Mapping Telemedicine in German Private Practice Urological Care: Implications for Transitioning beyond the COVID-19 Pandemic

Abstract

Background: There are limited data on the use and concern of telemedicine among German urologists, and thus, there are no established guidelines for telemedical diagnosis, treatment, and prevention of urological indications.

Methods: An anonymized survey was conducted among German private practice urologists during the 2019 coronavirus disease (COVID-19) pandemic. The χ2 test, Mann-Whitney U-test, and Kruskal-Wallis test were used for statistical analysis.

Results: 257 urologists were included in the final analysis. Thirty-five (14.0%) of urologists had used telemedicine as part of their consultation, and 221 (86.0%) had not used telemedicine. There was no difference between telemedicine adoption rates between rural and urban settings. Telemedicine users were significantly more satisfied with the information they had received regarding telemedicine issues. Users saw the greatest barrier to telemedicine that patients do not take up the offer of telemedicine. Nonusers were most concerned with unclear indications for telemedicine followed by lesser reimbursements during telemedicine than in-person visitations. Users were significantly more likely to use telemedicine beyond the COVID-19 pandemic. Urologists, who wanted to use the service in the future, wanted an active support by the German society of urology and guidelines for telemedicine. Last, users and nonusers preferred telemedicine for non-acute chronic diseases and follow-up visitations.

Conclusion: Despite the COVID-19 pandemic, telemedicine remains a rarely used service among German private practice urologists. Ultimately, to overcome the current challenges, urologists require an active support for the service through the German Society of Urology and telemedical guidelines.

Keywords: Guidelines; Telehealth; Telemedicine; Urology.

Fig. 1

a The source of information on telemedicine was analyzed whether urologist are using telemedicine (users; red) or not (non-users; blue). b Satisfaction with the received information was analyzed on a 10-item Likert scale and distinguished between users and non-users.

Fig. 2

a Barriers to use telemedicine were analyzed and again urologists who have used telemedicine during the pandemic (red) and urologists who have not (blue) were compared. b The likelihood to use telemedicne after the pandemic was analyzed. Users, telemedicine users; nonusers, telemedicine nonusers; ns, notsignificant; ** p < 0.01, *** p < 0.001.

Fig. 3

Preferred involvement of National Society of Urology and guideline implementation for telemedicine urologists categorized according to their response in b into urologists with unlikely (0–3/10, red), undecided (4–6/10, blue), and likely (7–10/10, green) intend to be users. a Urologists were asked whether the German Association of Urology (DGU) should be actively involved in telemedicine. Answers are ranked from 0 (no) to 10 (yes). b All urologists were asked whether guidelines should be developed for the application of telemedicine. Answers are ranked from 0 (no) to 10 (yes). DGU, Deutsche Gesellschaft für Urologie (German Society for Urology). ***p < 0.001.

Fig. 4

Preferred indications for telemedical consultation. Users, telemedicine users; nonusers, telemedicine nonusers; BPH, benign prostate hyperplasia; ns, not significant; * p < 0.05, *** p < 0.001.