UPJ Insight: Bridging the Gap: Building Surgical Subspecialty Telemedicine Clinics in the Rural Setting

By: Christopher Ferari, MD; Katharina Mitchell, MD; Chad Crigger, MD, MPH; Shirley Zupper, FNP; Amy Wildasin; Michael Ost, MD, MBA; Brian Hendricks, PhD; Osama Al-Omar, MD, MBA | Posted on: 01 Mar 2022

Ferari C, Mitchell K, Crigger C et al: Bridging the gap–building surgical subspecialty telemedicine clinics in the rural setting. Urol Pract 2021; https://doi.org/10.1097/UPJ.0000000000000284.

Study Need and Importance: Telemedicine has expanded into many fields, including urology. It has been seen that only 10% of urologists practice in nonmetropolitan areas. Several studies have noted the successful implementation of urology telemedicine programs, particularly in terms of cost, distance traveled, missed work and decrease in wait times for postoperative visits, all without sacrificing patient satisfaction, patient-provider facetime or saftey. However, in pediatric urology the concordance rate between physical diagnosis at the time of telehealth visit and preoperative/intraoperative physical examination has not been previously investigated. Our study is of value because it sheds light on our experience in building capacity for telemedicine in West Virginia and with advanced practice provider (APP) training and collaboration working alongside the 2 pediatric urologists in our state to provide care for the pediatric patients in Appalachia.

What We Found: For the 92 patients included the mean roundtrip driving time saved utilizing telemedicine consultation was 4 hours and 46 minutes with a mean driving distance saved of 299.8 miles per patient. Travel cost saved averaged $173.88 per patient. The most common surgical case booked by the APP in clinic was orchiopexy (10 cases; see table). Of the 23 patients who scheduled for surgery, only 2 patients (8.7%) had an initial diagnosis that was not concordant with their APP preoperative examination.

Table. Surgical cases booked by APP for 23 patients

Diagnosis Frequency
Meatoplasty 1
Circumcision revision 2
Circumcision 2
Orchiopexy 10 (1 case was canceled)
Orchiectomy 1
Hydrocelectomy 2
Inguinal hernia repair 1
Correction penoscrotal webbing 1
Correction concealed penis 1
Stone extraction 1
Release penile adhesions 1

Limitations: One limitation of our study is a relatively small sample size. This can be explained by the nature of our telemedicine consultation system and our comparatively small state pediatric urology population.

Interpretation for Patient Care: The high diagnosis concordance rate (91.3%) in physical diagnosis from time of initial consultation and preoperative/intraoperative setting shows that a well-trained APP can adequately perform an operative evaluation via telemedicine and can serve as a reproducible template in building clinics for additional surgical subspecialties elsewhere.

Data were collected prior to the COVID-19 pandemic.