Pd52-07 building access to urology specialist care through e-consultation in medically underserved patients in areas of tension and conflict

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making III1 Apr 2018PD52-07 BUILDING ACCESS TO UROLOGY SPECIALIST CARE THROUGH E-CONSULTATION IN MEDICALLY UNDERSERVED PATIENTS IN AREAS OF TENSION AND CONFLICT Sataa Sallami, Sana Abou El Makarim, Anwar Chalbak, Abdelwahab Abou Soua, and Ali Massoud Jornaz Sataa SallamiSataa Sallami More articles by this author , Sana Abou El MakarimSana Abou El Makarim More articles by this author , Anwar ChalbakAnwar Chalbak More articles by this author , Abdelwahab Abou SouaAbdelwahab Abou Soua More articles by this author , and Ali Massoud JornazAli Massoud Jornaz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2359AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the «official» end of the civil war, Libya is in total anarchy. The roads are cut off and the militias enforce their laws. The western region of Libya (Nafusa mountains)is often cut off from the capital and other major cities and Tunisian borders are also often closed. The civilian population was then in a deadly trap. One of the common public health problems were urological affections, thus urological care was urgent and mandatory. For all these reasons, we developed an e-consultation system between three PCPs in this region and an urologist surgeon in the north of Tunisia. This system was based on a secure web-based means, as an alternative to direct consultations. In this study we evaluated the use of an "ask-the-expert" e-consultation service in order to assess whether the service is efficient and useful. METHODS We prospectively collected all e-consultations submitted from April 2016 to October 2017 from 3 community health centers with mainly medically underserved patients. Collected data included number of e-consultations submitted, patient′s epidemiological data, specialist response, and time required for the specialist to complete the e-consultation. Perceived benefit to the PCPs and their patients and impact on care delivery were analyzed. RESULTS Three PCPs participated in the study, had referred a total of 390 patients. They were 247 men and 143 women. Their ages range from 3 months to 91 years. They were children (≤10 years old) in 51 cases. The total number of e-consultations was 747 (1 to 5 by patient). The percentage of e-consult patients grew by ≈ 22% every 6 months. The specialist provided an answer without requesting further information in 28,7% of cases, with ≥90% of cases taking ≤15 min for the specialist to complete. Eighty-nine percent of cases were answered within 48 hours. The service was perceived as highly beneficial to providers and patients in 75,9% of patients / parents. The e-consult rate was highest in benign prostatic hypertrophy (20%), urolithiasis (19,5 %), and urinary infection (13,3%). Only 18,4% of the referrals (n=72) had required face-to-face visit and follow-up. Of them, 11 underwent complementary explorations (cystoscopy, prostatic biopsy) or surgical intervention. For e-consult patients, the average potential miles needed to travel was 195.1 miles (148 - 430) per patient. The mean travel reimbursement cost was 144 dollars per patient with a total of 107.568 dollars. CONCLUSIONS The present study showed high levels of satisfaction of e-consultation system, improvement in the access to specialist advice in a much more timely manner than the traditional referral-consultation process that may be impossible in areas of conflict. Moreover, e-consult system may decrease travel burden/ risks and direct travel costs for patients with avoidance of unnecessary specialist visits and investigations. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e983-e984 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Sataa Sallami More articles by this author Sana Abou El Makarim More articles by this author Anwar Chalbak More articles by this author Abdelwahab Abou Soua More articles by this author Ali Massoud Jornaz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...