Access to Urological Care and Internet Connectivity in the United States: A Geospatial Analysis

Telemedicine video visits have been suggested as a mechanism to improve access to urological care in geographically isolated communities. However, Internet availability is not consistent across the United States. This study aims to better understand the interplay of broadband Internet, urologist density and county demographics to inform the strategic deployment of urological telemedicine.

A geospatial analysis was conducted to assess associations between broadband Internet and urologist density. Adequate broadband Internet availability was determined to be greater than 50% county coverage. Data were obtained from 2015 Federal Communications Commission filings. Physician density in 2015 was obtained from 2016-2017 Area Health Resources Files. A univariate regression was performed to estimate the associations of county demographics with broadband availability and urologist density.

More than 10.9 million Americans lack access to local urology care and broadband Internet. Overall 31.7 million Americans lack access to a urologist but have reliable broadband Internet coverage. Counties with no urologists were associated with having less accessibility to broadband Internet and greater distance to the nearest county with a urologist. Counties without Internet availability or urologists were more likely to be rural (OR 9.93) and be designated as a whole county health professional shortage area (OR 10.05).

A quarter of communities that lack access to local urologists also lack access to broadband Internet. Telemedicine cannot address poor access to urology care in communities without high-speed Internet. Future studies are needed to establish whether, pending expanded access to broadband Internet coverage, telemedicine will improve patient outcomes in geographically isolated communities.