Luse DL, Palasi SF, Geskin AA et al: Patient perceptions of telephonic visits during the COVID-19 pandemic—is video connectivity imperative? Urol Pract 2021; 8: 460.

The initial outbreak of COVID-19 in spring of 2020 led to rapid adoption of telehealth among practicing urologists. The abrupt rollout of remote ambulatory care presented difficulties for providers who lacked established platforms for conducting video-enabled telemedicine visits. These problems were further compounded by patients who did not have access to audio-video capable devices or chose not to use them. To ease the transition and expand access to care during the public health emergency, the Centers for Medicare and Medicaid Services (CMS) amended its telehealth payment requirements to allow payment parity for telephone visits, and waived previous video requirements for certain evaluation and management services.¹ In our practice, this led to the conversion of most ambulatory visits to audio-only telephonic encounters in the early months of the pandemic, as telemedicine platforms were slow to roll out across our institution. Once telemedicine platforms and equipment were made available, telephonic visits were converted to video-enabled telemedicine visits for most patients. We surveyed patients within our practice regarding their satisfaction with telephonic and telemedicine visits using a survey² adapted from a randomized study by Viers et al.³

A total of 76 patients participated in the survey within a month after their visit between March and July 2020, with 38 patients undergoing telephonic visits and 38 undergoing telemedicine visits. The dominant encounter type in the months of March and April 2020 was telephonic, while telemedicine became the dominant appointment type in June and July 2020. In-person appointments were available during the study period if the patient preferred, or required an examination or procedure. There were no significant differences in demographics, clinical characteristics, diagnoses, or interventions among groups. Diagnoses addressed during the visits included benign prostatic hyperplasia, lower urinary tract symptoms, elevated prostate specific antigen (PSA), prostate cancer, nephrolithiasis, renal masses, renal cell carcinoma, and bladder cancer. Interventions during the encounters included ordering prescriptions, refills, laboratory tests, imaging and scheduling procedures and surgeries.

The main findings of the survey are shown in the table. Overall, participants reported high levels of satisfaction with telehealth appointments, with no significant difference between telephonic and telemedicine visit types (6.65 [SD 1.1] vs. 6.55 [SD 1.0], p=0.155). Patients in the telephonic cohort reported increased timeliness and efficiency of the encounter (6.58 [SD 1.2] vs. 5.91 [SD 1.7], p=0.017) and increased willingness to have remote visits with urology residents (6.58 [SD 1.0] vs. 5.61 [SD 1.7], p=0.001) and advanced practice providers (APPs) (6.21 [SD 1.6] vs. 5.51 [SD 1.7], p=0.015). There was no association between reported satisfaction and prior experience with video calls or education level. Among the patients 76% reported saving both time and money by utilizing telehealth appointments. Subsequently, 91% of patients desired the option of telehealth appointments after the COVID-19 pandemic, with 65% requesting the option of both telemedicine and telephonic visits.

Our results are consistent with previous studies reporting high patient satisfaction with telehealth as well as significant time and cost savings to the patient.^2-4 In our study, patients undergoing telephonic encounters reported increased timeliness and efficiency compared to telemedicine visits. Possible explanations for this include elderly study participants (median age 63) and technical difficulties related to coordinating video connectivity. To our knowledge, no studies in urology have elicited patient perceptions of telehealth encounters with residents and APPs. Our results showed increased willingness of those undergoing telephonic visits to have future remote visits with residents and APPs. In our experience, residents and APPs performed many telephonic visits, while attendings performed most telemedicine encounters, which may explain these results. These findings support the role of residents and APPs in conducting telehealth encounters.

This study aims to contribute to the conversation surrounding the future of telehealth in urology moving forward after the COVID-19 pandemic. Much uncertainty exists regarding the duration of expanded telehealth policy. While there is payment parity between telephonic, telemedicine and in-person visits for Medicare during the current public health emergency declaration, the complexity of coding for these visits and differences in coverage across commercial payers have created hesitancy to incorporate telephonic encounters into clinic workflow.⁵ Our results demonstrate that patients are highly satisfied with telephonic encounters, and they may provide a simpler and efficient modality for receiving care from their urologist, especially among the elderly and those without compatible devices or internet connectivity. Further research is needed to assess provider perceptions as well as patient safety and outcomes related to telephonic visits to fully inform policy discussions related to these services.