Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study (Preprint)

Abstract

BACKGROUND Prior to the coronavirus disease 2019 (COVID-19) pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. OBJECTIVE To investigate current telemedicine usage by urologists, urologist perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. METHODS We performed a global, cross-sectional web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists’ perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. RESULTS A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1%. Of the urologists without telemedicine experience, interest in usage of telemedicine increased from 43.7 to 80.8% during COVID-19. Among urologists that used telemedicine during the pandemic, 80.9% were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic and the top three barriers to implementing telemedicine were patient lack of technological comprehension, patient lack of access to required technology, and reimbursement concerns. CONCLUSIONS This is the first study to quantify the use, usability, and pervading interest in telemedicine amongst urologists during the COVID-19 pandemic. In the face of this pandemic, urologists’ usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.

Telemedicine and Telehealth in Urology—What Do the ‘Patients' Think About It?

“…It has yet to gain widespread acceptance in the urological community because of various restrictions including patient and physician acceptability, licensure and responsibility, costs, safety, and concerns with ethical issues. A systematic review of the global challenges to telemedicine adoption found that technologyspecific concerns were the major barriers to telemedicine usage, with technically challenged employees being the most commonly identified impediment (77).…”

Specialty-level Factors Historically Influencing Telehealth Use Can Provide Implications for Sustainability in a Post-Pandemic Era: A Systematic Review and Narrative Synthesis

“…[7] The results of this study have already been widely cited in the general telehealth literature and corroborated by evidence and position statements in the specialty-speci c telehealth literature as well. [10][11][12][13][14][15] The wide variation in telehealth use across medical specialties is intriguing, since the US lacks a nationwide standardized set of telehealth reimbursement policies, which in turn, has historically posed a barrier to telehealth adoption in all specialties. [16] Despite these macro (policy-level) constraints experienced by all medical specialties, some specialties have been able to normalize telehealth to mainstream practice (e.g., Psychiatry, Cardiology); while others are just getting started during the COVID-19 pandemic (e.g., Allergy-Immunology), despite potential for all stakeholders within the specialty (e.g., patients, providers) to bene t from telehealth adoption.…”