Published on in Urology Update
The COVID-19 pandemic accelerated the widespread utilization of telemedicine in the Division of Urology. High patient satisfaction was noted in an early cohort of patients with a wide variety of diagnoses including voiding dysfunction, neurogenic bladder, circumcision evaluation, and urinary tract dilation. Families who reported high satisfaction with video visits recounted experiences such as the convenience of completing visits in their homes, avoiding prolonged travel, and the ability to connect with multiple providers at the same time.1
In some cases, even complex surgeries were scheduled following video visits. Additional laboratory work, diagnostic imaging and final examinations were done just before the surgery. In addition to patient satisfaction, telemedicine gave providers a window into a child’s life at home and an opportunity to more quickly get to know a child as a person and not just a patient. Some of the more common diagnoses seen by telemedicine were those involving urinary incontinence and other lower urinary tract symptoms (LUTS) — conditions that children are often embarrassed to talk about yet require a strong partnership to manage. Video visits shift the power dynamic and create a space in which children are often more comfortable and rapport can be built more quickly. Richness is added to a visit when the provider notices and engages a child in conversation about a hobby, interest or a favorite pet they notice in the background. Embedded in these conversations are ideas the clinician can use to engage the child in a treatment plan.
Video visits have supplemented in-person teaching visits and allowed providers to see how patients manage their regimens at home. For example, children and families are taught to use a trans-anal enema system during an in-person visit. Teaching takes place in a spacious restroom outfitted with a grab-bar to aid in maneuvering on the toilet, ample room for the child, parent and provider to work together and set up the enema system, and easy access to the necessary supplies. A subsequent video visit allowed the provider to see the child’s more limited space at home, and she was able to help the family create an optimum set up for the regimen at home.
Telemedicine provides significant advantages to patients residing in medical facilities. Accessing care at a facility eliminates the need to transport medically fragile children and allows multiple members of the care team to participate in the visit. Dr. Christopher Long described a recent video visit with a patient in a long-term care facility: “We were monitoring a wound after surgery. The patient had been picking at the stitches placed on his incision. Transport is a huge issue for these patients, so this was a big win for them.”
Finally, telemedicine has made it easier to collaborate with colleagues when patients see multiple providers. Rather than trying to arrange a visit when two providers are available together in the same place, we are now comfortable with the technology that allows us to bring colleagues into a visit, even when they are physically distanced from the clinic.
Our experience with close to 5,000 video visits suggests that there is a role for telemedicine going forward. Identifying the diagnoses and circumstances that lend themselves to telemedicine and the ability to reach a broader range of patients will occur as a result.
Patient families should check with their health plan to confirm that their insurance covers video visits their providers before taking part in a video visit.
1. Gan Z, Lee SY, Weiss DA, Van Batavia J, Siu S, Frazier J, Zderic SA, Shukla AR, Srinivasan AK, Kolon TF, Zaontz MR, Canning DA, Long CJ. Single institution experience with telemedicine for pediatric urology outpatient visits: Adapting to COVID-19 restrictions, patient satisfaction, and future utilization. J Pediatr Urol. 2021;S1477-5131(21)00280-1. Read the abstract.