Preliminary assessment of patient and physician satisfaction with the use of teleconsultation in urology during the COVID-19 pandemic

World Journal of Urology https://doi.org/10.1007/s00345-020-03432-4 ORIGINAL ARTICLE Preliminary assessment of patient and physician satisfaction with the use of teleconsultation in urology during the COVID‑19 pandemic Ugo Pinar1 · Julien Anract1 · Ophélie Perrot1 · Thomas Tabourin1 · Emmanuel Chartier‑Kastler1 · Jerome Parra1 · Christophe Vaessen1 · Alexandre de La Taille2 · Morgan Roupret1 Received: 8 May 2020 / Accepted: 30 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose Lockdown during the COVID-19 pandemic compelled urologists to change access to healthcare, especially for oncology patients. Teleconsultation is a safe way to receive medical advice without a risk of infection, and was implemented urgently in our academic centres. Our purpose was to evaluate patient and physician satisfaction with teleconsultation set up during the COVID-19 pandemic. Methods From March 16th 2020, all face-to-face consultations were cancelled in France, except for emergencies. Teleconsultation was started immediately by five senior urologists in two academic hospitals. All patients received an email survey including the validated Teleconsultation Satisfaction Questionnaire (TSQ) and demographic questions. Data were collected prospectively. Physicians also responded to the TSQ. Patient satisfaction was measured objectively with the validated 14-item TSQ. Each item was scored on a 5-point Likert scale. Factors associated with positive satisfaction with teleconsultation were assessed by multivariable logistic regression. Results Overall, 105 patients replied to the survey (91.3%). Median age was 66 years (IQR: 55‒71) and 95 were men (90.5%). Median overall TSQ score was 67 (IQR: 60‒69); teleconsultation was judged to be a good experience by 88 patients (83.8%) and four physicians (80%). Patients who met their surgeon for the first time were more likely to have a good experience (OR = 1.2 [95% CI 1.1‒1.5], p = 0.03). Conclusion Introduced rapidly during the COVID-19 lockdown, urology teleconsultation attained a high level of satisfaction among both patients and physicians. A major change in telemedicine use is foreseen in the post COVID-19 era. Keywords Telemedicine · Urology · Coronavirus · COVID-19 Introduction The coronavirus disease 2019 (COVID-19) pandemic has led many countries to total lockdown because of the contagious nature of the virus and the lack of effective treatment. In France, lockdown was pronounced on March 17th, 2020, for at least 2 months. The whole healthcare system * Morgan Roupret 1 Urology Department, Sorbonne University, GRC 5, Predictive Onco-Urology, Hôpital la Pitié-Salpêtrière, 75013 Paris, France 2 APHP, Henri Mondor Hôpital, Urology, Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France has been massively impacted to accommodate COVID-19 patients, especially intensive care units. On March 16th, the French Association of Urology recommended that every non-urgent consultation should be delayed and non-urgent surgery postponed [1]. This major decision could have a negative impact on patients, particularly those diagnosed with urological cancers [2]. Patients could also neglect relevant symptoms placing them in a dangerous situation. An important question that arises is “How will we catch-up with all the cancelled or delayed consultations?” In this context, French urologists have urgently set up teleconsultation facilities to provide patients with the best possible care without compromising their safety. Telemedicine consultation was first developed in the late 1960s, mainly in psychiatry, and consists of the delivery of healthcare services by healthcare professionals where 13 Vol.:(0123456789) World Journal of Urology distance is a critical factor [3, 4]. It is currently emerging as a way of providing medical services whilst respecting social distancing and reducing the spread of the virus within patient/physician populations. Improved outcomes, userfriendliness, low cost and decreased travel time are factors affecting telehealth effectiveness and efficiency [5, 6]. For some physicians and patients, this new tool has rarely been evaluated, particularly in urology, and even less so during a worldwide pandemic. Our aim was to assess patient and physician satisfaction with teleconsultation used during the COVID-19 pandemic. Materials and methods Study design This prospective, bi-centric study was carried out in two academic hospitals in Paris, France. Primary outcome was patient satisfaction with teleconsultation using the validated Telemedicine Satisfaction Questionnaire (TSQ) [7]. Secondary outcomes were predictive factors of adhesion to telemedicine and physician satisfaction. Telemedicine appointment All patients who were scheduled for a conventional consultation were given the opportunity to have a medical teleconsultation by the urology secretary. If they accepted, they were e-mailed detailed instructions. On the day and hour of the appointment, both physicians and patients could meet in a virtual room through the Doctolib© website. Doctolib© is a French company commonly used in France that manages medical appointments; it proposed teleconsultation as soon as the COVID-19 situation emerged. Patients and physicians could access the interface via a website (https://www. doctolib.fr), could speak to and see each other and exchange medical documents (laboratory reports, imaging reports, or prescription) through a secured encrypted platform. Patient population Patients who had a urological teleconsultation were systematically asked to answer the survey at the end of the clinical consultation. The teleconsultations were led by five senior urologists with more than 15 years’ experience in the field in two academic hospitals in Paris (Hospital Henri-Mondor and Hospital Pitié-Salpêtrière) between March 30th and April 13th. Approved consent was obtained at the end of the consultation. Each patient was e-mailed a 20-item questionnaire after their consultation and received a phone call in the case of further questions. 13 Data collection The TSQ is a validated 14-item questionnaire developed in 2003 to evaluate patient satisfaction with telemedicine [7]. The questionnaire is composed of three main components: quality of care provided (TSQ1), similarity to faceto-face encounter (TSQ2) and perception of the interaction (TSQ3). The TSQ uses a 5-point Likert scale ranging from “Strongly disagree” (1) to “Strongly agree” (5). TSQ score varies from 14 to 70, TSQ1 from 8 to 40, TSQ2 from 5 to 25 and TSQ3 from 1 to 5. Its content and construct have been validated for internal consistency reliability [8]. Total TSQ score > 56 was considered a good experience for the patient. In addition to the TSQ, various demographic questions were added to the survey. Patterns of use of smartphones and the internet were also assessed. All questionnaires were compiled in a unique survey that was sent to each patient who gave (...truncated)