Efficiency, Satisfaction, and Costs for Remote Video Visits Following Radical Prostatectomy: A Randomized Controlled Trial

Background: Telemedicine in an ambulatory surgical population remains incompletely evaluated. Objective: To investigate patient encounters in the outpatient setting using video visit (VV) technology compared to traditional office visits (OVs). Design, setting, and participants: From June 2013 to March 2014, 55 prescreened men with a history of prostate cancer were prospectively randomized. VVs, with the patient at home or at work, were included in the outpatient clinic calendar of urologists. Intervention: Remote VV versus traditional OV. Outcome measurements and statistical analysis: An equivalence analysis was used to assess the primary outcome, visit efficiency as measured by time studies. Secondary outcomes were patient/provider satisfaction and costs. Results and limitations: There were 28 VVs and 27 OVs. VVs were equivalent in efficiency to relative to OVs, as measured by patient-provider face time (mean 14.5 vs 14.3 min; p = 0.96), patient wait time (18.4 vs 13.0 min; p = 0.20), and total time devoted to care (17.9 vs 17.8 min; p = 0.97). There were no significant differences in patient perception of visit confidentiality, efficiency, education quality, or overall satisfaction. VVs incurred lower costs, including distance traveled (median 0 vs 95 miles), travel time (0 vs 95 min), missed work (0 vs 1 d), and money spent on travel ($0 vs $48; all p < 0.0001). There was a high level of urologist satisfaction for both VVs (88%) and OVs (90%). The major limitation was sample size. Conclusions: VV in the ambulatory postprostatectomy setting may have a future role in health care delivery models. We found equivalent efficiency, similar satisfaction, but significantly reduced patient costs for VV compared to OV. Further prospective analyses are warranted. Patient summary: Among men with surgically treated prostate cancer, we evaluated the utility of remote video visits compared to office visits for outpatient consultation with a urologist. Video visits were associated with equivalent efficiency, similar satisfaction, and significantly lower patient costs when compared to office visits. We conclude that video visits may have a future role in health care delivery models. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.