"There's just a tremendous opportunity for telehealth and being able to increase delivery to patients in these areas or at least reduce their amount of travel time to get to see a urologist based on where they live," says Kara L. Watts, MD.
In this video, Jennifer Robles, MD, MPH, and Kara L. Watts, MD, summarize key takeaways from the 2023 American Urological Association Quality Improvement Summit. Robles is an assistant professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee, and Surgical Quality Officer and Chief of Urology at the Tennessee Valley (VA) Healthcare System, and Watts is an associate professor of urology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Robles: We really wanted this summit to be a combination of things. The priority was to provide practical tips for urologists about how to incorporate telehealth into their practice, how to do it better, how to do more of it, and how to reach patients. But the other half of it was really to talk about barriers to telehealth, and that includes national policy barriers, billing barriers, medical ethics, and questions and concerns about telehealth. We really tried to have talks and panels that addressed both sides - both how to incorporate telehealth as well as potential barriers to telehealth.
Watts: This was actually, I think, one of the highest yield presentations that we had in the summit. It was a lot of what we think urologists as well as attendees were looking for - [hearing from] people who are successfully incorporating telehealth into their practices, how have they done it and what have they learned in doing so? A couple of things really resonated with us that we were hoping to share here. We had a number of speakers from the majority of the [subspecialty] domains within urology. Dr. Helen Bernie, who represented men's sexual health, talked about the different conditions that she sees and evaluates within her practice. The main things that she had mentioned were that a lot of the conditions are entirely amenable to evaluation initially by telehealth with the exception of Peyronie disease and erectile dysfunction. She has found that in her practice, those are more amenable to being seen initially in person but then follow-ups might be better by telehealth. Dr. Julia Finkelstein, from pediatric urology, also has done extensive research in telehealth in pediatric urology and she talked about, basically, chief complaints related to testicular or penile conditions are better evaluated in person initially, but the remainder of conditions being amenable to telehealth. The other thing that stood out was most of our panelists have shifted away from doing full days of telehealth. Those who incorporate telehealth in their practice really do so in set blocks within their schedule. A lot of people showed really great examples of what this looks like. What the resounding theme was maybe a brief block either at the very beginning or the very end of their clinic day so that they can accommodate the in-person visits around that and have set times for that. The last thing I'll just add is Dr. Adam Gadzinski, who's both endo and uro onc in the Pacific Northwest and has done quite a bit of research in telehealth outreach in rural communities, made a really interesting point that 62% of counties in the United States don't have a urologist. It just underscores the importance of telehealth. There's such a shortage of urologists in the United States, and it continues to worsen. There's just a tremendous opportunity for telehealth and being able to increase delivery to patients in these areas or at least reduce their amount of travel time to get to see a urologist based on where they live.
Robles: Another aspect that several of our panelists highlighted that I thought was really interesting was the fact that telehealth is really uniquely suited and really uniquely beneficial for patients who are seeing us for sensitive issues, which is a huge amount of patients in urology, a lot of patients are much more comfortable if they're at home, they're in private, they're not in a public waiting room. Second is for patients that maybe have mobility challenges, both pediatric patients as well as adult patients, it's much easier for them to do telehealth visits than to harness all the resources that they may need to make it to a clinic visit. That was something that I hadn't really given as much thought to but thought was really beneficial.
This transcription was edited for clarity.