Gadzinski Adam J, Dwyer Erin M, Reynolds Jason, Stewart Blair, Abarro Isabelle, Wolff Erika M, Ellimoottil Chad, Holt Sarah K, Gore John L
Department of Urology, Beaumont Hospital, Royal Oak, Michigan.
Department of Urology, University of Washington, Seattle, Washington.
J Urol. 2024 Jan;211(1):55-62. doi: 10.1097/JU.0000000000003749. Epub 2023 Oct 13.
US states eased licensing restrictions on telemedicine during the COVID-19 pandemic, allowing interstate use. As waivers expire, optimal uses of telemedicine must be assessed to inform policy, legislation, and clinical care. We assessed whether telemedicine visits provided the same patient experience as in-person visits, stratified by in- vs out-of-state residence, and examined the financial burden.
Patients seen in person and via telemedicine for urologic cancer care at a major regional cancer center received a survey after their first appointment (August 2019-June 2022) on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed.
Surveys were completed for 1058 patient visits (N = 178 in-person, N = 880 telemedicine). Satisfaction rates were high for all visit types, both interstate and in-state care (mean score 60.1-60.8 [maximum 63], > .05). More patients convening interstate telemedicine would repeat that modality (71%) than interstate in-person care (61%) or in-state telemedicine (57%). Patients receiving interstate care had significantly higher travel costs (median estimated visit costs $200, IQR $0-$800 vs median $0, IQR $0-$20 for in-state care, < .001); 55% of patients receiving interstate in-person care required plane travel and 60% required a hotel stay.
Telemedicine appointments may increase access for rural-residing patients with cancer. Satisfaction outcomes among patients with urologic cancer receiving interstate care were similar to those of patients cared for in state; costs were markedly lower. Extending interstate exemptions beyond COVID-19 licensing waivers would permit continued delivery of high-quality urologic cancer care to rural-residing patients.
美国各州在新冠疫情期间放宽了对远程医疗的许可限制，允许跨州使用。随着豁免到期，必须评估远程医疗的最佳使用方式，以为政策、立法和临床护理提供参考。我们评估了远程医疗就诊是否能提供与面对面就诊相同的患者体验，并按州内与州外居住情况进行分层，同时研究了经济负担。
在一家主要的地区癌症中心接受面对面和远程医疗的泌尿系统癌症患者，在首次就诊（2019年8月至2022年6月）后接受了一项关于护理满意度、就诊期间沟通感受、出行时间、出行成本以及误工天数的调查。
共完成了1058次患者就诊的调查（面对面就诊178例，远程医疗就诊880例）。所有就诊类型的满意度都很高，包括跨州和州内护理（平均得分60.1 - 60.8[满分63]，P>0.05）。相比于跨州面对面护理（61%）或州内远程医疗（57%），更多进行跨州远程医疗的患者会再次选择这种方式（71%）。接受跨州护理的患者出行成本显著更高（估计就诊成本中位数为200美元，四分位距为0 - 800美元，而州内护理中位数为0美元，四分位距为0 - 20美元，P<0.001）；55%接受跨州面对面护理的患者需要乘坐飞机出行，60%需要入住酒店。
远程医疗预约可能会增加农村地区癌症患者的就医机会。接受跨州护理的泌尿系统癌症患者的满意度结果与州内护理患者相似；成本明显更低。将跨州豁免延长至新冠疫情许可豁免期之后，将能够继续为农村地区患者提供高质量的泌尿系统癌症护理。
