Integration of Telehealth at Multidisciplinary Stone Clinic Increases Patient Adherence to Kidney Stone Prevention Visits
Sai Allu, BA1, Ji Whae Choi, BA1, Darshi Shah, BS2, Rebecca Ortiz, BA2, Philip Caffery, PhD2, Christopher Tucci, MS1, Jie Tang, MD1, Gyan Pareek, MD1, David Sobel, MD1.
1Minimally Invasive Urology Institute, The Miriam Hospital; Warren Alpert Medical School, Providence, RI, USA, 2Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA.
BACKGROUND: Recent studies have found that the implementation of the telehealth model has helped to improve access to specialty care, such as high-risk obstetrics and rheumatology outpatient clinics, by reducing the rate of missed appointments. However, little is known about the impact of telehealth on multidisciplinary kidney stone clinics (MSCs). An MSC is a relatively novel approach that provides individualized care, especially to high-risk stone formers, by a team made up of urologists, nephrologists, and dieticians, all in a single patient encounter. The goal of this study is to evaluate whether the implementation of telehealth improved patient adherence to their scheduled appointments with the MSC integrated care team. METHODS: A retrospective review of the patient records of a single MSC was performed to identify patient appointments at a single academic institution from 2018 to 2021. Scheduling and appointment data was collected and analyzed from the records. Date of the appointment, appointment type (in-person or virtual), and whether the patient showed or did not show to the appointment were recorded. If the visit was scheduled as a virtual encounter, patient adherence was measured as completion of the telephone visit and follow up scheduled. Two separate time intervals were analyzed: A pre-COVID-19 time interval from February 2018 to February 2020 and a post-COVID-19 interval from March 2020 to October 2021. Patient adherence to scheduled appointments prior to and after March 2020 were compared. Statistically significant differences between the experimental groups were determined using a two-sample t-test. RESULTS: A total of 1,065 patient encounters at the MSC were included in the analysis. 531 visits were recorded in the pre-COVID-19 interval and 534 visits in the post-COVID-19 interval. After March 2020, there was a significant increase in the scheduled appointments that were remote (+64.7%, p < 0.001). Additionally, there was a significant increase in patient adherence to scheduled appointments from 87.9% prior to March 2020 to 96.1% after March 2020 (+8.2%, p < 0.001). CONCLUSIONS: Amongst the patients who were treated at the MSC, there was a significant increase in adherence to scheduled appointments, which coincided with a significant increase in the percentage of telehealth appointments following the start of the COVID19 pandemic in March 2020. These results suggest that telehealth could potentially increase access to the integrated MSC model for chronic kidney stone formers. However, further studies are necessary to expand this analysis to a more diverse population and examine the long-term effects of the wide-scale implementation of telehealth on kidney stone prevention.
| Pre-COVID-19 Interval | Post-COVID-19 Interval | |
| Sex | 50.3% Male / 49.7% Female | 57.5% Male / 42.5% Female |
| Number of visits | 531 | 534 |
| Percentage of remove visits | 15.6% | 80.3% |
| Percentage of visits completed | 87.9% | 96.1% |
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