(UroToday.com) The 2024 SUO annual meeting included a health services session, featuring a presentation by Dr. Tracey Krupski discussing tele-cystoscopy for improving access to care for resource challenged populations. One of the AUA’s mandates is to address the urologic workforce shortage, but currently we are very resource challenged as urologists. Moreover, in Dr. Krupski’s state of Virginia, southwest Virginia has the worst area deprivation index of the state, suggesting poor access to care:
There are few urologists in rural areas, often necessitating that patients travel hours to receive follow-up care multiple times per year. Dr. Krupski’s group aimed to train registered nurses and allied health professionals to perform cystoscopies which are monitored and interpreted in real time by board certified urologists.1 The key is to ensure optimal picture resolution to guarantee this technology is not inferior to traditional cystoscopy:
The following diagram demonstrates the tele-pack, with the components needed for tele-cystoscopy:
In 2020, Dr. Krupski’s group published results of their pilot study of a blinded comparison of clarity, proficiency and diagnostic capability of tele-cystoscopy compared to traditional cystoscopy.2 The goal of this pilot study was to have blinded external reviewers retrospectively compare multisite, prospectively collected video data from tele-cystoscopy with the video of traditional cystoscopy in terms of video clarity, practitioner proficiency and diagnostic capability. Six tele-cystoscopy encounters were reviewed for a total of 36 assessments:
Video clarity, defined by speed of transmission and image resolution, was better for onsite compared to transmitted tele-cystoscopy. Practitioner proficiency for thoroughness of inspection was rated at 92% for tele-cystoscopy and 100% for traditional cystoscopy, and confidence in the identification of an abnormality was equivalent. Four of 6 videos had 100% agreement between reviewers for next action taken, indicating high diagnostic agreement:
Additionally, the provider performing cystoscopy and location of cystoscopy did not statistically influence the ability to make a diagnosis or action taken.
Earlier in 2024, their group published results of patient satisfaction with tele-cystoscopy. In this study, 48 patients underwent a standard of care cystoscopy along with a tele-cystoscopy. This was a truly underserved population with 13 patients (27%) being uninsured and 10 patients (20%) having Medicaid as their primary insurance. Moreover, 82% of patients resided in a distressed community indicating fewer economic resources. The tele-cystoscopy clinic saved patients an average of 235 miles and 434 min of travel time, and satisfaction results showed a mean score of 31.38 out of 32.
Dr. Krupski concluded her presentation discussing tele-cystoscopy for improving access to care for resource challenged populations with the following take home messages:
- Infrastructure is key, including adequate video quality for a tele-cystoscopy to be performed and interpreted
- Advanced practice provider training is one of the main limitations, in addition to keeping up with their skills. An advanced practice provider who travels to the rural sites seems to be more of a sustainable model
- The diagnostic utility is attractive to patients and improves access to care in rural communities. Agreement rates for cystoscopic findings are also promising
- The next step is adoption and figuring out reimbursement
Presented by: Tracey Krupski, MD, University of Virginia, Charlottesville, VA
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Society of Urologic Oncology (SUO) Annual Meeting, Dallas, TX, Tues, Dec 3 – Fri, Dec 6, 2024.
References:
- Hougen HY, Lobo JM, Corey T, et al. Optimizing and validating the technical infrastructure of a novel tele-cystsocopy system. J Telemed Telecare. 2016 Oct;22(7):397-404.
- Lobo JM, Horton B, Jones RA, et al. Blinded Comparison of Clarity, Proficiency and Diagnostic Capability of Tele-Cystoscopy Compared to Traditional Cystoscopy: A Pilot Study. J Urol. 2020 Oct;204(4):811-817.
- Kazeem AO, Hasken W, Sims T, et al. Patient satisfaction with a novel tele-cystoscopy model: Expanding access to bladder cancer surveillance for rural patients. Telemed Rep. 2024 Aug 5;5(1):229-236.