Background: The coronavirus disease 2019 (COVID-19) pandemic created a paradigm shift in healthcare delivery with rapid utilization of telehealth in urology. Despite cessation of pandemic policies, urologists continue to utilize telehealth at a high rate. While these visits can improve access and convenience for many, the degree to which they translate to in person encounters remains underexplored. This study aimed to evaluate features associated with in-person encounters following a virtual visit within our urology department.
Methods: Telehealth visits in our department with a new or consult billing code between January 2022 and December 2023 were retrospectively identified. The primary outcome was follow-up for an in-person appointment within 90 days. Secondary outcome was the number of surgical procedures. Multivariable logistic regression was used to model associations between patient features and subsequent in-person care, using benign prostatic hyperplasia (BPH) as the referent category for visit diagnosis.
Results: We identified 1,079 video visits, of whom 598 (55%) sought in-person care within 90 days. Following multivariable adjustment, patients living over 150 miles away [adjusted odds ratio (adjOR) 0.56, 95% confidence interval (CI): 0.41-0.78] and prostate cancer visits (adjOR 0.40, 95% CI: 0.30-0.65) were less likely to follow-up in-person. Among returning patients, 413 (69%) underwent urological surgery within 90 days. After multivariable adjustment, kidney cancer (adjOR 0.41, 95% CI: 0.23-0.72), elevated prostate-specific antigen (PSA) (adjOR 0.36, 95% CI: 0.23-0.56), and prostate cancer (adjOR 0.32, 95% CI: 0.22-0.47) were significantly less likely to pursue surgery than BPH visits.
Conclusions: Patients with a shorter travel distance and those being seen for a vasectomy were more likely to pursue in-person care within 90 days after a telehealth visit than those seen for oncologic indications. These findings may be useful to other urology departments seeking to efficiently integrate virtual visits in resource-constrained environments.
Keywords: Urology; health care delivery; telemedicine.
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