Nithesh Naik 1,2, B. M. Zeeshan Hameed2,3 *, Sanjana Ganesh Nayak 4 , Anshita Gera4, Shreyas Raghavan Nandyal 5 , Dasharathraj K. Shetty 6 , Milap Shah2,7, Sufyan Ibrahim2,8 , Aniket Naik 8 , Nagaraj Kamath8 , Delaram Mahdaviamiri 9 , Kenisha Kevin D’costa10 , Bhavan Prasad Rai 2,11, Piotr Chlosta12 and Bhaskar K. Somani 2,13

1 Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India,

2 iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India,

3 Department of Urology, Father Muller Medical College, Mangalore, India,

4 Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India,

5 Gandhi Medical College, Kaloji Narayana Rao University of Health Sciences, Secunderabad, India,

6 Department of Humanities and Management, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India,

7 Robotics and Urooncology, Max Hospital and Max Institute of Cancer Care, New Delhi, India,

8 Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India,

9 Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India,

10 Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India,

11 Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom,

12 Department of Urology, Jagiellonian University in Krakow, Kraków, Poland,

13 Department of Urology,University Hospital Southampton NHS Trust, Southampton, United Kingdom

       Telemedicine is the delivery of healthcare to patients who are not in the same location as the physician. The practice of telemedicine has a large number of advantages, including cost savings, low chances of nosocomial infection, and fewer hospital visits. Teleclinics have been reported to be successful in the post-surgery and post-cancer therapy follow-up, and in offering consulting services for urolithiasis patients. This review focuses on identifying the outcomes of the recent studies related to the usage of video consulting in urology centers for hematuria referrals and follow-up appointments for a variety of illnesses, including benign prostatic hyperplasia (BPH), kidney stone disease (KSD), and urinary tract infections (UTIs) and found that they are highly acceptable and satisfied. Certain medical disorders can cause embarrassment, social exclusion, and also poor self-esteem, all of which can negatively impair health-related quality-of-life. Telemedicine has proven beneficial in such patients and is a reliable, cost-effective patient-care tool, and it has been successfully implemented in various healthcare settings and specialties.

Keywords: telemedicine, telehealth, urology, patients perspective, COVID-19

Jennifer M. Polinski, ScD, MPH, Tobias Barker, MD, Nancy Gagliano, MD, Andrew Sussman, MD, Troyen A. Brennan, MD, JD, MPH, and William H. Shrank, MD, MSHS

CVS Health, Woonsocket, RI, USA.

BACKGROUND: One-quarter of U.S. patients do not have a primary care provider or do not have complete access to one. Work and personal responsibilities also compete with finding convenient, accessible care. Telehealth services facilitate patients’ access to care, but whether patients are satisfied with telehealth is unclear.

OBJECTIVE: We assessed patients’ satisfaction with and preference for telehealth visits in a telehealth program at CVS MinuteClinics.

DESIGN: Cross-sectional patient satisfaction survey.

PARTICIPANTS: Patients were aged ≥18 years, presented at a MinuteClinic offering telehealth in January–September 2014, had symptoms suitable for telehealth consultation, and agreed to a telehealth visit when the on-site practitioner was busy.

MAIN MEASURES: Patients reported their age, gender, and whether they had health insurance and/or a primary care provider. Patients rated their satisfaction with seeing diagnostic images, hearing and seeing the remote practitioner, the assisting on-site nurse’s capability, quality of care, convenience, and overall understanding. Patients ranked telehealth visits compared to traditional ones: better (defined as preferring telehealth), just as good (defined as liking telehealth), or worse. Predictors of preferring or liking telehealth were assessed via multivariate logistic

KEY RESULTS: In total, 1734 (54 %) of 3303 patients completed the survey: 70 % were women, and 41 % had no usual place of care. Between 94 and 99 % reported being Bvery satisfied^ with all telehealth attributes. Onethird preferred a telehealth visit to a traditional in-person visit. An additional 57 % liked telehealth. Lack of medical insurance increased the odds of preferring telehealth (OR=0.83, 95 % CI, 0.72–0.97). Predictors of liking telehealth were female gender (OR=1.68, 1.04–2.72) and being very satisfied with their overall understanding of telehealth (OR=2.76, 1.84–4.15), quality of care received (OR=2.34, 1.42–3.87), and telehealth’s convenience (OR=2.87, 1.09–7.94)

CONCLUSIONS: Patients reported high satisfaction with their telehealth experience. Convenience and perceived quality of care were important to patients, suggesting that telehealth may facilitate access to care.

KEY WORDS: telehealth; patient satisfaction; access to care.

Leslie A. Morland, PsyD,1 Michelle Raab, MA,1,2 Margaret-Anne Mackintosh, PhD,1,2 Craig S. Rosen, PhD,3,4 Clara E. Dismuke, PhD,5,6 Carolyn J. Greene, PhD,1,7 and B. Christopher Frueh, PhD8,9

1 Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii.

2 Pacific Health Research and Education Institute, Honolulu,

3 Dissemination and Training Division, National Center for PTSD, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.

4 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.

5 Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VAMC, Department of Veterans Affairs, Charleston, South Carolina.

6 Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.

7 Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.

8 The Menninger Clinic, Houston, Texas.

9 University of Hawaii, Hilo, Hawaii.

All views and opinions expressed herein are those of the authors and do not necessarily reflect those of the respective institutional affiliations or the Department of Veterans Affairs.

Abstract

       Background: Although effective psychotherapies for posttraumatic stress disorder (PTSD) exist, high percentages of Veterans in need of services are unable to access them. One particular challenge to providing cost-effective psychological treatments to Veterans with PTSD involves the difficulty and high cost of delivering in-person, specialized psychotherapy to Veterans residing in geographically remote locations. The delivery of these services via clinical video teleconferencing (CVT) has been presented as a potential solution to this access to care problem. Materials and Methods: This study is a retrospective cost analysis of a randomized controlled trial investigating telemedicine service delivery of an anger management therapy for Veterans with PTSD. The parent trial found that the CVT con dition provided clinical results that were comparable to the inperson condition. Several cost outcomes were calculated in order to investigate the clinical and cost outcomes associated with the CVT delivery modality relative to in-person delivery. Results: The CVT condition was significantly associated with lower total costs compared with the in-person delivery condition. The delivery of mental health services via CVT enables Veterans who would not normally receive these services access to empirically based treatments. Additional studies addressing long-term healthcare system costs, indirect cost factors at the patient and societal levels, and the use of CVT in other geographic regions of the United States are needed. Conclusions: The results of this study provide evidence that CVT is a costreducing mode of service delivery to Veterans with PTSD relative to in-person delivery.

Key words: medicine, military medicine, telehealth, telepsychiatry