ABSTRACT
Introduction: Telehealth has emerged as an increasingly useful tool to provide care amidst the COVID-19 pandemic. The acceptability and safety of telehealth has been previously reported in Urogynecology for preoperative counseling and postoperative care but not for new patient evaluation. Objective: To determine if new patient telehealth encounters are non-inferior to inperson office encounters for women presenting to a Urogynecology clinic using a patient satisfaction questionnaire. Secondary objectives were to assess number of follow up visits, phone calls, and travel distance and time. Methods: This was a randomized controlled trial of women presenting to a Urogynecology clinic for a new patient visit. Participants were randomized after appointment scheduling to either telehealth or in-person visits. Telehealth visits were scheduled for 15 minutes and conducted over a video platform by the attending physician. Pelvic exams were not performed over telehealth and patients were counseled and scheduled for follow-up including procedures and treatments. In-person visits included trainees and a pelvic exam. Patients completed the validated Patient Satisfaction Questionnaire-18 (PSQ-18) after their visit. The primary outcome was composite patient satisfaction on the PSQ-18 questionnaire. Demographics and health care utilization data were ed from chart review. Using a non-inferiority margin of 5 points on the PSQ-18 composite score, 25 patients per arm were required with a power of 80% and an alpha of 0.05. Results: From March to September 2021, 133 women were screened for eligibility, 71 were randomized, and 58 were included in the final analysis (30 in telehealth group and 28 in in-person group). Demographic characteristics were similar between groups. Patients overall had a high education level, with 60% having a college degree or higher. Patient satisfaction, as measured on the PSQ-18 questionnaire (maximum score 90), was high for both groups but higher for in-person visits vs telehealth visits (75.68 ± 8.55 vs 66.60 ± 11.80, P = 0.001, difference -9.08, 90% confidence interval -4.57 to -13.6) and our results were inconclusive with respect to determining non-inferiority. Patients ≥60 years reported higher rates of satisfaction overall compared to those younger than 60 years (P = 0.009). Women in the in-person group were more likely to perceive that they had enough time with the provider (P = 0.003) and their visit was timely and efficient (P = 0.016) despite having less attending physician face time. Women in the telehealth group expressed uncertainty regarding the format and the perceived benefits of telehealth. There were no differences in the number of follow up visits (P = 0.81), patient-initiated (P = 0.52) or staff-initiated phone calls (P = 0.07), distance from home to office (P = 0.87), or travel time from home to office (P = 0.94) between groups. There were no differences in treatments (surgical vs non-surgical) chosen based on PSQ-18 scores. Conclusions: Women seen by urogynecologic providers either in person or via telehealth demonstrated high satisfaction with their first visit. Although the results are inconclusive with respect to non-inferiority, telehealth is safe and does not impact conversion to surgical or procedural treatments. As telehealth use continues to demonstrate safety, efficacy, and tolerability by patients, we must educate providers and patients on the utility of this platform.
ABSTRACT
Objective: To describe the utilization of a popular online forum, subreddit r/ AskDocs, for the diagnosis of urinary tract infections (UTI) in 2020 and explore whether COVID was associated with increased utilization of online forum health care. Methods: The Reddit Pushshift API and Python were used to search for genitourinary infections in the subreddit r/AskDocs between the dates of January 1 2015-December 31 2020 to describe the trend in utilization over 5 years. The year 2020 and the diagnosis of UTI was then chosen for further analysis as the most queried diagnosis in the most utilized year. Posts, responses, and their associated URL were pooled into Microsoft Excel for manual review. Posts flagged by the forum moderators for insufficient information, duplicate requests, viral posts (>50 comments), and posts made on another's behalf were excluded. Manual review was performed to collect the original poster's self-reported age and sex, as well as responder classification. The forum classifies responders as unverified (not a doctor, or 'NAD') and verified medical professionals. Posts in April 2020 (peak timing of COVID19 restrictions in the US) were further analyzed and coded according to themes identified by manual qualitative review. Results: Over 5 years, UTI was the most frequently mentioned diagnosis, with 8100 posts written with an average annual growth rate of 205%. 3275 (40%) of posts for UTI were placed in 2020, of which 2738 met inclusion criteria. The majority of posts came from females (69%) with a mean (±SD) age of 24.4 ± 6. 86%of posts received a response from 'NAD', while 27%of requests received a response from verified medical professionals, 41% of whom identified as physicians. During April 2020, 248 posts for UTI were made which was not different than during other months in 2020 (p = 0.38). The median (IQR) duration of symptoms was 21 (4-90) days. 31% of requests were made for the purpose of receiving a new diagnosis and 35% were requesting a second opinion. Another 16% mentioned plans of seeing a doctor or wanted advice on whether their symptoms warranted a visit. The remainder of requests (9%) requested clarification on medications or other advice. Of all UTI posts in April 2020, 50 (21%) mentioned COVID19 as a barrier to receiving/seeking care. Several requests described concerning symptoms of hematuria (18%) and back pain (30%). 12% of individuals self-identified as having recurrent/ chronic UTI and 9% described the use of over the counter medications or supplements to prevent UTI. Conclusions: These data demonstrate that requests for online support for the diagnosis and management of UTIs are growing annually and that patients who received care in a medical office still go online to receive verification of the medical plan.Many users post in the hopes of getting a new diagnosis from a medical professional, however, they were more likely to get a response from a non-verified user. Additionally, COVID19 delays/closures were identified by many users as a barrier to seeking medical care in April 2020.