Patient travelling distance and reason for referral How far are they coming from ?

Introduction: In the province of Quebec, eight pediatric urologists practice in three tertiary centres covering large territories. To improve the availability of pediatric urology to distant families and to reduce the economic burden on them, we examined the chart of all patients attending the pediatric urological outpatient clinic. Our objectives were to evaluate the distance travelled by each urological pediatric outpatient and to report the most frequent urological referral complains. Methods: From July 2016 to June 2017, we retrospectively reviewed the charts of all the 3609 pediatric patients seen in the outpatient urological clinic in CHU de Québec. We specifically focused on the travelling distance covered by families and the purpose of referral. Results: Most patients were boys (78%) and the mean age was 7.2 years. The average one-way distance traveled by each family was 69 km. The patients came more frequently from Capitale-Nationale (63,7%) and Chaudière-Appalaches (21,9%), the closest regions. The most common reasons for consultations were postoperative followups (15%), phimosis and adherences (14%), enuresia (14%), hydronephrosis (13%), micturition disorder (11%), and cryptorchidism and retractile testicles (8%). Of all patients seen for phimosis or cryptorchidism, only 24% and 36% of them, respectively, were scheduled for surgery. Conclusions: Phimosis, cryptorchidism, and voiding disorders are the most frequent pediatric urological reasons for consultation; primary care continuing medical education seems worthwhile. It would, perhaps, be more beneficial for all to have the pediatric urologists travelling to perform clinics and surgeries in distant regions to save more than 300 km round trip to several families. CUAJ – Original Research Otis-Chapados et al Patient travelling distance and reason for referral Introduction In the province of Quebec, pediatric urologists are distributed between three tertiary centers: McGill University, Université de Montréal and Université Laval. Each center, in order to offer the best urological care, must cover a large part of the 1 667 millions km territory and several administrative regions. Unfortunately, some cities are several hundred kilometers away from the closest tertiary center. In this context, the children and their families must skip work and school to attend their urological appointment, which implies lost of incomes. They should plan for travel expenses including gas, food and lodging. It is a socio-economic problem that also concerns other specialities. On October 2012, telephone consultations became a legal fee-for-services benefit by the Régie de l’Assurance Maladie du Québec (RAMQ). This was one possible answer to address the issue. Telemedecine is emerging as a solution to overcome long distances and to decrease patient and families absenteeism. However, telemedecine is time-consuming, still not well defined in several provinces and it presents a frontier for physical examination. In pediatric urology, the physical examination is often the centerpiece of a consultation and for many complaints; it is capital and decisive for treatment recommendation and to establish surgical indications. The main objective of our study is to measure the distance travelled by each pediatric patient visiting the outpatient urology clinic and ultimately, to bring strategies to improve the situation. Our secondary endpoint is to report the most frequent urological referral complaints to develop better guidelines for first-line providers. Methods We retrospectively reviewed all the charts of the 3604 outpatient’s consultations performed by the two pediatric urologists in CHU de Québec between July 1 2016 and June 3