The COVID-19 pandemic has resulted in significant change to healthcare delivery. Whilst the use of telecommunication technology is well established in various urologic settings, it may offer additional benefits to patients and healthcare providers during the pandemic and beyond. Where practicable and safe, telecommunication allows socially-distanced consultations and may offer more patient-centred and convenient care, shorter waiting lists and reduced healthcare associated costs. Patient preference, particularly at the time of the pandemic, is an important factor to consider in planning healthcare delivery in the immediate and long term future. 

This prospective study, conducted within a tertiary-level Functional and  Reconstructive Urology unit in the UK gives insight into the preferences of our patient cohort with regards to telecommunication and in-person hospital clinic visits.

We identified a prospective cohort of all patients with pre-standing clinic appointments within the Female, Functional and Restorative Urology Unit of our hopsital during a 3-week period between June 8th and June 29th, 2020. Due to the pandemic, all such appointments were conducted as telephone consultations and the interview was undertaken after the clinical consultation had taken place. Only patients with follow-up appointments were eligible to participate in this study. All new referrals were excluded.  

Structured interviews were undertaken, asking participants about their preference on telemedicine clinic appointments, face-to-face appointments or whether they had no particular preference. They were then asked an open question about the factors impacting their preference and responses were recorded. These responses were subsequently categorised into 5 distinct domains: 1- Travel issues (including issues with transport, reduced mobility, commitments from work and childcare), 2- Communication issues (including time for the consultation, language barrier, need to involve family members), 3- Need for interaction with the surgeon, 4- Concerns about requiring clinical examination or other tests, and 5- Delays to appointments and waiting times. Patients could choose multiple factors or none at all. 

Baseline demographic characteristics, including age and gender were recorded and analyzed. Also, distance between patients’ permanent residence and hospital and average time required to access hospital via public transport were reported and included in the analysis.

A multinomial logistic regression analysis using SPSS Statistics software (IBM® SPSS® software platform) was performed to assess if demographic data and factors mentioned by patients had a statistically significant impact on their final preference. A p value less than 0.05 (p<0.05) was considered statistically significant for this analysis.

A total of 183 patients with clinic appointments during the pre-defined 3-week period were identified from the hospital waiting lists. 49 patients (35 females and 14 males) were excluded from the study due to the following reasons: 24 patients were new referrals, 23 patients could not be contacted (including 4 patients with invalid contact details) and 2 patients declined to participate in the study. 

134 patients with a mean age of 53.3 years (range 22-86 years) were, eventually, included in the study.  94 of the included patients were females and 40 were males (Table 1). 

Telephone clinics were preferred by 76/134 (56.7%) patients. 37/134 patients (27.6%) preferred face-to-face clinics and 21/134 (15.7%) expressed no particular preference for any type of consultation. Age, distance from hospital and time to access hospital via public transport did not differ significantly among the three groups of patients (telephone clinics, face to face clinics, no preference) (p>0.05). 

Multinomial logistic regression analysis revealed that among the factors impacting patients’ preferences on face to face or virtual consultations only travel and communication issues differed significantly among the three groups of patients (p<0.001). Desire to avoid travel to hospital was the most commonly stated reason for patients who favored teleconsultation (42 patients, 31.3%). On the other hand, most of the patients who preferred face to face consultations raised concerns regarding inferior communication between themselves and medical professionals in a teleconsultation setting compared to an in person consultation (22 patients, 16.4%) (Table 2).

Our findings indicate that the majority of our patient cohort (56.7%) expressed a preference for telemedicine appointments compared to in-person consultations (27.6%). Not surprisingly, the most frequently cited reason for this preference was patient convenience of not needing to travel, which was statistically significant for this group of patients. Of those who preferred face to face appointments, the majority reported that they found communication with their clinician to be better in person rather than over the telephone. 

At the moment, teleconsultations in our hospital are performed only via telephone calls. We strongly believe that by incorporating video-linked technology and smart phone applications, we will substantially improve virtual consultations and attract more patients who were initially resistant to telemedicine. This can be particularly valid if we take into account the relatively young age of many functional urology and neuro-urology patients who are familiar with electronic technology and videoconferencing software (mean age of 53.3 years in our study).

Teconconsultations can be a valid alternative to traditional face to face hospital appointments and, also, seem to be preferred by the majority of patients for follow-up appointments in a functional and reconstructive urology department. Certain improvements in the delivery of teleconsultations are likely to attract even more patients in the future.