MORGANTOWN, W.Va. – Researchers from WVU Medicine have found that pediatric urology consultations performed by highly trained advanced practice providers (APPs) in a telemedicine setting are a clinically reliable, cost-effective option for West Virginia families.
These findings led WVU Medicine Children’s to increase its urology telemedicine clinics from three to four locations across the state — with a fifth location scheduled to launch later this year.
The team’s study was published in the American Urological Association’s March 2022 issue of Urology Practice®. It’s the first study to demonstrate that children with various urological conditions (including undescended testes, penile anomalies, voiding issues, and recurrent urinary tract infections) can be accurately diagnosed and treated — and, when necessary, scheduled for surgery — without seeing a pediatric urologist in person.
“Because 90 percent of our country’s urologists practice in metropolitan areas, the use of telemedicine among urology specialists is on the rise, especially in rural areas,” Osama Al-Omar, M.D., M.B.A., chief of Pediatric Urology at WVU Medicine Children’s and the study’s primary investigator, said. “However, telemedicine is usually used to conduct routine follow-up visits, with patients and their caregivers primarily logging in from home. I wanted to see if we could use telemedicine in a different way.”
Dr. Al-Omar partnered with seven WVU Medicine providers, researchers, and epidemiologists to test an approach to address the state’s shortage of urology providers while reducing travel time and expenses for families needing care.
First, APPs with an interest in urology took part in an intensive, hands-on training program that let them work with children in both inpatient and outpatient settings. Then, they began seeing urology patients at two existing WVU Medicine satellite clinics equipped with telemedicine technology.
At the end of each examination, the APP initiated a video call with their supervising pediatric urologist, allowing the providers and family members to discuss the patient’s care plan. Patients needing surgical treatment were then scheduled for surgery at the main WVU Medicine Children’s campus in Morgantown.
“With this model of care, families still need to drive or find transportation to their appointment at their local communities, but they don’t have to travel nearly as far,” Al-Omar said. “Not only do they see a well-trained APP in person, but they also can speak to a physician.”
Al-Omar and his colleagues analyzed data gathered from 92 telemedicine visits between August 2018 and April 2020. They found that families saved an average driving time of four hours and 46 minutes, or the equivalent of 299.8 miles, by seeing a provider at the nearest satellite clinic instead of in Morgantown. Families also saved an average of $173.88 in fuel costs, based on gas prices during that period.
“Our study also confirmed that our use of APPs to evaluate and diagnose patients is safe and effective,” Al-Omar said. “The data showed that when our APPs recommended surgery, the urologist agreed with them more than 90 percent of the time.”
Today, WVU Medicine Children’s offers urology telemedicine at its satellite clinics in Martinsburg, Parkersburg, Princeton, and Wheeling. Each location is staffed by two urology-trained APPs.
Al-Omar said the team’s research illustrates how much of an impact healthcare providers can make when they use existing resources in creative ways.
“By taking advantage of the staff and technology we already had, we’ve helped more children receive the pediatric urology care they need without leaving the state,” Al-Omar said. “We can also replicate our results with other medical and surgical specialties. Even if West Virginia and the nation continue to face shortages of certain pediatric specialists, telemedicine technology is here to stay.”
Hudson’s Story
Hudson Gamino was at a well-baby visit when his pediatrician noticed he had a testicle that hadn’t descended. This condition is common for babies like Hudson and his twin Easton, who were born at 36 weeks and two days. In some cases, this condition resolves as the child grows, but at the age of 4, his pediatrician determined that Hudson required intervention by a pediatric urologist to prevent future complications.
Jennifer Gamino, Hudson’s mother, was able to schedule a telemedicine consultation with Al-Omar.
“One of the things that really appealed to me, living here in Martinsburg and being aware of pediatric telemedicine, was the fact that I wouldn’t need to make that drive all the way to Morgantown just for a consultation,” she said. “I think that’s a really great choice for everyone here locally, and it’s a really big help to everyone in the state to have those resources because otherwise folks in our area typically tend to go to Washington, D.C. I’m really happy that we have that available.”
Gamino brought Hudson to WVU Medicine Children’s in February 2022 for surgery to correct the testicle that hadn’t descended and repair an inguinal hernia. During the surgery, Al-Omar also corrected a narrowing of the end of the urethra, which can lead to difficulty urinating and bladder infections if not treated.
Hudson was discharged the same day as his surgery with minimal pain that was easily controlled with over-the-counter medications.
“He was back to himself the next day and didn’t really require anything outside of Tylenol and Advil at that point,” Gamino said. “We had a great recovery.”
Gamino and Hudson have been able to continue using telemedicine for follow-up care.
“I couldn’t be more grateful for Dr. Al-Omar and his staff. I appreciate the fact that he was extremely thorough, kind, and caring. He has a very calm demeanor, and that’s very reassuring to parents who are basically handing over their child and putting their child’s life in his hands. I love that he not only fixed the initial problem that we were there for but noticed that Hudson had an additional issue that needed to be taken care of, so he didn’t have to have another procedure in the future,” she said.
“I just can’t thank him enough for his expertise and his thoughtfulness. His compassion was really important to us when he came out to let us know how Hudson was doing after the procedure. He’s really great with parents, and that’s super important in pediatrics. You just can’t be a pediatric surgeon or a pediatric provider and not realize that not only treating the child is your job, but also taking care of our parents is very, very important.”
For more information on WVU Medicine Children’s, visit WVUKids.com.