Understanding Urogynecology Patient Access to Telemedicine

INTRODUCTION: Telemedicine is an effective and increasingly utilized method of healthcare delivery. The urogynecology literature reports benefits of telemedicine for new patient consultations, preoperative education, and postoperative follow-up. While social determinants of health (SDH) may impact the ability of some patients to attend in-person visits, SDH may also affect access to the technology necessary for telemedicine. To close the “digital divide” and make this access equitable, we must investigate the technology literacy of our patients and how they utilize broadband infrastructure. OBJECTIVE: The primary objective of this study is to determine whether urogynecology patients in an academic, multisite, diverse clinical practice have access to the technology necessary for telehealth visits. The secondary objective is to understand if technology access varies by SDH. METHODS: This is a retrospective cohort study of new patients presenting for urogynecologic care at an academic medical center between May and July 2024. All new patients completed a series of questionnaires through the electric medical records (EMR) before their initial visit, including health history and the Pelvic Floor Distress Inventory-20 (PFDI-20). Patients were also asked to answer 4 items related to access to technology to support telehealth visits: 1) Do you have reliable access to a phone or device that connects to the internet?; 2) How often do you have reliable access to the internet? Always, Usually, Not always; 3) Does your connection support video?; and 4) Which is your preferred mode for virtual visits? Telephone or Video. Data were abstracted from the EMR and analyzed using SPSS Version 29. Descriptive statistics are displayed. Categorical data were compared using chi-square test of association or Fisher exact test. P values <0.05 were considered significant. RESULTS: The cohort of 401 patients were (mean±SD) 58±16.6 years old with PFDI-20 scores of 82±52.2. The patient population was diverse: 74% identified as White, 20% as Black, 2.5% as Asian, and 3.5% as other. 7.5% identified as Hispanic/Latina. 58% of patients had private insurance, and the remaining 42% had government insurance (Medicare or Medicaid). Telehealth made up 82.5% (329/399) of new patient visits, and all but 4 were successfully completed via video. The majority (97%) had reliable access to a phone or device that could connect to the internet. Reliable internet access was available to 72% always, 24% usually, and 4% “not always.” Black patients were more likely than White patients to “not always” have reliable internet access (15% vs 1.3%, P<.001). Access to internet was not associated with age (P=.177), ethnicity (.602), or insurance status (P=.294). Nearly two-thirds (64%) of the cohort preferred video to phone visits, and 65% of patients with reliable or usually reliable internet access compared to 25% without reliable internet access preferred video to phone visits (P=.026). CONCLUSIONS: All but 3% of new patients presenting to a diverse academic urogynecology practice have access to a device that supports telehealth visits. Black women are disproportionately less likely to have reliable internet access than White women. More research is needed to ensure equitable access and remove disparities in telemedicine (Tables 1 and 2).