How far are they coming from?

Abstract

Introduction: In the province of Quebec, eight pediatric urologists practice in three tertiary centres covering large territories. To improve the availability of pediatric urology to distant families and to reduce the economic burden on them, we examined the chart of all patients attending the pediatric urological outpatient clinic. Our objectives were to evaluate the distance travelled by each urological pediatric outpatient and to report the most frequent urological referral complains.
 Methods: From July 2016 to June 2017, we retrospectively reviewed the charts of all the 3609 pediatric patients seen in the outpatient urological clinic in CHU de Québec. We specifically focused on the travelling distance covered by families and the purpose of referral.
 Results: Most patients were boys (78%) and the mean age was 7.2 years. The average one-way distance traveled by each family was 69 km. The patients came more frequently from Capitale-Nationale (63,7%) and Chaudière-Appalaches (21,9%), the closest regions. The most common reasons for consultations were postoperative followups (15%), phimosis and adherences (14%), enuresia (14%), hydronephrosis (13%), micturition disorder (11%), and cryptorchidism and retractile testicles (8%). Of all patients seen for phimosis or cryptorchidism, only 24% and 36% of them, respectively, were scheduled for surgery.
 Conclusions: Phimosis, cryptorchidism, and voiding disorders are the most frequent pediatric urological reasons for consultation; primary care continuing medical education seems worthwhile. It would, perhaps, be more beneficial for all to have the pediatric urologists travelling to perform clinics and surgeries in distant regions to save more than 300 km round trip to several families.

A prospective, multisite study analyzing the percentage of urological cases that can be completely managed by telemedicine

“…For instance, we recently reported that uro-pediatric patients travelled, on average, a 69 km distance one way for a urological visit at our center. 5 It seems reasonable that many parents would have chosen telemedicine from the 58.5% of pediatrics appointments judged as SCM by pediatric urologists. This shows that telemedicine probably would be optimal in more than our reported ratio of CCM.…”

Impact of distance on postoperative follow-up in patients of pediatric surgery: a retrospective review

“…15 Pediatric urology patients in Quebec, Canada, travel a mean of 70 km one way for their clinic appointments, but those from farther away can travel in excess of 1000 km. 16 Provincial monetary reimbursement is available for travel greater than 200 km for medical care. Our patient population can also receive subsidized medical transportation for care unavailable in their community, or if their required specialist care is not available within 100 km from their home.…”

“…One possible solution for reducing financial costs and school and employment absenteeism is telemedicine or e-medicine follow-up options, 8 16-18 although minimal research exists with respect to telemedicine in pediatric surgery. 16 In other surgical specialties using telemedicine, patient's families and surgeons have reported satisfaction with the system along with a decreased financial burden. 8 Telehealth and e-consult are both available for use by physicians in Manitoba; however, there is no mention of their use in our studied population.…”