Narrative Review: Telemedicine for Reducing Travel-Related Out-of-Pocket Costs Among Hong Kong Urological Patients and a Customized Tiered Consultation Pathway

The COVID-19 pandemic disrupted routine urological outpatient services in Hong Kong, imposing disproportionate travel burdens on outlying island and cross-border patients who rely on multi-stage ferry and bus journeys. Globally, existing teleurology cost evidence is dominated by Western private-vehicle models, and to date no peer-reviewed review has investigated teleurology cost outcomes in Hong Kong. This narrative review addresses this regional research gap by synthesizing international evidence and proposing a tiered workflow aligned with the Hospital Authority's 2022-2027 Smart Care strategy.

PubMed, CINAHL Complete and MEDLINE were searched for primary quantitative studies published between January 2012 and December 2022. Studies were screened following standard PRISMA protocols, and methodological quality was appraised using CASP and JBI checklists. Findings were aggregated via narrative thematic synthesis.

Eleven eligible studies (9 cohort studies, 1 randomized controlled trial, 1 cross-sectional survey) were included in the final analysis. Four core patient cost themes were identified by evidence strength: travel time savings (81.8% of studies), direct transport expenditure reduction (72.7%), travel distance reduction (54.5%), and lost work opportunity cost (45.5%). Western mileage-based cost frameworks have limited applicability to Hong Kong's ferry-dominated public transit ecosystem.

Evidence drawn predominantly from Western populations suggests that teleurology may reduce travel-related time and financial burdens for urology patients, with potential applicability to Hong Kong's remote island and cross-border patient groups. The proposed tiered consultation pathway represents a theoretically evidence-informed framework aligned with local digital healthcare policy, to support future telehealth pilot implementation and service optimization. As all included studies were conducted in North America and the United Kingdom, and the pathway has not been locally validated, its real-world effectiveness and cost-saving magnitude in Hong Kong remain to be confirmed in future primary research. Although this study focuses on the public healthcare setting in Hong Kong, the proposed telemedicine consultation pathway may serve as a reference clinical and operational blueprint for other highly urbanized regions with outlying islands or cross-border patient demographics.