TeleBBD: Telehealth management of bladder bowel dysfunction - A provider survey of benefits and limitations.

Summary Introduction Bladder bowel dysfunction (BBD), defined by the International Children's Continence Society (ICCS) as a spectrum of lower urinary tract and bowel symptoms, represents to up to 40% of pediatric urology consults. Management of BBD involves strict behavioral management with frequent follow ups by urology advanced practice providers (APPs). If left untreated, patients may develop secondary comorbidities that impact their renal and/or bladder function, bowel function, and psychosocial well-being. Previous studies have reported feasibility for virtual post-operative visits and prenatal consultations, however, telehealth management of BBD, or TeleBBD, has not yet been studied. The goal of this study is to survey APPs in pediatric urology to understand how TeleBBD compares to in-person visits, and identify benefits and limitations of TeleBBD. Study design An online survey via Qualtrics was designed based on current practice guidelines for BBD management and telehealth considerations. Survey was distributed in September 2020 via the Pediatric Urology Nurses & Specialists listserv. Group qualitative coding was completed by the authors to generate themes that emerged from the results. Results/Discussion A total of 53 APPs from across 21 states in the US completed the online survey, with 49 (92%) APPs reporting currently providing TeleBBD. Those who did not provide TeleBBD typically do not manage BBD patients. Summary Table shows the comparison of TeleBBD with in-person visits, with many elements of TeleBBD better or the same as in-person visits. APPs reported that TeleBBD has been most beneficial in increasing access and overall improvement in follow up which is significant for management of this chronic condition. Barriers include access to technology/internet and inability to perform full physical exams via televisit. Limitations of the study include lack of validated survey and small sample size. Overall increased access and improved patient adherence and resolution from BBD is significant for this patient population for prevention of secondary comorbidities. Conclusion This is the first study to survey APPs across the US specifically exploring indication of TeleBBD as well as comparison of TeleBBD with in-person visits. The perception of improved access to care and less no-show rates is significant especially during the pandemic in providing continuity of care and prevent secondary comorbidities. Additionally, TeleBBD was felt to be just as effective as in-person visits for patient adherence to treatment, and other components of care, with the exception of ability to provide physical exams. Providers leveraged the benefits of TeleBBD and shared strategies for best practices. Summary Table . APP Perspective of TeleBBD Compared to In-Person Visits (n = 49). Question Better than in-person visits % (n) Same as in-person visits % (n) Worse than in-person visits % (n) Total response per question (n) Frequency of follow up visits 50.00% (22) 47.73% (21) 2.27% (1) 44 No show rates 47.73% (21) 45.45% (20) 6.82% (3) 44 Patient/Parent/Caretaker satisfaction 29.27% (12) 68.29% (28) 2.44% (1) 41 Adherence to treatment regimen 7.32% (3) 80.49% (33) 12.20% (5) 41 Ability to discuss recommendations and teaching with parents/caretakers 6.82% (3) 79.55% (35) 13.64% (6) 44 Ability to collect history 6.98% (3) 79.07% (34) 13.95% (6) 43 Timing to resolution/discharge from clinic 17.65% (6) 67.65% (23) 14.71% (5) 34 Ability to review studies/imaging with patients/parents/caretakers 13.64% (6) 63.64% (28) 22.73% (10) 44 Ability to discuss recommendations and teaching with patients 9.09% (4) 68.18% (30) 22.73% (10) 44 Ability to perform PE 0.00% (0) 0.00% (0) 100.00% (42) 42 PE: Physical Examination.