Comparing Telemedicine and In-Person Clinical Evaluations for Pediatric Urology Concerns

Abstract

IntroductionTelemedicine may promote equitable health care delivery, particularly in rural and underserved regions. While patient and provider satisfaction with telemedicine appear to be high, it remains unclear if telemedicine accomplishes the same clinical goals as in-person clinic visits. We undertook this study to compare the differences in history-taking, physical examination, and recommended follow-up in new pediatric urology patients seen via telemedicine and in-person. MethodsThis cross-sectional study was performed by retrospectively reviewing the charts of all new patients visiting the general pediatric urology clinic at a single freestanding children's hospital in January and April of three consecutive years (2019, 2020, 2021). Data were abstracted on patient demographics, comprehensiveness of history of present illness, completeness of physical examination, and recommended follow-up. Patients seen by telemedicine and in-person were compared. ResultsOf 1354 patients, 1244 (91.9%) had in-person and 110 (8.1%) telemedicine visits. Telemedicine patients had a median of 4 history of present illness components recorded; in-person patients had 3 (P < 0.0001). Patients seen in-person had a more comprehensive physical examination recorded compared with telemedicine patients (median 12 vs 2 systems, P < 0.0001). Significantly fewer telemedicine patients were discharged from clinic after the initial visit (2.7% vs 16.5%), and significantly more were asked to return for additional evaluation (39.1% vs 23.2, P < 0.0001). ConclusionsInitial pediatric urology telemedicine consultations gathered more historical and fewer physical examination components and were more likely to require an additional clinic visit for evaluation. Goals of care should be considered when selecting a visit modality.