1
|
Schults A, Tham RL, Nelson CP, Finkelstein JB. Factors contributing to telemedicine efficacy in pediatric urology. J Pediatr Urol 2024:S1477-5131(24)00200-6. [PMID: 38679525 DOI: 10.1016/j.jpurol.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Despite swift implementation of telemedicine with the coronavirus disease 2019 pandemic, there is a paucity of research on its use for management of pediatric urology patients. Specifically, there is limited knowledge and inconsistent data on the effectiveness of telemedicine for various pediatric urologic conditions. Our aim was to evaluate the efficacy of pediatric urological care provided via video visits (VVs) at a large tertiary care children's hospital. MATERIAL AND METHODS We performed a prospective assessment of pediatric urology patients younger than 21 years who had a VV between 5/18/2022 and 5/17/2023. New patients with a testicular diagnosis were not eligible for VVs. After entering the diagnosis and submitting billing using a modifier for telemedicine, clinicians were mandated to select whether the VV allowed for: complete case management (CCM), suboptimal case management (SCM), or incomplete case management (ICM) requiring an in-person visit. Case management categorizations were analyzed according to patient pathology, visit type (i.e., new or established), and patient-centered variables including age, sex, race, insurance type, need for an interpreter, and distress score [a proxy for socioeconomic status]. RESULTS During the one-year period, there were 3267 telemedicine patients with a median age of 9 years (IQR 3-13) and 57.0% were male. Most VVs (89.3%) were established encounters. Almost 12% of telemedicine patients had external organ pathology (EOP, e.g., phimosis), 43.0% had internal organ pathology (IOP, e.g., hydronephrosis), and 45.1% had functional urological pathology (FUP, e.g., dysfunctional voiding). Clinicians deemed 96.9%, 2.7%, and 0.5% of VVs as having CCM, SCM or ICM, respectively. Telemedicine patients with IOP or FUP were more likely to have CCM, than those with EOP (98.5% and 97.8% vs 87.1%, p < 0.0001). On multivariable analysis, patient age, pathology, and visit type were predictive of VV efficacy. DISCUSSION Now that telemedicine use has slowed, it is necessary to evaluate and establish its optimal role in pediatric urology. Factors associated with VV efficacy included older patient age, internal organ or functional urological pathology, and established encounters. The long-term success of telemedicine requires suitable patient selection. CONCLUSIONS Telemedicine is quite effective for the management of a wide variety of pediatric urology patients. Continued evaluation of telemedicine, including multi-institutional investigation and corroboration, is necessary for the development of evidence-based best practice guidelines regarding appropriate, safe, and effective integration of telemedicine that drives pediatric urological care forward to meet the demands of the future.
Collapse
Affiliation(s)
- Austin Schults
- Department of Urology Massachusetts General Hospital, Boston, MA, USA.
| | - Regina L Tham
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | | |
Collapse
|
2
|
Finkelstein JB, Rosoff JS, Tham RL, Perlman CA, Nelson CP. Characterizing digital access in pediatric urology. J Pediatr Urol 2023; 19:523.e1-523.e6. [PMID: 37121815 DOI: 10.1016/j.jpurol.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Virtual medicine has the potential to improve access for underserved populations by facilitating timely remote evaluation. However, challenges in the real-world implementation of this technology may paradoxically exacerbate health disparities. We sought to characterize families' digital access and how social determinants of health may impact virtual medicine access within pediatric urology. We hypothesized that disadvantaged socioeconomic status would be a barrier to virtual medicine access. STUDY DESIGN A digital access screening tool was prospectively developed and launched in July 2021. Schedulers are prompted to complete this optional screening questionnaire at the time of patient intake, for video or in-person encounters. The parent is screened for access to a device and reliable internet or cellular data that could be used to participate in a video visit. These represented the primary study outcomes. A modality preference for an in-person visit, video visit, or no preference was also recorded. Patient demographics were retrospectively evaluated, and socioeconomic status was estimated using the Distressed Communities Index generated for each patient's zip code. For each zip code, the Distressed Communities Index produces a normalized, comparative distress score ranging from 0 ("prosperous") to 100 ("distressed"). RESULTS 3885 patients were included, with median age of 5 years (IQR 1-11). Almost 74% were male, 71.3% were White, 20.9% had public insurance, and 2.9% required an interpreter. The median distress score was 14.2 (IQR 7.2-27.5). Screening revealed that 136 families (3.5%) lacked digital access. On multivariable logistic regression analysis, insurance type (p = 0.0020) and distress score (p = 0.0125) were significant predictors of digital access (Summary Table). Those patients who lacked access to a device (p < 0.0001) or reliable internet/cellular data (p < 0.0001) were more likely to prefer an in-person visit. DISCUSSION Family screening revealed that there is a small but significant proportion of families who lack digital access, and this cohort disproportionately represents underserved communities with higher distress scores, likely reflecting lower socioeconomic status. Those families without digital access were more likely to prefer an in-person visit. Improved identification of these socially complex "at-risk" patients can assist in the development of more inclusive health care strategies. CONCLUSIONS Despite the chance for virtual medicine to expand access for underserved populations, lack of digital tools may hinder its potential impact on health disparities in pediatric urology. Ongoing digital access screening and further studies are needed to design interventions tailored to the specific needs of our patients, allowing for more equitable pediatric urological care.
Collapse
Affiliation(s)
- Julia B Finkelstein
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - James S Rosoff
- Division of Urology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA.
| | - Regina L Tham
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Caroline A Perlman
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| |
Collapse
|
3
|
Turcotte B, Bélanger L, Blais AS, Blouin AC, Bolduc S, Bolduc-Mokhtar A, Bureau M, Caumartin Y, Cloutier J, Deschênes-Rompré MP, Dujardin T, Fradet Y, Gaudreau N, Lacombe L, Moore K, Morin F, Nadeau G, Paquet S, Simard F, Simonyan D, Soucy F, Tiguert R, Toren P, Lodde M, Pouliot F. Perception and satisfaction of patients after telemedicine urology consultations: A matched analysis with physicians' perspective. Can Urol Assoc J 2022; 16:334-339. [PMID: 35621285 PMCID: PMC9565072 DOI: 10.5489/cuaj.7819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
INTRODUCTION During the first regional COVID-19 lockdown in March 2020, we conducted a study aimed at evaluating completeness of telemedicine consultation in urology. Of 1679 consultations, 67% were considered completely managed by phone. The aim of the present study was to assess patients' experience and satisfaction with telemedicine and to compare them with urologists' perceptions about quality and completeness of the telemedicine consultation. METHODS We contacted a randomly selected sample of patients (n=356) from our previous study to enquire about their experience. We used a home patient experience questionnaire, inspired by the Patient Experiences Questionnaire for Out-of-Hours Care (PEQOHC) and the Consumer Assessment Health Profile Survey (CAHPS). RESULTS Of 356 patients contacted, 315 agreed to complete the questionnaire. Urological consultations were for non-oncological (104), oncological (121), cancer suspicion (41), and pediatric (49) indications. Mean patient satisfaction score after telemedicine consultation was 8.8/10 (median 9/10) and 86.3% of patients rated the quality of the consultation as either excellent (54.6%) or very good (31.7%). Consultations regarding cancer suspicion had the lowest score (8.3/10). Overall, 46.7% of all patients would have preferred an in-person visit outside of the pandemic situation. Among patients whose consultations were rated suboptimal by urologists, almost a third more (31.2%) would have preferred an in-person visit (p=0.03). CONCLUSIONS Despite high reported patient satisfaction rates with telemedicine, it is noteworthy that nearly half of the patients would have preferred an in-person visit. Post-pandemic, it will be important to incorporate telemedicine as an alternative, while retaining and offering in-person visits.
Collapse
Affiliation(s)
- Bruno Turcotte
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Lynda Bélanger
- Office of Patient Experience Expertise, CHU de Québec-Université Laval, Quebec, QC, Canada
- Department of Nursing Sciences and School of Design (Public Services), Université Laval, Quebec, QC, Canada
| | - Anne-Sophie Blais
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Annie-Claude Blouin
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Stéphane Bolduc
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Amélie Bolduc-Mokhtar
- Office of Patient Experience Expertise, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Michel Bureau
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Yves Caumartin
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Jonathan Cloutier
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | | | - Thierry Dujardin
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Yves Fradet
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Noémie Gaudreau
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Louis Lacombe
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Katherine Moore
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Fannie Morin
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Geneviève Nadeau
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Sophie Paquet
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Francis Simard
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Research Center, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Frédéric Soucy
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Rabi Tiguert
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Paul Toren
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Michele Lodde
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| | - Frédéric Pouliot
- Division of Urology, Department of Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
ElAgami H, Woodward B, Awolaran G, Kalidasan V. Virtual consultation in paediatric urology during the COVID-19 pandemic: The effect of pathology on the outcome. J Telemed Telecare 2022; 28:539-546. [PMID: 35253528 PMCID: PMC8902319 DOI: 10.1177/1357633x221076967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Virtual consultation (VC) has exponentially increased during the COVID-19
pandemic. Lessons from using this modality during the pandemic will need to
be appraised carefully before integrating it into the routine practice. Some
paediatric urology patients can potentially be excellent candidates for
routine VC. Objectives Investigate the ability of clinicians to make management plans using VCs and
identify accordingly the group of patients that can benefit from routine VC.
Evaluate the routine use of VC without travel restrictions. Methods Designed in two phases. Phase 1, during the lockdown, prospective collection
of data after the consultation assessing the clinician satisfaction in
making a decision by VC. The results were then divided according to the
patient pathology; internal organ pathology (IOP), functional urological
pathology (FUP) or external organ pathology (EOP). Data was then analysed to
demonstrate if different outcomes can be related to the pathology. Phase 2
after the ease of the lockdown to judge the lessons learnt looking at the
same parameters in patients who are selected to receive VC and evaluate
journey saved by the patients, measured in miles. Results One hundred and forty-four consultations were assessed. One hundred and
fourteen in phase 1 and 30 from phase 2. Mean age 7.2 years. In phase 1, 57%
of patients were reviewed by consultants and 72% were followed up.
Thirty-seven per cent had IOP, 24.5% FUP and 38.5% EOP. Clinicians were more
likely to reach a decision with patients with IOP and FUP
P < 0.0001 and 0.0024, respectively. Phase 2
demonstrated the change of practice where 93% of the patients were either
IOP or FUP. An average of 27 miles per patient was saved on journeys. Discussion VC for paediatric urology patients was employed effectively to avoid hospital
contact during the lockdown. From the lessons learnt that patients with IOP
and FUP can continue to benefit from VC after the ease of lockdown without
compromising the decision making. VC is a viable way to structure services
in the future for selected paediatric urology conditions.
Collapse
Affiliation(s)
- Hesham ElAgami
- University Hospital Sussex, Royal Alexandra Children Hospital, Brighton, UK
| | - Benjamin Woodward
- University Hospital Sussex, Royal Alexandra Children Hospital, Brighton, UK
| | | | | |
Collapse
|
6
|
Dramburg S, Braune K, Schröder L, Schneider W, Schunck KU, Stephan V. [Mobile applications (apps) for diagnosis and treatment control in pediatric and adolescent medicine]. Monatsschr Kinderheilkd 2021; 169:726-737. [PMID: 34248207 PMCID: PMC8261800 DOI: 10.1007/s00112-021-01233-6] [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: 06/02/2021] [Indexed: 12/02/2022]
Abstract
Die Digitalisierung hält in der Medizin in vielfältigster Form Einzug. Ob patientenzentriert, vernetzend, zur Unterstützung medizinischen Fachpersonals oder in der (klinischen) Forschung: Digitale Technologien sind aus dem medizinischen Alltag spätestens seit der durch das SARS-CoV-2 Virus ausgelösten Pandemie nicht mehr wegzudenken. Hierbei zählen u. a. mobile Smartphone-Anwendungen zu den häufigsten Entwicklungen. Doch die Vielzahl der erhältlichen Produkte und der Zeitmangel in der medizinischen Praxis machen eine zuverlässige Einschätzung der Qualität, Sicherheit und Funktionalität oft schwer. Der vorliegende Übersichtsbeitrag fasst aktuelle Entwicklungen „mobiler“ Technologien aus dem Bereich der Kinder- und Jugendmedizin zusammen und veranschaulicht erhältliche Anwendungen anhand konkreter Beispiele. Ziel ist es, die Leser:innen zu animieren, eigene Erfahrungen zu machen und ihren Blick für evtl. Risiken zu schärfen.
Collapse
Affiliation(s)
- Stephanie Dramburg
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
| | - Katarina Braune
- Klinik für Pädiatrie mit Schwerpunkt Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Lisa Schröder
- Perinatalzentrum, Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Welfhard Schneider
- Perinatalzentrum, Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Karl-Ulrich Schunck
- Perinatalzentrum, Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Volker Stephan
- Klinik für Kinder- und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Deutschland
| |
Collapse
|
7
|
Leveridge M. The algebra of clinic and telephone medicine. Can Urol Assoc J 2020; 14:296-297. [PMID: 33275548 PMCID: PMC7716833 DOI: 10.5489/cuaj.6925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2024]
Affiliation(s)
- Michael Leveridge
- Department of Urology, Queen's University, Kingston, ON, Canada, and CUAJ Editor-in-Chief
| |
Collapse
|