Telemedicine for Urologic Care in Rural Nigeria

This is a multi-center study that will be using three primary care rural clinics in Kaduna State, Nigeria and a tertiary care hospital. These clinics were chosen based upon previous studies that have been conducted using them. Further, these sites were chosen for their relative frequency of patients presenting with urologic complaints. The clinics feature a primary doctor that fields urologic concerns and refers them to the main tertiary care center in Ahmadu Bello University in Zaria, Kaduna State, Nigeria. These clinics are in rural localities throughout the state, ensuring a broad representation of the study participant population.

Methods for telemedicine implementation have been discussed. The interventions will take place in the rural clinics and not at patients' homes given the clinics' reliable internet capabilities and for the consultations to be standardized. Our collaborators in Nigeria have been conducting an ongoing series of site visits to rural clinics in the proposed catchment area to assess for telemedicine capacity and any upgrades needed to make the rural clinics telemedicine capable.

The post-intervention survey will begin by collecting demographic variables such as age, gender, location of inhabitance, income, employment status, and ethnic group (due to the presence of many major and minor ethnic groups in Nigeria). Next, the survey will ask about patient experiences with ease of consultation, ease of travel, and the urologist's timeliness and responsiveness. Finally, the survey will ask about the cost and distance of travel for the urologic consultation, the time from initial presentation to the urology consultation, and patient satisfaction with care. A Likert scale will be employed for the ordinal variables, whereas patients will be able to manually enter estimates for continuous variables. Data from the RedCAP surveys will be securely stored in the research academic environment, allowing for data privacy.

Potential confounding variables, such as many of the demographic variables, will be addressed in the data analysis phase through stratification. Data will be analyzed using the appropriate statistical tests for the specific variables; Chi-squared or Fisher's exact tests will be used for categorical and binary variables, whereas T tests will be used for continuous variables. Multivariable generalized linear mixed effects regression models will be calculated with time to consultation as the primary outcome. The primary predictor in these models will be telemedicine consult compared to non-telemedicine consult. Potential confounding variables will be added including patient age, sex, location, ethnicity. Statistical significance will be defined by alpha > 0.05. All statistical testing will be completed using R and/or Stata.

Inclusion criteria

• Adults (at least 18 years old, any gender) that reside in rural Kaduna State.
• Present to primary clinics with an active urologic chief complaint(s), either surgical or non-surgical in nature.

Exclusion criteria

• Children (<18 years old).
• Individuals who do not live in rural Kaduna State localities.
• Those experiencing urologic emergencies.
• Those who do not present with any urologic chief complaints defined as the primary reason the patient is seeking medical care.