Evaluating the Effectiveness, Efficiency and Safety of Telemedicine for Urological Care in the Male Prisoner Population

Abstract

Introduction We reviewed the safety and effectiveness of our hospital's urological telemedicine program that has been used for the Iowa prisoner population for more than a decade. Methods A retrospective review was performed of telemedicine visits of male prisoners from 2007 to 2014. The effectiveness of these visits was assessed by 1) concordance of telemedicine and in-person diagnoses, 2) compliance with radiologic and medication orders, and 3) in-person visits saved with telemedicine. Safety was assessed by analyzing the number of patients for whom an emergency department visit was required after the telemedicine visit, and missed or delayed cases of malignancy. Estimates were then made of the number of cases that could safely be managed with telemedicine alone. Results The most common diagnosis was voiding dysfunction (24%), followed by genitourinary pain (23%). Diagnoses were concordant in 90% of patients, compliance was high (radiology 91%, medications 89%) and in-person visits were estimated to be saved in 80% to 94%. No men required emergency department visits after telemedicine visits and no cases of malignancy were missed in the population that returned for an in-person visit. We estimated that more than 50% of urological complaints in this cohort could have been managed with telemedicine alone. Conclusions Telemedicine was shown to be a safe and effective method of providing general urological care that obviated the initial in-person visits for nearly 90% of patients. It is likely that telemedicine could safely replace in-person visits for many urological conditions, especially for younger men and those for whom access to specialized care may be limited.