Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study

Background: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel.

Objective: The aim of this study was to investigate current telemedicine usage by urologists, urologists’ perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation.

Methods: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists’ perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only.

Results: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom,, and Epic, and the top three barriers to implementing telemedicine were patients’ lack of technological comprehension, patients’ lack of access to the required technology, and reimbursement concerns.

Conclusions: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists’ usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.

Justin M Dubin1, MD ; W Austin Wyant1, MSc ; Navin C Balaji1, BE ; William LK Ong2, MD ; Reda H Kettache3, MD ; Malik Haffaf4, MD ; Skander Zouari5, MD ; Diego Santillan6, MD ; Ana Maria Autrán Gómez7,8, MD, PhD ; Hossein Sadeghi-Nejad9,10, MD ; Stacy Loeb11, MD, MSc ; James F Borin12, MD ; Juan Gomez Rivas13,14, MD, PhD ; Jeremy Grummet15, MD ; Ranjith Ramasamy1, MD ; Jeremy Y C Teoh16, MD

  1. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
  2. Department of Urology, Penang General Hospital, Penang, Malaysia
  3. Department of Urology, Bachir Bennacer - Biskra Hospital, Biskra, Algeria
  4. Department of Urology, EHU 1er Novembre, Oran, Algeria
  5. Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
  6. Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  7. Department of Urology, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
  8. Research Office of Confederacion Americana de Urologia, Buenos Aires, Argentina
  9. Department of Urology, Rutgers New Jersey Medical School, Newark, NJ, United States
  10. Department of Urology, Hackensack Meridian Health, Hackensack, NJ, United States
  11. Department of Urology and Population Health, New York University and Manhattan Veterans Affairs Medical Center, New York City, NY, United States
  12. Department of Urology, New York University, New York City, NY, United States
  13. Department of Urology, La Paz University Hospital, Madrid, Spain
  14. Department of Urology, Autonomous University of Madrid, Madrid, Spain
  15. Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
  16. SH Ho Urology Centre, Prince of Wales Hospital, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
Source: Dubin JM, Wyant WA, Balaji NC, Ong WL, Kettache RH, Haffaf M, Zouari S, Santillan D, Autrán Gómez AM, Sadeghi-Nejad H, Loeb S, Borin JF, Gomez Rivas J, Grummet J, Ramasamy R, Teoh JYC. "Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study." J Med Internet Res. 2020;22(11):e21875.
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