EducationEfficiency, Satisfaction, and Costs for Remote Video Visits Following Radical Prostatectomy: A Randomized Controlled Trial☆
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.
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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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