Introduction: Access to urologic care can be a significant challenge to rural patients. Due to policy changes related to telemedicine during COVID-19, restrictions on interstate telemedicine were waived by several states beginning in March 2020. The aim of this study is to evaluate telemedicine as a means of extending care to patients in rural areas in a cost-effective manner. We collected information on in-person and telemedicine visits for in-state and out-of-state patients to provide insight on delivery of care to rural patients.
Methods: From August 2019 to October 2021, all patients seen for urologic cancer care and related complaints (e.g., elevated PSA) at the University of Washington and Seattle Cancer Care Alliance in-person and via telemedicine were sent a survey after each visit. The survey queried patients about travel time, travel costs, and days of work missed. We compared out-of-state (OOS) patients (patients residing in Oregon, Alaska, Idaho, or Montana) seen in-person with those seen via telemedicine.
Results: We collected complete surveys for 1094 patient visits, both in-person (N=207) and telemedicine (N=887), excluding repeat visits for established patients. Among established OOS patients, those receiving care via telemedicine had decreased patient-estimated travel costs per appointment compared with those receiving care in-person (80.4% telemedicine vs 4.4% in-person visits patients reported no cost). Similarly, 82.1% of patients receiving care via telemedicine, vs 6.7% of in-person visits, reported $0 in cost for their visit. Telemedicine patients reported fewer missed days of work compared with in-person patients (2+ days of work missed for 7.9% of telemedicine patients vs 40.7% of in-person patients). Median self-reported costs for in-person visits among OOS patients were significantly higher than costs reported by Washington State residents (median $500 vs $50, respectively, p= <0.05).
Conclusions: Telemedicine appointments for urologic oncology care for OOS patients increase access to subspecialty care for rural patients at lower cost. Extending OOS exemptions beyond the COVID-19 telemedicine waivers would permit continued delivery of high-quality urologic cancer care to rural patients.
Source of Funding: Funded by a Cancer Consortium Catchment Award, ASCO Conquer Cancer Foundation Young Investigator Award (AG), and SCCA Swim Across America Grant (AG).
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