Bridging the Gap—Building Surgical Subspecialty Telemedicine Clinics in the Rural Setting

Abstract

Introduction:Pediatric urology is a much-needed subspecialty with a breadth of complex disorders that can often prove challenging to diagnose and manage. Exacerbating this need is the minimal exposure medical trainees receive to pediatric urology. Pediatric urology arrived in West Virginia in 1983 but the subspecialty has been inconsistently represented since then. Currently there are 2 fellowship-trained pediatric urologists in the state of West Virginia, which has an area of approximately 24,038 square miles. We review our experience with the use of telemedicine in providing outreach to the wider parts of our medically underserved state and ultimately evaluate its efficacy from a patient-centric cost analysis and diagnosis concordance perspective. We hypothesized that the use of telemedicine would be cost and time-effective for patients in our rural state.Methods:We retrospectively reviewed our series of patients presenting from outside telemedicine “referral centers” in Martinsburg, Parkersburg and Wheeling for pediatric urological consultation. We evaluated reason for consultation, geographic driving distance, drive time and travel cost saved from telemedicine consultation.Results:A total of 92 patients presented to outside designated telemedicine centers from August 2018 to April 2020. The mean driving time saved utilizing telemedicine consultation was 4 hours and 46 minutes, and mean driving distance saved was 299.8 miles. Travel costs saved in terms of fuel averaged $173.88 per patient. The most common reason for consultation was undescended testis, followed by recurrent urinary tract infection and nocturnal enuresis. Of the 23 patients who required surgery, only 2 (8.7%) had an initial diagnosis that was not concordant with their operating room examination.Conclusions:While modest, our data indicate a modern solution to a historical need in our state. Our high diagnosis concordance rate (91.3%) shows that a well-trained advanced practice provider can adequately perform an operative evaluation via telemedicine.

From Start-to-Finish: A Partnership With Advanced Practice Providers in Tele-Consultation Within Pediatric Urology

“…Most importantly, in our preliminary experience with 92 teleconsultation visits we found an overall concordance rate in diagnoses (teleconsultation vs in-person) of 91.3%. Additionally, our results were reproducible at two other sites, increasing the capacity within a rural state to 4 total sites (5).…”

“…Telemedicine technology has existed within pediatric surgical subspecialty care for just over a decade, however, its implementation was only rapidly accelerated as a result of the COVID-19 pandemic, with a six-fold increase in the percentage of urologists using telemedicine programs in 2020 alone compared to 2019 (6). It has proven a useful tool in increasing access of surgical subspecialty care and a particular benefit in rural settings (5,7).…”

Evolution of telemedicine utilization for pediatric urology during the COVID-19 pandemic and beyond: A single center experience

“…Given that the time involved in travel and waiting for care can account for up to 98.4% of the total time spent for in-person visits and that opportunity costs for pediatric urology IPVs have been calculated at 20 times higher per minute than those of VVs, patients living far away greatly benefit from the increased efficiency of telemedicine and decreased missed time from work or school (13). Further investigation is warranted to determine if these patients are from underserved areas, such as rural areas that may benefit most from expansion of telemedicine in pediatric urology, and whether telemedicine at our institution is reaching socioeconomically disadvantaged patients who may benefit most from these cost savings (14). Despite the potential for telemedicine to increase access to care across disparity domains by overcoming travel distance and opportunity cost barriers, VVs across the study period were less frequently covered by subsidized insurance compared to IPVs.…”