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JU INSIGHT Interstate Telemedicine for Urologic Cancer Care
By: Adam J. Gadzinski, MD, MS, Beaumont Hospital, Royal Oak, Michigan; Erin M. Dwyer, MS, University of Washington, Seattle; Jason Reynolds, MD, University of Washington, Seattle; Blair Stewart, MS, University of Washington, Seattle; Isabelle Abarro, BS, University of Washington, Seattle; Erika M. Wolff, PhD, University of Washington, Seattle; Chad Ellimoottil, MD, MS, University of Michigan, Ann Arbor; Sarah K. Holt, PhD, University of Washington, Seattle; John L. Gore, MD, MS, University of Washington, Seattle, Fred Hutchinson Cancer Center, Seattle, Washington | Posted on: 19 Jan 2024
Gadzinski AJ, Dwyer EM, Reynolds J, et al. Interstate telemedicine for urologic cancer care. J Urol. 2024;211(1):55-62.
Study Need and Importance
Patients with urologic cancers who reside in rural areas confront challenges accessing needed care, especially when they require complex surgeries. For rural-residing individuals, this may require traveling to another state, which can be an artificial barrier to care. Telehealth is a potential solution to the burden of interstate cancer care, yet licensure restrictions limit broad access to interstate telehealth. Optimal uses of telemedicine must be assessed to inform policy, legislation, and clinical care. We compared satisfaction with care, perceptions of communication, and visit costs for patients convening telemedicine visits and those convening in-person visits based on their state of residence.
What We Found
We assessed the survey responses of 1058 patients seen between August 2019 and June 2022. Satisfaction rates were high for all visit types, whether telemedicine or in person, and independent of their state of residence. Patients receiving interstate care had significantly higher travel costs (Table), including a higher need for planned travel or an overnight hotel stay.
Table. Travel Burden Associated With Telemedicine or In-Person Care
| Telemedicine | In person | |||||
|---|---|---|---|---|---|---|
| Interstate | In state | P value | Interstate | In state | P value | |
| Total costs, median (IQR), $ | 0 (0) | 0 (0) | < .001 | 500 (250-1000) | 73 (35-143) | < .001 |
| Travel time, median (IQR), min | 0 (0-248) | 0 (0-60) | .02 | 335 (240-470) | 180 (120-213) | < .001 |
| Required plane travel, No. (%) | 6 (8.0) | 1 (0.1) | < .001 | 48 (55) | 3 (2.1) | < .001 |
| Required hotel, No. (%) | 8 (11) | 18 (2.2) | < .001 | 52 (60) | 28 (20) | < .001 |
| Missed work, No. (%) | 14 (19) | 89 (11) | .05 | 41 (47) | 57 (41) | .3 |
Limitations
The study participants were a convenience sample rather than consecutively enrolled patients. Further, we were unable to assess nonresponders or patients convening audio-only visits.
Interpretation for Patient Care
Satisfaction outcomes among patients with urologic cancer receiving interstate telemedicine care were similar to those of patients cared for in state and in person. Costs, however, were markedly lower. Expanding telemedicine access should be a priority for patients and health care providers.
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