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Gudipudi R, Jungbauer WN, Brennan E, Pecha PP. Parent and provider satisfaction of telehealth in pediatric surgical subspecialty care: A systematic review. J Telemed Telecare 2024; 30:905-917. [PMID: 35850559 DOI: 10.1177/1357633x221110368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Telehealth is becoming an increasingly common presence in health care, particularly amidst the coronavirus disease 2019 pandemic. We aimed to investigate ways in which telehealth has been implemented in pediatric surgical specialties, as well as the success and satisfaction rates of these interventions. METHODS A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Scopus, and CINAHL databases for telehealth and pediatric surgical specialties on August 20th, 2021. There were 1227 studies screened and 17 studies met final inclusion criteria for patient, parent/guardian, or physician satisfaction measures of a telehealth intervention in the United States. RESULTS Studies implementing telehealth interventions included all major pediatric surgical subspecialties with a total of 2926 patients. Of the 17 studies, common themes were the use of telehealth for synchronous video and/or telephone virtual visits, including comparing virtual visits to in-person clinic visits (nine studies) and postoperative virtual visits (six studies). Telehealth was also used in the perioperative setting to deliver care instructions via mobile application or text message (two studies). Telehealth interventions had a high rate of parent satisfaction (75%-98%), and 57%-75% of parents stated they would choose or prefer virtual appointments in the future, often citing travel and cost savings as benefits. Provider satisfaction was also high with satisfaction scores ranging from 7.5 to 9.4/10. DISCUSSION This systematic review suggests that both parent and physician satisfaction with telehealth in pediatric surgical specialties is generally high. Expanding telehealth applications allow greater access to care, particularly for specialized surgical services which often pose significant costs and travel burdens.
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Affiliation(s)
- Rachana Gudipudi
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Walter Nicholas Jungbauer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina, Charleston, SC, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Cai PY, Balthazar A, Logvinenko T, Nelson CP, Finkelstein JB. Accuracy of telemedicine for diagnosis and pre-operative assessment of pediatric penile conditions. J Pediatr Urol 2023; 19:521.e1-521.e7. [PMID: 37055341 PMCID: PMC11211001 DOI: 10.1016/j.jpurol.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Patients with penile conditions comprise a significant proportion of any pediatric urology practice, and physical examination is the mainstay of diagnosis for such conditions. While the rapid adoption of telemedicine (TM) facilitated access to pediatric urology care during the pandemic, the accuracy of TM-based diagnosis for pediatric penile anatomy and pathology has not been studied. Our aim was to characterize the diagnostic accuracy of TM-based evaluation of pediatric penile conditions by comparing diagnosis during the initial virtual visit (VV) with a subsequent in-person visit (IPV). We also sought to assess the agreement between scheduled and actual surgical procedure performed. METHODS A single-institution prospective database of male patients less than 21 years of age who presented for evaluation of penile conditions between August 2020 and December 2021 was analyzed. Patients were included if they had an IPV with the same pediatric urologist within 12 months of the initial VV. Diagnostic concordance was based on a surgeon-reported survey of specific penile diagnoses, completed at both initial VV and follow-up IPV. Surgical concordance was assessed based on the proposed versus billed CPT code(s). RESULTS Median age among 158 patients was 10.6 months. The most frequent VV diagnoses were penile adhesions (n = 37), phimosis (n = 26), "other" (n = 24), post-circumcision redundancy (n = 18), and buried penis (n = 14). Initial VV and subsequent IPV diagnoses were concordant in 40.5% (64/158); 40/158 (25%) had partial concordance (at least one diagnosis matched). There was no difference in age, race, ethnicity, median time between visits, or device type between patients with concordant vs. discordant diagnoses. Of 102 patients who underwent surgery, 44 had VV only while 58 had IPV prior to surgery. Concordance of scheduled versus actual penile surgery was 90.9% in those patients who only had a VV prior to surgery. Overall, surgery concordance was lower among those with hypospadias repairs vs. non-hypospadias surgery (79.4% vs. 92.6%, p = 0.05). CONCLUSION Among pediatric patients being evaluated by TM for penile conditions, there was poor agreement between VV-based and IPV-based diagnoses. However, besides hypospadias repairs, agreement between planned and actual surgical procedures performed was high, suggesting that TM-based assessment is generally adequate for surgical planning in this population. These findings leave open the possibility that, among patients not scheduled for surgery or IPV, certain conditions might be misdiagnosed or missed entirely.
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Affiliation(s)
- Peter Y Cai
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Andrea Balthazar
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Julia B Finkelstein
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
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Jungbauer WN, Gudipudi R, Brennan E, Melvin CL, Pecha PP. The Cost Impact of Telehealth Interventions in Pediatric Surgical Specialties: A Systematic Review. J Pediatr Surg 2023; 58:1527-1533. [PMID: 36379748 PMCID: PMC10121966 DOI: 10.1016/j.jpedsurg.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Telehealth is a rapidly expanding care modality in the United States. Pediatric surgical patients often require complex care which can incur significant expenses, some of which may be alleviated by telehealth. We performed a systematic review comparing telehealth and in-person visits, and telehealth's impacts on the cost of healthcare across pediatric surgical specialties. METHODS A systematic review was performed using the following databases: PubMed (MEDLINE), Scopus (Elsevier), and CINAHL (EBSCOHost), searched from inception to July 10th, 2022. Studies were included per the following criteria: (1) investigated a telehealth intervention for pediatric surgical care and (2) provided some metric of telehealth cost compared to an in-person visit. Non-English or studies conducted outside of the U.S. were excluded. RESULTS Fourteen manuscripts met inclusion criteria and presented data on 7992 visits, including patients with a weighted average age of 7.5 ± 3.5 years. Most (11/14) studies used telehealth in a synchronous, or "real-time" context. Of the studies which calculated dollar cost savings for telehealth visits compared to in-person appointments we found a substantial range of savings per visit, from $48.50 to $344.64. Cost savings were frequently realized in terms of reduced travel expenditures, lower opportunity costs (e.g. lost wages), and decreased hospital labor requirements. CONCLUSIONS This review suggests that telehealth provides cost incentives to pediatric surgical care in many scenarios, including post-operative visits and some routine clinic visits. Future work should focus on standardizing the metrics by which cost impacts are analyzed and detailing which visits are most appropriately facilitated by telehealth. LEVEL OF EVIDENCE V.
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Affiliation(s)
- W Nicholas Jungbauer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Rachana Gudipudi
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina, Charleston, SC, United States
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States.
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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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Gross K, Georgeades C, Farazi M, Calaway L, Gourlay D, Van Arendonk KJ. Utilization and Adequacy of Telemedicine for Outpatient Pediatric Surgical Care. J Surg Res 2022; 278:179-189. [PMID: 35605570 PMCID: PMC9121887 DOI: 10.1016/j.jss.2022.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/25/2022] [Accepted: 04/08/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Telemedicine (TM) use accelerated out of necessity during the COVID-19 pandemic, but the utility of TM within the pediatric surgery population is unclear. This study measured utilization, adequacy, and disparities in uptake of TM in pediatric surgery during the COVID-19 pandemic. METHODS Scheduled outpatient pediatric surgery clinic encounters at a large academic children's hospital from January 2020 through March 2021 were reviewed. Sub-group analysis examined post-operative (PO) visits after appendectomy and umbilical, epigastric, and inguinal hernia repairs. RESULTS Of 9149 scheduled visits, 87.9% were in-person and 12.1% were TM. TM visits were scheduled for PO care (76.9%), new consultations (7.1%), and established patients (16.0%). Although TM visits were more frequently canceled or no shows (P < 0.001), most canceled TM visits were PO visits, of which 41.7% were canceled via electronic communication reporting the absence of any PO concerns. TM visits were adequate for accomplishing visit goals in 98.2%, 95.5%, and 96.2% of PO, new, and established patient visits, respectively. Patients utilizing TM visits were more frequently of white race, privately-insured, from less disadvantaged neighborhoods, and living a greater distance from clinic (P < 0.001 for all comparisons). CONCLUSIONS TM was adequate for the majority of visits in which it was utilized, including the basic PO visits that occurred via TM. TM was used more by patients with greater travel and less by those of minority race, with public insurance, and from more disadvantaged neighborhoods. Future work is necessary to ensure broad access to this useful tool for all children requiring surgical care.
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Affiliation(s)
- Kendall Gross
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Manzur Farazi
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lynn Calaway
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Gourlay
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin.
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Wang HHS, Xu R, Nelson CP, Campbell J, Estrada CR, Kurtz MP. Hybrid Clinics: A New Model for Ambulatory Care to Reduce Infection Risk. Telemed J E Health 2022; 29:560-568. [PMID: 36036799 DOI: 10.1089/tmj.2022.0170] [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: 11/12/2022] Open
Abstract
Objectives: To assess the viability of a hybrid clinic model combining in-person examination with video-based consultation to minimize viral transmission risk. Methods: Data were collected prospectively in a pediatric urology clinic for in-person visits from January to April 2018 ("classic") and hybrid visits from October to December 2020 of the COVID-19 pandemic ("hybrid"). Variables included provider, diagnosis, patient type, time of day, prior surgery, postoperative status, and decision-making for surgery. The primary outcome was "room time" or time in-person. The secondary outcome was "total time" or visit duration. Proportion of visits involving close contact (room time ≥15 min) was assessed. Univariate analyses were performed using the Wilcoxon rank-sum test and Fisher's exact test. Mixed models were fitted for visit approach and other covariates as fixed effects and provider as random effect. Results: Data were collected for 346 visits (256 classic, 90 hybrid). Hybrid visits were associated with less room time (median 3 min vs. 10 min, p < 0.001) but greater total time (median 13.5 min vs. 10 min, p = 0.001) as compared with classic visits. On multivariate analysis, hybrid visits were associated with 3 min less room time (95% confidence intervals [CIs]: -5.3 to -1.7, p < 0.001) but 3.8 min more total time (95% CI: 1.5-6.1, p = 0.001). Close contact occurred in 6.7% of hybrid visits, as compared with 34.8% of classic visits (p < 0.001). Conclusions: Hybrid clinic visits reduce room time as compared with classic visits. This approach overcomes the examination limitations of telemedicine while minimizing viral transmission, and represents a viable model for ambulatory care whenever close contact carries infection risk.
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Affiliation(s)
- Hsin-Hsiao S Wang
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rena Xu
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Julie Campbell
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
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Shin YJ, Mohanty A, Kang A, Judge CE, Baroody FM, Shogan A, Rodriguez SH, Reid RR, Frim D, Chokshi NK, Mak G, Slidell MB, Lee TK, Kandel J, Truehart A, Gundeti MS. Telehealth: A new paradigm? Paediatric surgical subspecialty telemedicine survey in the COVID-19 Pandemic at a tertiary care centre. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221086137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Although the technology has been available and several pilot studies have shown success, use of telemedicine has previously been limited in the United States, especially among surgeons. This study aimed to investigate the benefits and obstacles for successful implementation of telemedicine visits in paediatric surgical subspecialties amid the COVID-19 pandemic. Methods: We analysed survey data from telemedicine visits with paediatric surgical subspecialists from May 1 through June 30, 2020 at our paediatric surgery subspecialty clinics. Univariate logistic regression was used to determine associations in survey responses and various demographic factors. Results: There were 164 respondents to the survey. The most frequently cited barrier to care was ability to get time off work (46.3%). Overall satisfaction with the telemedicine visit was 93.8%, and 55.6% responded that they would choose video telemedicine rather than an in-person or telephone visit. Those living at least 25 miles from the hospital had increased odds of indicating interest in using telemedicine for future visits (OR = 2.56, 95% CI = 1.12–5.86, p = 0.026). The average respondent saved between 30 minutes and 1 hour, and 45 minutes using telemedicine. Conclusions: The implementation of telemedicine at our institution in the paediatric surgical subspecialties has proven to be effective and well-received. Given the benefits of time and money saved for families, paired with high satisfaction rates and continued interest, paediatric surgical subspecialists should work to incorporate virtual visits into regular patient care, even well after the COVID-19 pandemic. Level of Evidence: Level IV
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Affiliation(s)
- Yu Jin Shin
- Biological Sciences Learning Center, Pritzker School of Medicine, The University of Chicago, USA
| | - Amrita Mohanty
- Biological Sciences Learning Center, Pritzker School of Medicine, The University of Chicago, USA
| | - Audry Kang
- Department of Surgery, University of Chicago Medicine, USA
| | - Clark E Judge
- Department of Surgery, University of Chicago Medicine, USA
| | - Fuad M Baroody
- Department of Surgery, University of Chicago Medicine, USA
| | - Andrea Shogan
- Department of Surgery, University of Chicago Medicine, USA
| | | | - Russell R Reid
- Department of Surgery, University of Chicago Medicine, USA
| | - David Frim
- Department of Surgery, University of Chicago Medicine, USA
| | | | - Grace Mak
- Department of Surgery, University of Chicago Medicine, USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago Medicine, USA
| | - Thomas K Lee
- Department of Surgery, University of Chicago Medicine, USA
| | - Jessica Kandel
- Department of Surgery, University of Chicago Medicine, USA
| | - Amber Truehart
- Department of Surgery, University of Chicago Medicine, USA
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Shim JY, Kaur R, Laufer MR, Grimstad FW. The Use of Telemedicine in Pediatric and Adolescent Gynecology. J Pediatr Adolesc Gynecol 2022; 35:133-137. [PMID: 34619357 DOI: 10.1016/j.jpag.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To study the feasibility of virtual visits for ambulatory encounters in pediatric and adolescent gynecology DESIGN: A retrospective review SETTING: Boston Children's Hospital PARTICIPANTS: Patients who were seen virtually through the Division of Gynecology between January 1, 2020 and June 1, 2020 MAIN OUTCOME MEASURE(S): Patient demographics, visit diagnoses, and operational characteristics of the completed visits RESULTS: There were a total of 654 virtual visits for 614 patients. Ninety-one percent (n=558) of patients were in-state, and the median age of patients was 17 years (range 0 - 37 years). The majority were return visits (n=502, 76.8%), 115 (17.6%) were new patient visits, and 32 (4.89%) were post-operative visits. The median virtual visit duration was 12 minutes and 39 seconds (range 5 minutes to over 1 hour). The most common gynecologic diagnoses were dysmenorrhea/endometriosis (n=485, 74.2%), abnormal uterine bleeding (n=225, 34.4%), and pelvic pain (n=82, 12.5%). The percentage of virtual visits which required an in-person follow-up visit within 90 days was low (n=14, 2.1%). Five of these were within 30 days from the initial virtual visit, 6 were within 60 days, and 3 were within 90 days. CONCLUSION Telemedicine is a feasible method for expanding access to, and healthcare delivery for, pediatric and adolescent gynecology, with low rates of short interval in-person follow-up required. Virtual visits can be conducted for a range of patients with a variety of gynecologic conditions, upon initial presentation and follow-up.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Ravneet Kaur
- Innovative and Digital Health Accelerator, Boston Children's Hospital, Boston, Massachusetts
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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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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Pettit S, Young E, Jung I. Systematic review of telemedicine in pediatric urology. J Pediatr Urol 2022; 18:17-22. [PMID: 34642111 DOI: 10.1016/j.jpurol.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Telemedicine has bridged the distance gap between patients and pediatric urologists for over a decade, yet many pediatric urologists have not embraced it as a major part of their practice. The purpose of this systematic review is to evaluate and clarify the optimal role of telemedicine in pediatric urology, as well as the benefits, barriers, risks, and other important considerations that must be accounted for in its optimal adoption. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review utilized Medical Subject Headings (MeSH) to search PubMed through April 29, 2021 as follows: (Humans [MeSH]) AND ((Child [MeSH]) OR (Infant [MeSH])) AND ((Remote Consultation [MAJR]) OR (Telemedicine [MAJR]) OR (Videoconferencing [MAJR]) OR (Health Services Accessibility [MAJR])) AND ((Urology [MAJR]) OR (Postoperative Care [MAJR]) OR (Urologic Surgical Procedures [MAJR])). 73 resulting articles, plus 21 from manual searches (e.g. papers too recent to have MeSH terms), were screened. 17 met inclusion criteria by discussing telemedicine in context of pediatric urology in a full manuscript. Non-complete manuscripts and papers not specifically considering pediatric urology, or in which telemedicine was not a major focus, were excluded. RESULTS 17 papers met inclusion criteria. Varied approaches to the topic included surveys, controlled studies, retrospective studies, and descriptive opinion pieces. Quality of evidence varied, representing at least 1851 virtual encounters, 409 in-person encounters, and 68 clinician opinions. Four papers included a comparison or control group, and none utilized randomization. All 17 papers support expanded application of telemedicine in pediatric urology with varied evidence that telemedicine improves patient access to pediatric urologic care, satisfies both patient families and clinicians, is safe, provides equivalent outcomes, and is practicable. CONCLUSIONS Implementation of telemedicine in pediatric urology should be expanded as it can practicably and safely improve patient access to pediatric urologic care, satisfy both patient families and clinicians, and maintain outcomes.
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Affiliation(s)
- Samuel Pettit
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME, 04005, USA.
| | - Ezekiel Young
- Department of Urology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo General Medical Center, 100 High Street Buffalo, NY, 14203, USA.
| | - Ichabod Jung
- Department of Urology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo General Medical Center, 100 High Street Buffalo, NY, 14203, USA.
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Kuo AC, Geleris B, Arnhym A. TeleBBD: Telehealth management of bladder bowel dysfunction - A provider survey of benefits and limitations. J Pediatr Urol 2021; 17:792.e1-792.e7. [PMID: 34656434 DOI: 10.1016/j.jpurol.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/03/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bladder bowel dysfunction (BBD), defined by the International Children's Continence Society (ICCS) as a spectrum of lower urinary tract and bowel symptoms, represents to up to 40% of pediatric urology consults. Management of BBD involves strict behavioral management with frequent follow ups by urology advanced practice providers (APPs). If left untreated, patients may develop secondary comorbidities that impact their renal and/or bladder function, bowel function, and psychosocial well-being. Previous studies have reported feasibility for virtual post-operative visits and prenatal consultations, however, telehealth management of BBD, or TeleBBD, has not yet been studied. The goal of this study is to survey APPs in pediatric urology to understand how TeleBBD compares to in-person visits, and identify benefits and limitations of TeleBBD. STUDY DESIGN An online survey via Qualtrics was designed based on current practice guidelines for BBD management and telehealth considerations. Survey was distributed in September 2020 via the Pediatric Urology Nurses & Specialists listserv. Group qualitative coding was completed by the authors to generate themes that emerged from the results. RESULTS/DISCUSSION A total of 53 APPs from across 21 states in the US completed the online survey, with 49 (92%) APPs reporting currently providing TeleBBD. Those who did not provide TeleBBD typically do not manage BBD patients. Summary Table shows the comparison of TeleBBD with in-person visits, with many elements of TeleBBD better or the same as in-person visits. APPs reported that TeleBBD has been most beneficial in increasing access and overall improvement in follow up which is significant for management of this chronic condition. Barriers include access to technology/internet and inability to perform full physical exams via televisit. Limitations of the study include lack of validated survey and small sample size. Overall increased access and improved patient adherence and resolution from BBD is significant for this patient population for prevention of secondary comorbidities. CONCLUSION This is the first study to survey APPs across the US specifically exploring indication of TeleBBD as well as comparison of TeleBBD with in-person visits. The perception of improved access to care and less no-show rates is significant especially during the pandemic in providing continuity of care and prevent secondary comorbidities. Additionally, TeleBBD was felt to be just as effective as in-person visits for patient adherence to treatment, and other components of care, with the exception of ability to provide physical exams. Providers leveraged the benefits of TeleBBD and shared strategies for best practices.
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Affiliation(s)
- Angel Chen Kuo
- University of California San Francisco School of Nursing, Dept of Family Health Care Nursing, 2 Koret Way, Room N411Y, San Francisco, CA, 94143, USA.
| | - Bethany Geleris
- University of California, San Francisco, Department of Pediatric Urology, 744 52nd Street, 4th Floor, Oakland, CA, 94609, USA.
| | - Anne Arnhym
- University of California, San Francisco, Department of Pediatric Urology, 1825 4th Street, 5th Floor, San Francisco, CA, 94143, USA.
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Radtke S, Umeh R, Chavez M, Curiel Z, Mendez K. Utilizing Telemedicine for Delivery of Postoperative Care Following Minimally Invasive Gynecologic Surgery: A Randomized Controlled Trial. Gynecol Minim Invasive Ther 2021; 10:148-153. [PMID: 34485058 PMCID: PMC8384027 DOI: 10.4103/gmit.gmit_66_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/22/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Materials and Methods: University-based outpatient clinic; Randomized controlled trial (Canadian Task Force classification I). Females between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis were invited to participate. Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. PSQ-18 satisfaction surveys were performed by phone after the visit. Results: Forty-one patients were analyzed out of which 25 were in the office group and 16 in the telemedicine group. Groups were homogenous to age (41.4 vs. 43.3 p. 48), body mass index (31.9 vs. 30.6 P = 0.52), distance in miles from home (12.7 vs. 12.4 P = 0.92), and parity (P = 0.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (interquartile range), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 [4.0, 4.5] vs. 4.5 [4.5, 5.0] P = 0.05), (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.05). The remainder of the categories analyzed were not different between groups Technical Quality (4.0 [3.8, 4.5] vs. 4.5 [3.9, 5.0] P = 0.13), Interpersonal Manner (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.34), Communication (4.5 [4.0, 4.5] vs. 4.5 [4.3, 5.0] P = 0.21), Accessibility and Convenience (4.0 [3.5, 4.5] v 4.0 [3.6, 4.5] P = 0.84). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group went to the ER after postoperative visit, and 0 in the telemedicine group (P = 0.42). Conclusion: Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction.
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Affiliation(s)
- Steven Radtke
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Randle Umeh
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Martha Chavez
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Zuleika Curiel
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Karla Mendez
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
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13
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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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14
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Lombardo AM, Andolfi C, Deshpande AP, Aizen JM, Dangle PP, Gundeti MS. Pediatric urology amidst SARS-CoV-2 pandemic: Building the future with current knowledge. J Pediatr Surg 2021; 56:923-928. [PMID: 33483106 PMCID: PMC7816876 DOI: 10.1016/j.jpedsurg.2021.01.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has ripped around the globe, stolen family members and forced healthcare systems to operate under an unprecedented strain. As of December 2020, 74.7 million people have contracted COVID-19 worldwide and although vaccine distribution has commenced, a recent rise in cases suggest that the pandemic is far from over. METHODS This piece explores how COVID-19 has explicitly impacted the field of pediatric urology and its patients with a focus on vulnerable subpopulations. RESULTS Various medical and surgical associations have published guidelines in reaction to the initial onset of the pandemic in early 2020. DISCUSSION AND CONCLUSION As the number of patients with COVID-19 increases, long-term recovery and future preparedness are imperative and should be cognizant of patient subpopulations that have been subject to disproportionate morbidity and mortality burden. Development of a dedicated response team would aid in achieving preparedness by drafting and implementing plans for resource allocation during scarcity, including logistic and ethical considerations of vaccine distribution. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alyssa M. Lombardo
- University of Chicago Pritzker, School of Medicine, 924 E 57th St. Ste. 104, Chicago, IL 60637, United States,Corresponding author
| | - Ciro Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States,The MacLean Center for Clinical Medical Ethics, The University of Chicago, 5841 S Maryland Ave. MC 6098, Chicago, IL 60637, United States
| | - Abhishek P. Deshpande
- University of Illinois, College of Medicine, 1853W Polk St. MC 785, Chicago, IL 60612, United States
| | - Joshua M. Aizen
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States
| | - Pankaj P. Dangle
- Section of Pediatric Urology, Department of Urology, University of Alabama at Birmingham, Children's of Alabama, 1530 3rd Ave. S, Birmingham, AL 35233, United States
| | - Mohan S. Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States
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15
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Charnell AM, Hoen L', Sforza S, Spinoit AF, Radford A. Remote consultations in paediatric urology-Not just for pandemics? J Pediatr Urol 2021; 17:260-262. [PMID: 33478900 DOI: 10.1016/j.jpurol.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/24/2020] [Accepted: 01/01/2021] [Indexed: 11/15/2022]
Abstract
Although some centres have successfully integrated remote clinics into their paediatric urological practice, for many, remote clinics have developed due to the COVID-19 pandemic. One UK-based institution has integrated remote clinics in their practice for over two years and has developed guidelines considering which conditions may be suitable for remote consultations. These guidelines have been appraised by the European Association of Urology Young Academic Urologists paediatric working group. Through practical experience and anticipated difficulties, we have discussed considerations that paediatric urology departments should ponder when integrating remote clinics into their practice as we move forward from the pandemic.
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Affiliation(s)
- Aimee M Charnell
- Department of Paediatric Surgery, Leeds Children's Hospital NHS Trust, Leeds, UK; Leeds Institute of Medical Education, University of Leeds, UK
| | - Lisette 't Hoen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands.
| | - Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Anne-Françoise Spinoit
- Pediatric and Reconstructive Urology, Robotics, Department of Urology, Ghent University Hospital, Belgium
| | - Anna Radford
- Department of Paediatric Surgery, Leeds Children's Hospital NHS Trust, Leeds, UK; Hull York Medical School, York, UK
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16
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Permana W, Djojodimedjo T, Renaldo J. Tubularized incised plate urethroplasty for megameatus intact prepuce hypospadias variant: First reported case in Indonesia. Int J Surg Case Rep 2021; 80:105698. [PMID: 33676288 PMCID: PMC7982488 DOI: 10.1016/j.ijscr.2021.105698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Megameatus intact Prepuce (MIP) is a rare variant of hypospadias characterized by a wide meatus with a normally conformed prepuce, no chordee, and usually no effects in micturition or sexual physiology. However, quality of life and psychosexuality may be affected. CASE PRESENTATION A 6-year-old-boy was referred by a general practitioner to the hospital due to an abnormality of the urethral meatus. The patient did not have any complaints. A large external urethral orifice at the ventral area of the coronal glans was discovered. The prepuce was normally-conformed, and there weren't any signs of chordee. The patient was diagnosed with an MIP hypospadias variant and underwent a tubularized incised plate (TIP) urethroplasty. During the follow-up, one week after the procedure, the patient did not have any complaints. Physical examination showed excellent anatomical and functional outcome based on the cosmetic appearance resembling a normal penis and urinary stream. CLINICAL DISCUSSION Awareness regarding this abnormality is necessary as MIP is often not diagnosed until circumcision. Even though MIP patients are usually asymptomatic, surgery should still be considered based on aesthetic and psychosexual reasons. TIP urethroplasty was chosen for this patient based on the clinical findings of this patient. TIP procedure for MIP patients could result in an excellent penile performance and function with a very low complication rate. CONCLUSION TIP urethroplasty is able to fulfil satisfactory cosmetic and functional outcomes for the MIP hypospadias variant. Awareness of the disorder should be increased to prevent potential psychosexual disturbances.
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Affiliation(s)
- Wien Permana
- Department of Urology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tarmono Djojodimedjo
- Department of Urology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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17
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Lakshin G, Banek S, Keese D, Rolle U, Schmedding A. Telemedicine in the pediatric surgery in Germany during the COVID-19 pandemic. Pediatr Surg Int 2021; 37:389-395. [PMID: 33388961 PMCID: PMC7778404 DOI: 10.1007/s00383-020-04822-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The COVID-19 pandemic has led to an unprecedented expansion of telemedicine services worldwide. This study aimed to explore the practice of telemedicine in Pediatric Surgery in Germany, the impact of the pandemic on its development and parents' and surgeons' experiences with telemedicine. METHODS The study is a cross-sectional analysis using three surveys between 6/2020 and 10/2020: (1) all Pediatric Surgery departments of Germany reported whether they provide telemedicine services. (2) Members of the German Society of Pediatric Surgery and (3) families who participated in an outpatient visit by telephone or video with the Department of Pediatric Surgery and Pediatric Urology of the University Hospital Frankfurt completed an anonymous survey on their experience with telemedicine. RESULTS 21% of the Pediatric Surgery departments in Germany provided telemedicine, of which 57% started due to the pandemic. The lack of physical examination and face-to-face contact seem to be the major limitations to surgeons and parents. 48% of the parents answered that telemedicine is equal to or better than traditional appointments, while 33% thought that telemedicine is worse. CONCLUSIONS This study shows that families and doctors alike have had positive experiences with telemedicine and most will continue to use this format after the pandemic.
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Affiliation(s)
- G Lakshin
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - S Banek
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - D Keese
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - U Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - A Schmedding
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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18
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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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19
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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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20
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Winkelman AJ, Beller HL, Morgan KE, Corbett ST, Leroy SV, Noona SW, Berry KL, Kern NG. Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic. J Pediatr Urol 2020; 16:840.e1-840.e6. [PMID: 33077389 PMCID: PMC7543732 DOI: 10.1016/j.jpurol.2020.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Telemedicine video visits are an under-utilized form of delivering health care. However due to the COVID-19 pandemic, practices are rapidly adapting telemedicine for patient care. We describe our experience in rapidly introducing video visits in a tertiary academic pediatric urology practice, serving primarily rural patients during the COVID-19 pandemic. OBJECTIVE The primary aim of this study was to assess visit success rate and identify barriers to completing video visits. The secondary aim identified types of pathologies feasible for video visits and travel time saved. We hypothesize socioeconomic status is a predictor of a successful visit. MATERIALS AND METHODS Data was prospectively collected and analyzed on video visits focusing on visit success, defined by satisfactory completion of the visit as assessed by the provider. Other variables collected included duration, video platform and technical problems. Retrospective data was collected via chart review and analyzed including demographics, insurance, and distance to care. Socioeconomic status was estimated using the Distressed Communities Index generated for patient zip code. RESULTS/DISCUSSION Out of 116 attempted visits, 81% were successful. The top two reasons for failure were "no-show" (64%) and inability to connect (14%). Success versus failure of visit was similar for patient age (p = 0.23), sex (p = 0.42), type of visit (initial vs. established) (p = 0.51), and socioeconomic status (p = 0.39). After adjusting for race, socioeconomic status, and type of provider, having public insurance remained a significant predictor of failure (p = 0.017). Successful visits were conducted on multiple common pediatric urologic problems (excluding visits requiring palpation on exam), and video was sufficient for physical exams in most cases (Summary Table). A median of 2.25 h of travel time was saved. CONCLUSIONS While socioeconomic status, estimated using the Distressed Communities Index, did not predict success of video visits, patients with public insurance were more likely to have a failed video visit. There is compelling evidence that effective video visits for certain pathologies can be rapidly achieved in a pediatric urology practice with minimal preparation time.
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Affiliation(s)
| | - Haerin L Beller
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Kathryn E Morgan
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Sean T Corbett
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Susan V Leroy
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Sean W Noona
- School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Kaitlin L Berry
- School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Nora G Kern
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
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21
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Huth K, Hotz A, Starmer AJ. Patient Safety in Ambulatory Pediatrics. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2020; 6:350-365. [PMID: 38624507 PMCID: PMC7553853 DOI: 10.1007/s40746-020-00213-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 05/16/2023]
Abstract
Purpose of Review The majority of patient care occurs in the ambulatory setting, and pediatric patients are at high risk of medical error and harm. Prior studies have described various safety threats in ambulatory pediatrics, and little is known about effective strategies to minimize error. The purpose of this review is to identify best practices for optimizing safety in ambulatory pediatrics. Recent Findings The majority of the patient safety literature in ambulatory pediatrics describes frequencies and types of medical errors. Study of effective interventions to reduce error, and particularly to reduce harm, have been limited. There is evidence that medical complexity and social context are important modifiers of risk. Telemedicine has emerged as a care delivery model with potential to ameliorate and exacerbate safety threats. Though there is variation across studies, developing a safety culture, partnerships with patients and families, and use of structured communication are strategies that support patient safety. Summary There is no standardized taxonomy for errors in ambulatory pediatrics, but errors related to medications, vaccines, diagnosis, and care coordination and care transitions are commonly described. Evidence-based approaches to optimize safety include standardized prescribing and medication reconciliation practices, appropriate use of decision support tools in the electronic health record, and communication strategies like teach-back. Further high-quality intervention studies in pediatric ambulatory care that assess impact on patient harm and clinical outcomes should be prioritized.
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Affiliation(s)
- Kathleen Huth
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
| | - Arda Hotz
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
| | - Amy J. Starmer
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
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22
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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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23
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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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Denning NL, Glick RD, Rich BS. Outpatient follow-up after pediatric surgery reduces emergency department visits and readmission rates. J Pediatr Surg 2020; 55:1037-1042. [PMID: 32171531 DOI: 10.1016/j.jpedsurg.2020.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/20/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The factors affecting outpatient follow-up (OFU) after pediatric surgery have not been well studied. We evaluate factors impacting OFU and the effect of OFU in pediatric surgical patients. METHODS A retrospective review of all pediatric patients operated on by the Division of Pediatric Surgery from February 1st to September 30th, 2017, and subsequently discharged was performed. RESULTS 1242 patients were identified. Overall OFU was 69.6%. Language and distance between patient residence and the hospital had no impact on OFU. Inpatient surgical patients followed-up at a higher rate than ambulatory surgical patients (72.7% vs 64.8%, p < 0.01). Out-of-system transfers had the lowest OFU rate at 52.8% (p < 0.001). Insurance type and patient age had a significant impact on OFU rates. Thirty-day ED visit and readmission rates were significantly lower in those patients with OFU than in those without (8.8% vs 12.7%, p = 0.04 and 3.7% to 11.0%, p < 0.001, respectively). OFU was more beneficial in patients with inpatient procedures or longer hospitalization lengths of stay than in the cohort of ambulatory patients. CONCLUSIONS Socioeconomic status, hospital presentation, and procedural complexity influenced rates of OFU. OFU was associated with significant reductions in 30-day ED visits and readmissions, and this benefit was more pronounced for complex procedures or patients. TYPE OF STUDY Retrospective review. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Naomi-Liza Denning
- Cohen Children's Medical Center, Division of Pediatric Surgery, Northwell Health, 269-01 76(th) Ave, Queens, NY 11040
| | - Richard D Glick
- Cohen Children's Medical Center, Division of Pediatric Surgery, Northwell Health, 269-01 76(th) Ave, Queens, NY 11040
| | - Barrie S Rich
- Cohen Children's Medical Center, Division of Pediatric Surgery, Northwell Health, 269-01 76(th) Ave, Queens, NY 11040.
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25
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"Ramping up telemedicine in pediatric urology- Tips for using a new modality". J Pediatr Urol 2020; 16:288-289. [PMID: 32327290 DOI: 10.1016/j.jpurol.2020.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/22/2022]
Abstract
The COVID pandemic has incited the rapid implementation of telehealth services. Through telemedicine, pediatric urologists can counsel children and their families about genitourinary tract conditions, while adhering to social distancing requirements and keeping families safe at home. With the accelerated use of telemedicine, it is crucial to maintain standards of providing high-quality and secure urologic care. Clinicians must practice effective virtual communication or 'webside' manner. While research may not be a priority, collecting data on telemedicine efforts will be critical in bringing about both payer-based and legislative reforms to encourage and enable wider telemedicine use in the post-COVID world.
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26
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Anderson PM, Hanna R. Defining Moments: Making Time for Virtual Visits and Catalyzing Better Cancer Care. HEALTH COMMUNICATION 2020; 35:787-791. [PMID: 30907145 DOI: 10.1080/10410236.2019.1587695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Time is quite possibly a physician's most valuable asset, yet the tendency of almost all physicians is to be overly committed. How do we slowdown and make a meaningful difference? Virtual visits provide a new way to share and care without sacrificing the important nuances of face-to-face communication. When the Cleveland Clinic expanded our Distance Health capabilities in 2017 using virtual visits, we began a successful journey which provides cancer patients and their caregivers a new type of expert, unrushed cancer care access. This essay describes our current process for providing virtual visit access, preparing prior to the visit, keeping the visit as informative a possible, and closing the visit with a "distance health encounter" in the electronic medical record coupled with a summary and additional information via email.
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Affiliation(s)
- Peter M Anderson
- Pediatric Hematology/Oncology and Bone Marrow Transplantation, Pediatrics Institute and Taussig Cancer Institute
| | - Rabi Hanna
- Pediatric Hematology/Oncology and Bone Marrow Transplantation, Pediatrics Institute and Taussig Cancer Institute
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27
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Abstract
Introduction Telehealth is gaining more attention in multiple specialties, including urology. Video visits in particular have shown high satisfaction and cost-saving for patients. However, there has been little investigation into how video visits compare to traditional clinic visits on measures of clinical efficiency and reimbursement. Methods Our dataset included 250 video visits of established patients at Michigan Medicine Department of Urology and 250 in-person clinic visits with the same providers completed between July 2016 and July 2017. Information on visit completion and cancellation rates; cycle time (time from check in to check out); reimbursement; and patient out-of-pocket expenses was collected using the electronic medical record and billing data. Results Completion rates were similar between video and clinic visits (58% versus 61%, respectively; p=0.24). Average cycle time for video visits was significantly shorter compared to clinic visits (24 min vs 80 min, respectively; p<0.01). Neither average commercial payer reimbursement (p=0.21) nor average out-of-pocket expense (p=0.22) was statistically different between video and traditional visits. More video visits than clinic visits were billed as level 3 encounters (85% and 63%, respectively, p=0.002). Conclusions Our study demonstrates that video visits have the potential to reduce the time patients spend on follow-up care without negatively impacting reimbursement rates. However, these visits could reduce average billing levels. These findings suggest that the incorporation of video visits into practice may be more efficient for patients but may also reduce billing levels.
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28
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Appireddy R, Khan S, Leaver C, Martin C, Jin A, Durafourt BA, Archer SL. Home Virtual Visits for Outpatient Follow-Up Stroke Care: Cross-Sectional Study. J Med Internet Res 2019; 21:e13734. [PMID: 31593536 PMCID: PMC6803894 DOI: 10.2196/13734] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/13/2019] [Accepted: 08/21/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Timely, in-person access to health care is a challenge for people living with conditions such as stroke that result in frailty, loss of independence, restrictions in driving and mobility, and physical and cognitive decline. In Southeastern Ontario, access is further complicated by rurality and the long travel distances to visit physician clinics. There is a need to make health care more accessible and convenient. Home virtual visits (electronic visits, eVisits) can conveniently connect physicians to patients. Physicians use a secure personal videoconferencing tool to connect to patients in their homes. Patients use their device of choice (smartphone, tablet, laptop, or desktop) for the visit. OBJECTIVE This study aimed to assess the feasibility and logistics of implementing eVisits in a stroke prevention clinic for seniors. METHODS A 6-month eVisit pilot study was initiated in the Kingston Health Sciences Centre stroke prevention clinic in August 2018. eVisits were used only for follow-up patient encounters. An integrated evaluation was used to test the impact of the program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by telephone interviews, using a brief questionnaire. Access and patient satisfaction metrics were compared with concurrent standard of care (patients' prior personal experience with in-person visits). Values are presented as median (interquartile range). RESULTS There were 75 subjects in the pilot. The patients were aged 65 (56-73.5) years, and 39% (29/75) resided in rural areas. There was a shorter wait for an appointment by eVisit versus in-person (mean 59.98 [SD 48.36] days vs mean 78.36 [SD 50.54] days; P<.001). The eVisit was also shorter, taking on an average of only 10 min to deliver follow-up care with a high degree of patient satisfaction versus 90 (60-112) min for in-person care. The total time saved by patients per eVisit was 80 (50-102) min, 44 (21-69) min of which was travel time. Travel distance avoided by the patients was 30.1 km (11.2-82.2). The estimated total out-of-pocket cost savings for patients per eVisit was Can $52.83 (31.26-94.53). The estimated savings (opportunity cost for in-person outpatient care) for our eVisit pilot project was Can $23,832-$28,584. The patient satisfaction with eVisits was very good compared with their prior personal experience with in-person outpatient care. CONCLUSIONS The eVisit program was well received by patients, deemed to be safe by physicians, and avoided unnecessary patient travel and expense. It also has the potential to reduce health care costs. We plan to scale the project within the department and the institution.
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Affiliation(s)
- Ramana Appireddy
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Sana Khan
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | | | - Cally Martin
- Stroke Network of Southeastern Ontario, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Albert Jin
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Bryce A Durafourt
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Stephen L Archer
- Department of Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
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Current use of telehealth in urology: a review. World J Urol 2019; 38:2377-2384. [PMID: 31352565 DOI: 10.1007/s00345-019-02882-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Applications of telehealth have been growing in popularity. However, there is little information on how telehealth is being used in Urology. In this review, we examine current applications of telehealth in urological practices as well as barriers to implementation. METHODS A review was conducted of original research within the past 10 years describing telehealth applications in urology. Articles on telehealth as applied to other specialties were reviewed for discussion on real or perceived barriers to implementation. RESULTS Twenty-four articles met the inclusion criteria. The most common application of telehealth was using a video visit to assess or follow-up with patients. The second most commonly described applications of telehealth were telementorship, or the use of telehealth technology to help train providers, and telemedicine used in diagnostics. Studies consistently stated the effectiveness of the telehealth applications and the high level of patient and provider satisfaction. CONCLUSIONS Telehealth is sparingly used in urology. Barriers to implementation include technological literacy, reimbursement uncertainties, and resistance to change in workflow. When used, telehealth technologies are shown to be safe, effective, and satisfactory for patients and providers. Further investigation is necessary to determine the efficacy of telehealth applications.
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Cohen AJ, Ndoye M, Fergus KB, Lindsey J, Butler C, Patino G, Anger JT, Breyer BN. Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census. J Rural Health 2019; 36:300-306. [DOI: 10.1111/jrh.12376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/18/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew J. Cohen
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Medina Ndoye
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Kirkpatrick B. Fergus
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - John Lindsey
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Christi Butler
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - German Patino
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Jennifer T. Anger
- Cedars‐Sinai Department of SurgeryDivision of Urology Los Angeles California
| | - Benjamin N. Breyer
- Department of UrologyUniversity of California‐San Francisco San Francisco California
- Department of Biostatistics and EpidemiologyUniversity of California‐San Francisco San Francisco California
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