PD25-05 EVALUATING THE EFFECTIVENESS OF UROLOGIC TELEMEDICINE IN MALE PRISONERS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures I1 Apr 2016PD25-05 EVALUATING THE EFFECTIVENESS OF UROLOGIC TELEMEDICINE IN MALE PRISONERS Brenton Sherwood, Kenneth Nepple, and Bradley Erickson Brenton SherwoodBrenton Sherwood More articles by this author , Kenneth NeppleKenneth Nepple More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.235AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Healthcare resources are limited in prison populations, and patient transportation for healthcare adds significant cost and burden. The purpose of this study was to analyze our use of telemedicine (TM) to provide urologic care to prisoners. We hypothesize that TM is a safe and effective means to provide general urologic care to populations with poor access to healthcare specialists. METHODS We reviewed 376 medical records of male prisoners in our state whose initial urologic complaint was evaluated with TM from 1/2007- 7/2014. Distance from the prison ranged from 6 to 236 miles away. We analyzed the effectiveness of the TM visit using three measures: 1) concordance of TM diagnosis with the (eventual) face-to-face visit (F2F) diagnosis, 2) compliance with radiologic and pharmacologic orders placed prior to F2F and 3) number of F2F avoided using TM, defined when any of the following conditions were met: a) TM visit orders (e.g. radiology) were completed prior to F2F b) follow-up was via TM or PRN c) the patient had >1 TM visit before a F2F. Finally, we estimated the percentage of patients who required an eventual F2F (i.e. could not have been handled solely by TM) using the following criteria: a) the patient complaint could not be evaluated completely using TM b) a procedure (e.g. cystoscopy) or surgery was required c) F2F was for interventional treatment. RESULTS The most common TM diagnosis was scrotal pain, followed by symptoms from lower urinary tract dysfunction (LUTD) (Figure). TM care alone was sufficient for 27%, F2F was scheduled for 56%, and 17% were lost to follow-up. TM orders included radiology (47%), medication (40%) and labs (38%). Compliance with the TM management was high (medication 91%, radiology 88%). Of men that had F2F, the TM and F2F diagnoses were the same in 90% of cases, the most common incorrect diagnoses being urethral stricture (27%). We estimated that TM saved at least one F2F in 94% of patients and that less than 50% of patients required eventual F2F. CONCLUSIONS We found TM to be a safe and effective method to increase access to urologic care, effectively replacing 94% of initial visits in this access-poor population. We estimated that with refined, prospective protocols, over 50% of the patients could have eliminated the F2F completely. Expansion to other access-poor populations is underway. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e589 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brenton Sherwood More articles by this author Kenneth Nepple More articles by this author Bradley Erickson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...