For men who live in remote areas, there are always medical challenges

Men and their families who live in rural and relatively remote areas face additional, and sometimes specific, challenges when it comes to medical issues (above and beyond those associated with unexpected and serious injuries or acute medical conditions).

In an article available on-line and scheduled for future publication in BJU International, McCombie et al. describe their experience in setting up a so-called “one-stop” prostate clinic in Western Australia that was specifically designed to address the needs of men apparently at risk for prostate cancer who may live between 50 and 2,000 miles from the nearest major medical center. The goal is to ensure that such men, when referred, can get initial evaluation and biopsies (when needed) in a single visit to the center as opposed to having to make multiple trips to get a diagnosis.

McCombie et al. conducted a prospectively designed evaluation of the first 200 men from rural and remote areas of Western Australia to access their new “one-stop” clinic between August 2011 and August 2014. Referral criteria for patients were either two abnormal, age-related PSA levels in the absence of any evident urinary tract infection (UTI), or an abnormal DRE regardless of PSA level.

Here are the core study findings:

  • The average (median) distance traveled to attend the clinic was 1,545 km (range, 56 to 3,229 km), which is equivalent to  960 miles (range, 35 to 2,006 miles).
  • The average (median) time from referral to assessment was 33 days (range, 2 to 165 days).
  • With respect to the patient individual characteristics,
    • Their average (median) age was 62 years (range, 38 to 85 years).
    • Their average (median) PSA level was 6.7 ng/ml (range, 0.5 to 360 ng/ml).
    • 78/200 (39 percent) had a suspicious DRE.
  • Most patients (184/200 or 92 percent) were given a prostate biopsy on the day of their visit to the clinic.
  • The biopsy complication rate was 6/172 patients for whom follow-up data were available (3.5 percent).
  • 111/184 patients biopsied (60 percent) were diagnosed with prostate cancer.
  • The majority of patients diagnosed (100/111 or 90 percent) received one of three standard forms of management:
    • Radical prostatectomy (46/111 or 41 percent)
    • Active surveillance (28/111 or 25 percent)
    • External beam radiation therapy (26/111 or 23 percent)

The authors also estimate that there was cost-saving of A$1,045 (i.e., Australian dollars) per person — equivalent to about US$760 — based on the reduced need for travel through the use of this “one-stop” clinic model.

Whether such a model would have value in other areas is perhaps worth exploring — especially in other places where there is a nationalized health care system is in place. For example, it might be useful in parts of Canada or in Alaska, where, for the patient, knowing that you only had to take a single day from home to get all relevant initial diagnostic tests done at one visit would clearly be beneficial. It might also be beneficial in some rural parts of Western and Midwestern America, where having to travel 200+ miles twice (each way) to get an initial examination from a qualified urologist is clearly not good use of the patient’s time. Clinics that set a particular day every so often for the evaluation and diagnosis of individual patients within a single day might be able to offer a really valuable service within their communities.

One Response

  1. One of the reasons we set up The Reluctant Brotherhood Advanced PCa virtual support group was to serve men and caregivers who are geographically compromised.

    We have several people who attend from remote locations in Idaho, Pennsylvania, British Columbia, and even Thailand.

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