Elsevier

European Urology

Volume 68, Issue 4, October 2015, Pages 729-735
European Urology

Education
Efficiency, Satisfaction, and Costs for Remote Video Visits Following Radical Prostatectomy: A Randomized Controlled Trial

https://doi.org/10.1016/j.eururo.2015.04.002Get rights and content

Abstract

Background

Telemedicine in an ambulatory surgical population remains incompletely evaluated.

Objective

To investigate patient encounters in the outpatient setting using video visit (VV) technology compared to traditional office visits (OVs).

Design, setting, and participants

From June 2013 to March 2014, 55 prescreened men with a history of prostate cancer were prospectively randomized. VVs, with the patient at home or at work, were included in the outpatient clinic calendar of urologists.

Intervention

Remote VV versus traditional OV.

Outcome measurements and statistical analysis

An equivalence analysis was used to assess the primary outcome, visit efficiency as measured by time studies. Secondary outcomes were patient/provider satisfaction and costs.

Results and limitations

There were 28 VVs and 27 OVs. VVs were equivalent in efficiency to relative to OVs, as measured by patient–provider face time (mean 14.5 vs 14.3 min; p = 0.96), patient wait time (18.4 vs 13.0 min; p = 0.20), and total time devoted to care (17.9 vs 17.8 min; p = 0.97). There were no significant differences in patient perception of visit confidentiality, efficiency, education quality, or overall satisfaction. VVs incurred lower costs, including distance traveled (median 0 vs 95 miles), travel time (0 vs 95 min), missed work (0 vs 1 d), and money spent on travel ($0 vs $48; all p < 0.0001). There was a high level of urologist satisfaction for both VVs (88%) and OVs (90%). The major limitation was sample size.

Conclusions

VV in the ambulatory postprostatectomy setting may have a future role in health care delivery models. We found equivalent efficiency, similar satisfaction, but significantly reduced patient costs for VV compared to OV. Further prospective analyses are warranted.

Patient summary

Among men with surgically treated prostate cancer, we evaluated the utility of remote video visits compared to office visits for outpatient consultation with a urologist. Video visits were associated with equivalent efficiency, similar satisfaction, and significantly lower patient costs when compared to office visits. We conclude that video visits may have a future role in health care delivery models.

Introduction

The rising costs of health care have required the development of efficient and cost-effective health care delivery models [1]. One such initiative has been the implementation of medical care at a distance, known as telemedicine. It is estimated that in the USA, 72% of adults [2] and 81% of those using internet services currently access online health information [3]. With 55% of patients owning a smart mobile device [4], the increasing use of virtual technology has facilitated remote video communication and access to online health media. Thus, several specialties have investigated the feasibility, acceptance, and efficacy of teleconsultations, including primary care [5], [6], [7], [8], dermatology [9], and orthopedics [10], [11], with studies reporting high levels of satisfaction, equivalent health outcomes, and reduced costs [12], [13].

Nevertheless, the efficacy of remote video communication has not been studied in an ambulatory urologic patient population. As part of a prospective randomized trial, we investigated the utility of remote video visits (VVs) relative to traditional office visits (OVs) in a urologic patient population. The study aims included analysis of differences in timing efficiency, patient and provider satisfaction, and costs accrued to patients. To assess the experience of a standardized population with VV, the study was limited to those with a history of surgically treated prostate cancer undergoing surveillance.

Section snippets

Patients and methods

After institutional review board approval, an equivalence designed [14] randomized controlled trial was developed to assess the efficiency, satisfaction, and costs of VV compared to OV at a single tertiary health care clinic. We hypothesized that VV would be equivalent in efficiency and patient satisfaction, with a reduction in associated patient costs.

From June 2013 to March 2014, 295 males with a history of radical prostatectomy (RP) for prostate cancer (>90 d after surgery) who were

Results

After screening, 295 men met the initial criteria. Figure 1 shows a flow schema for all patients identified. A total of 70 (24%) patients could not be reached by telephone. After prescreening, 155 (69%) did not meet criteria, including 70 (45%) who declined the invitation, 25 (16%) who lacked appropriate equipment, 15 (10%) who were not comfortable with the technology, 15 (8%) who elected for an OV secondary to medical reasons, and 32 (21%) who had additional appointments or reasons for travel.

Discussion

A prospective randomized trial of remote VV in a prescreened, ambulatory, post-RP population revealed that the majority (96%) of patients undergoing VV would participate in this type of encounter again. For VV, we noted equivalence in timing efficiency, similar patient satisfaction, and significantly reduced costs when compared to OV. Specifically, VVs were associated with reductions in distance traveled, travel time, missed work, and money spent. Similarly, urology providers were often very

Conclusions

Our results revealed equivalent timing efficiency, similar patient satisfaction, and significantly lower costs among post-RP men participating in remote VV compared to traditional OV. This suggests that VV may provide a viable alternative to traditional health care delivery models by improving access to care, enhancing the quality of services delivered, and providing an effective means for cost containment. It is critical that we continue to explore the utility of telemedicine through

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