title: The burden of attending a pediatric surgical clinic and family preferences toward telemedicine.
abstract: OBJECTIVE
  Indirect expenses for accessing health care may place significant fiscal strain on Canadian families. Telemedicine alternatives, using email, telephone, and video conferencing, can mitigate such financial burdens by reducing travel and related costs. Our objectives were to assess costs that families incur visiting an outpatient pediatric surgical clinic, and family attitudes toward telemedicine alternatives.
  
  
  METHODS
  A survey was offered pre-consult to all families who attended pediatric urology and general surgery outpatient clinics over a three-month period.
  
  
  RESULTS
  A total of 1032 of 1574 families screened participated (66.0%). Less than half (18.5%) of participants traveled over 200 km, and 32.9% spent over 4 hours in transit, round-trip. The proportion of participants who spent over $50 on travel and ancillary expenses was 33.0%. In 74.0% of families, 1 or more adults missed work. The proportion of families who perceived costs as somewhat high or high was 29.1%. Perceived cost was positively correlated to distance traveled, money spent, and missed work (p<0.01). Most were comfortable with medical communication using technology; and 34.3%-42.7% would avoid an in-person clinic visit utilizing email, telephone, and video conferencing. Higher perceived cost (p<0.001) and distance traveled (p<0.01) were only weakly associated with greater willingness to substitute a clinic visit with video conferencing.
  
  
  CONCLUSIONS
  Many families face high costs related to routine outpatient clinical visits, and there is a substantial willingness by them to access telemedicine alternatives, rather than the traditional face-to-face clinical visit.
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor, Black Wing Room M299, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: eli.bator@hotmail.com.
authors.forename: Eli X
authors.initials: EX
authors.lastname: Bator
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor, Black Wing Room M299, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Gleason
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor, Black Wing Room M299, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; University of Toronto, 563 Spadina Crescent, Toronto, Ontario M5S 2J7, Canada.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor, Black Wing Room M299, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Niki
authors.initials: N
authors.lastname: Kanaroglou
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor, Black Wing Room M299, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; University of Toronto, 563 Spadina Crescent, Toronto, Ontario M5S 2J7, Canada.
authors.forename: Walid A
authors.initials: WA
authors.lastname: Farhat
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor, Black Wing Room M299, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; University of Toronto, 563 Spadina Crescent, Toronto, Ontario M5S 2J7, Canada.
authors.forename: Darius J
authors.initials: DJ
authors.lastname: Bägli
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor, Black Wing Room M299, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; University of Toronto, 563 Spadina Crescent, Toronto, Ontario M5S 2J7, Canada.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Koyle
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D000554:Ambulatory Care Facilities / Q000191:economics*; D001294:Attitude to Health; D002170:Canada; D002648:Child; D005190:Family; D005260:Female; D013502:General Surgery; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D010372:Pediatrics; D012017:Referral and Consultation / Q000191:economics; D011795:Surveys and Questionnaires; D017216:Telemedicine; D014195:Travel / Q000191:economics; D014572:Urology
keywords: Burden; Cost; Pediatrics; Surgery; Telemedicine; Urology