SPU Main Site  |  Past & Future Meetings
Society For Pediatric Urology

Back to 2022 Abstracts


Characterizing Digital Access in Pediatric Urology
Julia Beth Finkelstein, MD, MPH1, James S. Rosoff, MD2, Jessica Zhang, MPH1, Christina Brown, MSHP1, Caleb P. Nelson, MD, MPH1.
1Boston Children's hospital, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA.

Background: Telemedicine has the potential to improve access for underserved populations by facilitating timely remote evaluation, without the direct financial and time costs associated with seeking specialty care in person. However, challenges in the real-world implementation of this technology may paradoxically exacerbate health disparities. When implemented with consideration of health disparities, telemedicine has the potential to bridge the gap between patients and pediatric urologists. Thus, we sought to characterize families' digital access and how socioeconomic status (SES) impacts telemedicine use within pediatric urology. Our specific aim was to implement a screening tool to identify barriers to telemedicine access for pediatric urology encounters. We hypothesized that disadvantaged SES will be a barrier to telemedicine use.
Methods:The screening tool was launched in July of 2021. At the time of new patient intake, the patient representative (patient, parent, or guardian) is screened as to whether the family has a device that can be used for a virtual visit (VV) and reliable internet or cellular data to complete a VV. A preference for an in-person visit, VV or no preference was also recorded. Patient demographics, including age, sex, race, ethnicity, zip code, first language, insurance type, and whether an interpreter was needed, were noted. Patient SES was estimated using the Distressed Communities Index (DCI) generated for each patient's zip code. For each zip code, the DCI produces a normalized, comparative distress score ranging from 0 ("prosperous") to 100 ("distressed"), which estimates the approximate SES of the respondent.
Results: Since implementation, 2866 patients/families were screened for digital access. Median patient age was 6 years (IQR 1.9-12) and 71.6% were male. Eleven percent of patients had public insurance, 3.7% required an interpreter and the overall median distress score was 15.7 (IQR 7.8-37.1). Approximately 55% of families noted a preference for in-person visits, while 30% had no preference and 15% preferred a VV. The distress score was significantly higher (i.e., lower SES) for those who preferred an in-person visit, compared to those who had no preference (p=0.002). Almost 5% of patients did not have access to a digital device, 121 (4.2%) lacked reliable internet/cellular data and 96 patients (3.3%) lacked access to both a digital device and internet. Those patients who did not have access to a digital device (p=0.004) or internet (p=0.021) had a significantly higher distress score. Those patients who had public insurance (p<0.001), required an interpreter (p<0.001) or were non-white, non-Asian race (p<0.001) had a significantly higher distress score.
Conclusions: Family screening revealed that there is a small but significant proportion of families who lack digital access, and these families have a higher distress score, likely reflecting lower SES. We found that a little more than half of families preferred an in-person visit and these patients also had a higher distress score. Ongoing digital access screening and future studies will enable us to develop interventions tailored to the specific needs of our patients, allowing us to provide equitable pediatric urological care.


Back to 2022 Abstracts