The COVID-19 pandemic provided a springboard for telemedicine use as a necessity to deliver care while social distancing affected all aspects of health care. The declaration of a public health emergency in March 2020 resulted in a rapid expansion of telehealth services with a relaxing of regulations at the state and national levels. Nationally, there is mounting evidence that many aspects of patient care can continue virtually, 1 including a more prominent role across surgical disciplines in preoperative and postoperative care and management of chronic wounds. More widespread use of telemedicine and the ability to engage in new patient evaluations can help reduce geographic barriers and allow hospital systems to create capacity for patients with more severe illness to be seen in person, while patients who are stable and healthier can engage from home. Combining virtual and hands-on care will undoubtably persist beyond the pandemic.However, reliance on technology brings forth pressures that can widen the gap in access to care for vulnerable populations; the COVID-19 pandemic has undoubtedly redefined what it means to be vulnerable in society. A recent study of more than 600 000 Medicare beneficiaries dwelling in communities from the 2018 American Community Survey demonstrated that 26% did not have access to either a computer with highspeed internet or a smartphone with a wireless data plan. Among other factors, individuals who were older, Black or Hispanic, widowed, or lacking more than a high school education reported more limited digital access. 2 Furthermore, during this time, millions of individuals in the US are facing financial, emotional, and physical constraints that are unique and life changing. How can we move forward while not leaving the most vulnerable behind?
Objective
To evaluate whether video visits were being used as substitutes to clinic visits prior to COVID-19 at our institution's outpatient urology centers.
Methods
We reviewed 600 established patient video visits completed by 13 urology providers at a tertiary academic center in southeast Michigan. We compared these visits to a random, stratified sample of established patient clinic visits. We assessed baseline demographics and visit characteristics for both groups. We defined our primary outcome (“revisit rate”) as the proportion of additional healthcare evaluation (ie, office, emergency room, hospitalization) by a urology provider within 30 days of the initial encounter.
Results
Patients seen by video visit tended to be younger (51 vs 61 years,
P
<.001), would have to travel further for a clinic appointment (82 vs 68 miles,
P
<.001), and were more likely to be female (36 vs 28%,
P
= .001). The most common diagnostic groups evaluated through video visits were nephrolithiasis (40%), oncology (18%) and andrology (14.3%). While the 30-day revisit rates were higher for clinic visits (4.3% vs 7.5%,
P
= .01) primarily due to previously scheduled appointments, revisits due to medical concerns were similar across both groups (0.5% vs 0.67%;
P
= .60).
Conclusions
Video visits can be used to deliver care across a broad range of urologic diagnoses and can serve as a substitute for clinic visits.
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