpatient Telemedicine Program During the COVID-19 Pandemic. J Am Coll Surg 2020; 231:216-222.e2. [PMID: 32360960 PMCID: PMC7192116 DOI: 10.1016/j.jamcollsurg.2020.04.030] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the novel coronavirus disease 2019 (COVID-19) pandemic, social distancing has been necessary to help prevent disease transmission. As a result, medical practices have limited access to in-person visits. This poses a challenge to maintain appropriate patient care while preventing a substantial backlog of patients once stay-at-home restrictions are lifted. In practices that are naïve to telehealth as an alternative option, providers and staff are experiencing challenges with telemedicine implementation. We aim to provide a comprehensive guide on how to rapidly integrate telemedicine into practice during a pandemic. METHODS We built a toolkit that details the following 8 essential components to successful implementation of a telemedicine platform: provider and staff training, patient education, an existing electronic medical record system, patient and provider investment in hardware, billing and coding integration, information technology support, audiovisual platforms, and patient and caregiver participation. RESULTS Rapid integration of telemedicine in our practice was required to be compliant with our institution's COVID-19 task force. Within 3 days of this declaration, our large specialty-care clinic converted to a telemedicine platform and we completed 638 visits within the first month of implementation. CONCLUSIONS Effective and efficient integration of a telemedicine program requires extensive staff and patient education, accessory platforms to facilitate video and audio communication, and adoption of new billing codes that are outlined in this toolkit.
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Affiliation(s)
- Whitney R Smith
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Anthony J Atala
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Ryan P Terlecki
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Erin E Kelly
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC
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Edison MA, Connor MJ, Miah S, El-Husseiny T, Winkler M, Dasgupta R, Ahmed HU, Hrouda D. Understanding virtual urology clinics: a systematic review. BJU Int 2020; 126:536-546. [PMID: 32463991 DOI: 10.1111/bju.15125] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To perform a systematic review to identify the clinical, fiscal and environmental evidence on the use of urological telehealth and/or virtual clinic (VC) strategies, and to highlight research gaps in this rapidly evolving field. METHODS Our PROSPERO-registered (CRD42019151946) systematic search of Embase, Medline and the Cochrane Review Database was performed to identify original research articles pertaining to adult urology telehealth or VC strategies. Risk-of-bias (RoB) assessment was performed according to the Cochrane 2.0 RoB tool or the Joanna Briggs Institute Checklist for non-randomized studies. RESULTS A total of 5813 participants were included from 18 original articles (two randomized controlled trials [RCTs], 10 prospective studies, six retrospective studies). Urology sub-specialities comprised: uro-oncology (n = 6); general urology (n = 8); endo-urology (n = 2); and lower urinary tract symptoms and/or incontinence (n = 2). Across all sub-specialties, prospective studies using VCs reported a primary median (interquartile range [IQR]) VC discharge rate of 16.6 (14.7-29.8)% and a primary median (IQR) face-to-face (FTF) clinic referral rate of 32.4 (15.5-53.3)%. Direct cost analysis demonstrated median (IQR) annual cost savings of £56 232 (£46 260-£61 116). Grade II and IIIb complications were reported in two acute ureteric colic studies, with rates of 0.20% (3/1534) and 0.13% (2/1534), respectively. The annual carbon footprint avoided ranged from 0.7 to 4.35 metric tonnes of CO2 emissions, depending on the mode of transport used. Patient satisfaction was inconsistently reported, and assessments lacked prospective evaluation using validated questionnaires. CONCLUSION Urology VCs are a promising new platform which can offer clinical, financial and environmental benefits to support an increasing urological referral burden. Further prospective evidence is required across urological sub-specialties to confirm equivalency and safety against traditional FTF assessment.
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Affiliation(s)
- Marie Alexandra Edison
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Martin John Connor
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Imperial Prostate I Department of Surgery and Cancer, Imperial College London, London, UK
| | - Saiful Miah
- Department of Urology, Wycombe Hospital, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Tamer El-Husseiny
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Mathias Winkler
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Imperial Prostate I Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ranan Dasgupta
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Hashim Uddin Ahmed
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Imperial Prostate I Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Hrouda
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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Etingen B, Patrianakos J, Wirth M, Hogan TP, Smith BM, Tarlov E, Stroupe KT, Kartje R, Weaver FM. TeleWound Practice Within the Veterans Health Administration: Protocol for a Mixed Methods Program Evaluation. JMIR Res Protoc 2020; 9:e20139. [PMID: 32706742 PMCID: PMC7399961 DOI: 10.2196/20139] [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: 05/11/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic wounds, such as pressure injuries and diabetic foot ulcers, are a significant predictor of mortality. Veterans who reside in rural areas often have difficulty accessing care for their wounds. TeleWound Practice (TWP), a coordinated effort to incorporate telehealth into the provision of specialty care for patients with skin wounds, has the potential to increase access to wound care by allowing veterans to receive this care at nearby outpatient clinics or in their homes. The Veterans Health Administration (VA) is championing the rollout of the TWP, starting with regional implementation. OBJECTIVE This paper aims to describe the protocol for a mixed-methods program evaluation to assess the implementation and outcomes of TWP in VA. METHODS We are conducting a mixed-methods evaluation of 4 VA medical centers and their community-based outpatient clinics that are participating in the initial implementation of the TWP. Data will be collected from veterans, VA health care team members, and other key stakeholders (eg, clinical leadership). We will use qualitative methods (ie, semistructured interviews), site visits, and quantitative methods (ie, surveys, national VA administrative databases) to assess the process and reach of TWP implementation and its impact on veterans' clinical outcomes and travel burdens and costs. RESULTS This program evaluation was funded in October 2019 as a Partnered Evaluation Initiative by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). CONCLUSIONS Evaluation of the TWP will identify barriers and solutions to TeleWound implementation in a small number of sites that can be used to inform successful rollout of the TWP nationally. Our evaluation work will inform future efforts to scale up the TWP across VA and optimize reach of the program to veterans across the nation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20139.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Jamie Patrianakos
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
| | - Rebecca Kartje
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
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Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, De Nunzio C, Galfano A, Giannarini G, Gregori A, Liguori G, Bartoletti R, Porpiglia F, Scarpa RM, Simonato A, Trombetta C, Tubaro A, Ficarra V. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol 2020; 78:786-811. [PMID: 32616405 PMCID: PMC7301090 DOI: 10.1016/j.eururo.2020.06.025] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Context Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse. Objective To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth. Evidence acquisition After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed. Evidence synthesis We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good. Conclusions Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary. Patient summary The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.
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Affiliation(s)
- Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Italy.
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alberto Abrate
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | | | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urologic Unit, University of Pisa, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
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Shahinyan RH, Amighi A, Carey AN, Yoffe DA, Hodge DC, Pollard ME, Nork JJ, Mills JN, Eleswarapu SV. Direct-To-Consumer Internet Prescription Platforms Overlook Crucial Pathology Found During Traditional Office Evaluation of Young Men With Erectile Dysfunction. Urology 2020; 143:165-172. [PMID: 32535075 DOI: 10.1016/j.urology.2020.03.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/23/2020] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine comorbidities in young men with erectile dysfunction (ED) who are increasingly targeted by direct-to-consumer (DTC) internet platforms that sell phosphodiesterase-5 (PDE-5) inhibitors without comprehensive clinical evaluation; and, further, to characterize the portrayal of DTC platforms by popular news media. METHODS We retrospectively reviewed all men age ≤40 evaluated for ED at an andrology clinic during January 2016-March 2019 to obtain demographics, exam and lab findings, and treatments. Five news sources were analyzed during the study period to characterize whether articles about DTC platforms were positive, critical, or balanced/neutral. RESULTS We identified 388 patients, with age 29.5 ± 5.0 years, 15% rate of obesity, 20% prediabetes or diabetes, 54% dyslipidemia, and 20% hypogonadism. Serum lab findings associated with subfertility were found in 11%. Semen analysis was conducted in 64 men, of whom 40% were abnormal. Varicoceles were found in 35%. PDE-5 inhibitor was prescribed to 328 men (88%). Off-label empiric therapies included clomiphene (32.9%) or aromatase inhibitor (12.1%). Testosterone replacement was initiated in 9.7%. Analysis of news coverage revealed 18 articles, of which 61% portrayed DTC platforms exclusively in a positive light. CONCLUSION Office consultation identified young men with significant comorbidities that would be missed by DTC platforms, which employ only questionnaires for health screening. DTC platforms present themselves as medical authorities without following AUA Guidelines, yet garner mostly positive press coverage. Patients engaging these platforms may falsely believe they are receiving adequate medical assessment. Urologists may do well to incorporate telemedicine to enfranchise young men with evidence-based evaluation.
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Affiliation(s)
- Robert H Shahinyan
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Arash Amighi
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Alson N Carey
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Dar A Yoffe
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Devyn C Hodge
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Matthew E Pollard
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Jesse N Mills
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sriram V Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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DeNicola N, Marko K. Connected Health and Mobile Apps in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2020; 47:317-331. [DOI: 10.1016/j.ogc.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Do prostate cancer-related mobile phone apps have a role in contemporary prostate cancer management? A systematic review by EAU young academic urologists (YAU) urotechnology group. World J Urol 2020; 38:2411-2431. [PMID: 32322996 PMCID: PMC7508932 DOI: 10.1007/s00345-020-03197-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/31/2020] [Indexed: 10/31/2022] Open
Abstract
AIMS AND OBJECTIVES To review the available literature regarding the use of prostate cancer-related mobile phone applications (PCA). MATERIALS AND METHODS The search was for English language articles between inceptions of databases to June 2019. Medline, EMBASE, Cochrane Library, CINAHL and Web of Science were searched. Full-text articles were reviewed, and the following data were extracted to aid with app analysis: name of application, developer, platform (Apple App Store or Google Play Store) and factors assessed by the article. RESULTS The search yielded 1825 results of which 13 studies were included in the final review. 44 PCAs were identified from the data collected of which 59% of the PCAs had an educational focus. 11 apps were inactive and 5 weren't updated within the last year. Five studies focused on the development and testing of apps (MyHealthAvatar, CPC, Rotterdam, Interaktor, NED). Two studies evaluated the readability of PCAs. Most PCAs had a reading level greater than that of the average patient. Two studies evaluated the quality and accuracy of apps. Majority of PCAs were accurate with a wide range of information. The study reported most PCAs to have deficient or insufficient scores for data protection. Two studies evaluated the accuracy of Rotterdam, CORAL and CPC risk calculators. Rotterdam was the best performer. CONCLUSIONS PCAs are currently in its infancy and do require further development before widespread integration into existing clinical practise. There are concerns with data protection, high readability standards and lack of information update in current PCAs. If developed appropriately with responsible governance, they do have the potential to play important roles in modern-day prostate cancer management.
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Abstract
Objectives: Persons with dementia face barriers to attending in-person medical care. Despite the potential for video telemedicine to ameliorate these barriers, little is known about in-home video telemedicine for dementia.Methods: Outpatients of a dementia clinic were invited to participate in in-home video telemedicine, and reasons for enrolling or declining were tracked. Visit experience was directly compared between in-person and video visits.Results: Of 230 families invited to enroll in video telemedicine, 96% agreed to join or gave reasons for declining, with the primary reasons for participating being convenience and less disruption of routines. Lack of a computer was the main reason for declining. Those who agreed to participate and those who declined were demographically similar in terms of race and education, but slightly younger in the telemedicine group (patient mean age 79 v 84). Equivalent visit satisfaction was reported between in-person and video telemedicine.Conclusions: Persons with dementia and their families were willing to enroll in an in-home telemedicine clinic. Satisfaction with home visits was high and equal to in-clinic visits.Clinical implications: Video telemedicine is a promising dementia service delivery model for rural patients and others for whom travel to a specialty clinic is burdensome.Abbreviations: ADL: Activities of Daily Living; Home-CVT: Home Clinical Video Telehealth; iADL: Instrumental Activity of Daily Living; GRECC: The New England Geriatric Research Education and Clinical Center; IM: Instant Messaging; LTC: long term care; THT: Telehealth Technician; VA: Veterans Affairs; VAMC: Veterans Affairs Medical Center.
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Affiliation(s)
- Lauren R Moo
- Geriatric Research Education and Clinical Center, Bedford VAMC-GRECC, MA, USA
| | - Megan E Gately
- Geriatric Research Education and Clinical Center, Bedford VAMC-GRECC, MA, USA
| | - Zehra Jafri
- College of Human Ecology, Cornell University, Ithaca, USA
| | - Steven D Shirk
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Addiction and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Portney DS, Ved R, Nikolian V, Wei A, Buchmueller T, Killaly B, Alam HB, Ellimoottil C. Understanding the cost savings of video visits in outpatient surgical clinics. Mhealth 2020; 6:32. [PMID: 33437830 PMCID: PMC7793011 DOI: 10.21037/mhealth-20-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/26/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Expansion of telehealth is a high-priority strategic initiative for many health systems. Surgical clinics' implementation of video visits has been identified as a way to improve patient and provider experience. However, whether using video visits can reduce the cost of an outpatient visit is unknown. METHODS Prospective case study using time-driven activity-based costing at two outpatient surgical clinics at an academic institution. We conducted stakeholder interviews and in-person observations to map outpatient clinic flow and measure resource utilization of four key steps: check-in, vitals collection and rooming, clinician encounter, and check-out. Finally, we calculated the resource cost for each step using representative salary information to calculate total visit cost. RESULTS Video visits did not systematically reduce the amount of time clinicians spent with patients. Mean [standard deviation (SD)] visit costs were as follows: traditional clinic visits, $26.84 ($10.13); physician-led video visits, $27.26 ($9.69); and physician assistant-led video visits, $9.86 ($2.76). There was no significant difference in the total cost associated with physician-led traditional clinic visits and video visits (P=0.89). However, physician assistant-led video visits were significantly lower cost than physician-led video visits (P<0.001). CONCLUSIONS Using physician-led video visits does not reduce the cost of outpatient surgical visits when compared to traditional clinic visits. However, the use of less expensive clinician resources for video visits (e.g., physician-assistants) may yield cost savings for clinics.
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Affiliation(s)
- David S. Portney
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Rohan Ved
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Vahagn Nikolian
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Wei
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tom Buchmueller
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - Brad Killaly
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - Hasan B. Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res 2019; 19:974. [PMID: 31852493 PMCID: PMC6921587 DOI: 10.1186/s12913-019-4815-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.
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Affiliation(s)
- Melissa E Cyr
- School of Nursing, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Anna G Etchin
- VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA, 02130, USA
| | - Barbara J Guthrie
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.
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