LAUSR

The difficulty in delivering health care to remote areas is a challenge for many states of Australia. Economic and physical barriers (distance, transportation difficulties, need to travel and, in some areas, poor health literacy) impact diagnosis and treatment choices for rural patients. It has been shown that patients in remote areas have less prostate specific antigen testing, decreased rates of radical prostatectomy and have also been found to have worse prostate cancer outcomes. Providing equitable access to diagnosis and treatment for prostate cancer, and urological diseases in general, is a challenge that needs to be overcome in rural areas. The rapid uptake and integration of telehealth, pushed into ‘primetime’ due to COVID-19, has changed the doctor–patient interaction and interprofessional consultations. This may help to overcome some of these above-mentioned difficulties of delivering urological care to remote areas of Australia. Within this framework of telehealth sits rapid access clinics or ‘one-stop clinics’ that utilize aspects of telemedicine and physical interactions to efficiently triage, diagnose and/or treat patients. The two articles from the Fiona Stanley Group are the first Australian series to present a one-stop clinic for prostate cancer and haematuria assessment and diagnosis, which lessens demands on public hospital outpatient appointments and reduces the travel burden for rural patients. The One-Stop Prostate Clinic described the outcomes of 1000 rural men who were given access to a same-day prostate cancer diagnostic clinic via aid of a transrectal ultrasound biopsy, and since 2015, a same-day multi parametric magnetic resonance imaging prostate. The implementation of this clinic was inspired by data demonstrating worse outcomes for rural men with prostate cancer. Their study demonstrated that rural men can be given equivalent access and diagnostic outcomes to men in metropolitan centres. The One-Stop Haematuria Clinic processed 3000 patients over a 10-year period of whom 10.9% had a urothelial malignancy. The One-Stop Haematuria Clinic was an extremely efficient, rapid and streamlined approach resulting in 53% of patients being able to be discharged after a single visit. This streamlined process helped reduce the economic and physical barriers for rural patients. Should there be a new standard of care in urology outpatients? Will a ‘one-stop’ clinic improve efficiency and quality of healthcare delivery and perhaps overcome the difficulties of delivering health care to remote areas? Can the implementation of telehealth, together with a one-stop clinic, overcome the economic and physical barriers that compromise urological service delivery to remote areas? It has been shown that one-stop urology clinics are feasible, safe and provide similar outcomes in a shorter time compared to the standard diagnostic pathways. The COVID-19 pandemic has led to a substantial change in all aspects of healthcare delivery, which is predicted to shape healthcare service into the foreseeable future. The rapid implementation of telehealth has drastically reduced the rural–metropolitan heath differential, which in Australia may have profound improvements in healthcare delivery to some of the most remote areas and overcome the difficulties previously encountered. People in rural and removed areas are skewed towards higher rates of mortality, morbidity and hospitalisations for a wide range of diseases. As urological conditions can be managed well without a face-to-face interaction or physical examination being necessary, urological practice lends itself to telehealth, thereby helping to reduce this skew towards poorer outcomes. Telehealth and one-stop clinics can save money, travel time and is particularly helpful for rural areas. The realities of remote living limit healthcare access and hence urological care can be compromised. One-stop clinics and telehealth hold significant promise as a modality to improve access to health care for patients living in rural and remote areas. As urologists, we should enthusiastically embrace one-stop clinics and telemedicine as a way to efficiently care for all patients. It may help break down the health differential that exists between rural and metropolitan areas and overcome some of the difficulties that exist in delivering care to some of the most vulnerable, isolated and remote patients.