Presentation Authors: Alex Nourian*, Philadelphia, PA, Nicholas Smith, Jeremy Shelton, Los Angeles, CA
Introduction: Telehealth is a well-received and effective tool in urology, but few studies have described how it can be combined with face-to-face (FTF) visits in the care of urologic conditions. We describe our experience in the Veterans Affairs Greater Los Angeles Healthcare System with the use of telehealth in delivering urologic care, which included a general urology clinic and an erectile dysfunction education clinic. To further examine the way primary care (PC), telehealth and FTF visits were utilized together to provide care, we examined the patient course through three common urologic referrals: elevated prostate-specific antigen (PSA), microscopic hematuria, and obstructive lower urinary tract symptoms (LUTS).
Methods: We performed a retrospective review of telemedicine visits from 2013 to 2018 to assess patients' presenting urologic condition to telehealth, as well as the number of subsequent telemedicine and in-person encounters. To illustrate how telehealth, FTF visits and PC were integrated into patient care, we used a random convenience sample of 20 patients from each of the three common referrals listed above and reviewed their care over a two-year period following the initial referral to telehealth, and described the site of care delivery for the following key components of care: history and physical, laboratory tests, imaging and procedures.
Results: 811 unique patients were evaluated through telehealth for a total of 2008 telehealth visits. The most common conditions evaluated at the initial encounter were sexual dysfunction (26.8%), LUTS (20.6%), hematuria (15.0%), prostate cancer (13.3%), an elevated PSA (12.1%), stones (2.5%), renal masses (1.7%), and urinary tract infections (1.7%). 34% of patients were managed with telehealth alone, while 64% were seen via telehealth and FTF encounters. The mean number of telehealth to FTF visits was similar (2.48 versus 2.42, respectively). Table 1 shows the proportion of each aspect of care delivered for each condition by setting: in PC, urologic telehealth and FTF visits.
Conclusions: Telehealth was utilized for a wide array of diseases and was often used in conjunction with FTF visits to capture the components of evaluation for three disease states, suggesting a novel model for urologic care delivery.