Urology Patients at Risk for COVID-19 Prefer Telemedicine Visits

By Marilynn Larkin

May 08, 2020

NEW YORK (Reuters Health) - Many urology patients have risk factors for severe COVID-19 infection, and most would prefer telemedicine to an in-person visit, researchers say.

Dr. Katharina Boehm of Johannes Gutenberg University in Mainz, Germany, and colleagues conducted phone interviews with 399 urology patients (median age, around 69) to assess their risks from COVID-19 and their suitability for and willingness to participate in telemedicine.

As reported in European Urology, more than 94% were at high risk for adverse outcomes from COVID-19 infection. The majority (63.2%) were judged suitable for telemedicine. Reasons for consultation included cancer, andrology, bladder pain syndrome, incontinence, and urinary tract infection.

When asked, 84.7% of patients wanted a telemedical rather than a face-to-face consultation.

Those favoring telemedicine were younger (median, 68 vs. 76). Preferences were similar among those with cancer (mean, 86%) versus benign diagnoses (mean 85%) and didn't vary by the number of COVID-19 risk factors (three or less, 85%; three or more 86.4%).

In a subgroup analysis, men with prostate cancer also preferred telemedicine (odds ratio: 2.93).

Personal contact and technical limitations were the most common reasons for preferring an in-patient visit.

The authors conclude that telemedicine "appears to be a solution to offer contact-free continuity of care."

Dr. Boehm did not respond to requests for a comment, but two U.S. urologists who use telemedicine commented in emails to Reuters Health.

Dr. Jennifer Linehan, associate professor of urologic oncology at the John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, California, said that for most of her patients, "telemedicine has been working well, especially when just providing follow-up to a previous appointment to see if the initiated treatments are helping."

"I feel that if patients have one risk factor (for COVID-19), this automatically qualifies them for telemedicine," she said. "I agree that many patients who did not wish to schedule a telemedicine consult were older, and my theory is that they have limited access or knowledge of technology. Yet, I feel those were the patients who would most benefit from the telemedicine consult given their age as an increased risk factor for a more tenuous COVID course."

"For new patient visits, telemedicine was much more challenging," she acknowledged. Such patients "often require a physical exam and in-office testing such as urinalysis, labs, post-void residuals, bladder testing, urine flow testing and reviewing images. I found...that if we did a telemedicine visit for a new patient, 75% of those patients ultimately needed in-person visit to accurately diagnose them and make sure there was not a more serious issue at hand."

Dr. Michael Lutz, president of the Michigan Urology Institute's Men's Health Foundation, in Rochester, said, "Our practice immediately implemented telemedicine at the onset of the COVID-19 pandemic and noted similarities to the German group. Our practice is in an area of Michigan with the highest outbreak in the (state), and the governor's 'Stay-at-Home' order has made telemedicine even more important as a 'contact-free' option for patient care."

"Since urology has an older patient population and Michigan has a significant incidence of obesity and hypertension, well over the majority of our patients qualify for telemedicine for risk aversion," he said. "I believe that more patients than outlined in the German group are amenable to telemedicine since it offers significant advantages that cannot be achieved by requiring a face-to-face office visit."

SOURCE: https://bit.ly/2W4nKY1 European Urology, online April 27, 2020.