title: Veterans Affairs Telemedicine: Bringing Urologic Care to Remote Clinics.
abstract: OBJECTIVE
  To report the use of telemedicine to deliver general urologic care to remote locations within the Veterans Affairs Greater Los Angeles Healthcare System. We describe the diagnoses managed, patient satisfaction, safety, and benefit to patients in terms of saved travel time and expense.
  
  
  METHODS
  We conducted a retrospective chart review examining care delivered through urology telemedicine clinics over a 6-month period. We examined the urologic conditions, patient satisfaction, and emergency department visits within 30 days of the visit. We estimated patient benefit by calculating travel distance and time and the saved travel-associated costs using Google Maps and US Census income data.
  
  
  RESULTS
  Ninety-seven unique telemedicine visits were conducted and a total of 171 urologic diseases were assessed. The most common conditions were lower urinary tract symptoms (35%), elevated prostate-specific antigen level (15%), and prostate cancer (14%). One patient was seen in the emergency department within 30 days with an unpreventable urologic complaint. Patient satisfaction was "very good" to "excellent" in 95% of cases, and 97% would refer another veteran to the urology telemedicine clinic. Patients saved an average of 277 travel miles, 290 minutes of travel time, $67 in travel expenses, and $126 in lost opportunity cost.
  
  
  CONCLUSIONS
  Telemedicine was successfully and safely used to evaluate and treat a wide range of urologic conditions within the Veterans Affairs Greater Los Angeles Healthcare System, and saves patients nearly 5 hours and up to $193 per visit. Further investigation of the potential of telemedicine for the delivery of urologic care in a cost-effective manner is warranted.
authors.affiliation: Department of Urology, University of California, Los Angeles, CA. Electronic address: sdchu@mednet.ucla.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chu
authors.affiliation: Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA.
authors.forename: Richard
authors.initials: R
authors.lastname: Boxer
authors.affiliation: Veterans Affairs Greater Los Angeles, Los Angeles, CA.
authors.forename: Pauline
authors.initials: P
authors.lastname: Madison
authors.affiliation: Veterans Affairs Greater Los Angeles, Los Angeles, CA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kleinman
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; HSR&D Center for Health Communications Research, Veterans Affairs Ann Arbor, Ann Arbor, MI.
authors.forename: Ted
authors.initials: T
authors.lastname: Skolarus
authors.affiliation: Veterans Affairs Greater Los Angeles, Los Angeles, CA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Altman
authors.affiliation: Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA.
authors.forename: Carol
authors.initials: C
authors.lastname: Bennett
authors.affiliation: Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shelton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019114:Remote Consultation; D012189:Retrospective Studies; D012424:Rural Population; D017216:Telemedicine; D014481:United States; D014493:United States Department of Veterans Affairs; D014570:Urologic Diseases / Q000175:diagnosis / Q000628:therapy; D058014:Veterans Health