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

Abstract

Purpose

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.

Patients and Methods

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.

Results

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.

Conclusion

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.

Introduction

Since the global outbreak of COVID-19 starting in 2020, the public hospitals in Hong Kong implemented strict service rearrangement policies to reduce in-hospital viral transmission risks.1 All non-life-threatening elective procedures and routine specialist follow-ups, including stable urology check-ups, were repeatedly postponed or scaled down over multiple pandemic waves. While these infection control measures achieved public health targets, they created long-term barriers to continuous chronic disease management for a large subset of Hong Kong’s population.1,2

For the purposes of this review, teleurology is defined as the delivery of specialist urological outpatient care including symptom assessment, medication review and routine follow-ups via synchronous video consultation between patient and urologist, replacing mandatory in-person clinic attendance.3,4

The travel-related economic burden of in-person care falls into two broad categories: direct out-of-pocket costs, which include public transit fares, ferry tickets, petrol, parking fees and other transport-related expenditure incurred to attend a clinic appointment; and indirect opportunity costs, which refer to lost working income, missed caregiving responsibilities and productivity losses associated with time spent travelling and attending the appointment.

Stable chronic urological conditions such as controlled lower urinary tract symptoms and stable benign prostatic hyperplasia are particularly well suited to virtual consultation.4 These routine follow-ups typically require only symptom review, medication dose adjustment and discussion of test results, rather than physical examination, invasive testing or urgent clinical intervention, making them clinically appropriate for remote delivery.5

A unique structural healthcare access challenge exists for residents based on outlying islands such as Peng Chau, Lamma and Cheung Chau, as well as Hong Kong citizens residing across the border in Guangdong Province. To attend routine urological appointments in urban public hospitals, island patients must take ferries followed by lengthy bus transfers, creating round-trip travel times frequently exceeding one and a half hours. For elderly patients with limited mobility, joint pain or chronic renal and bladder conditions, repeated long-distance travel becomes physically exhausting and financially burdensome.6,7 Hong Kong official transport policy documents confirm metro, bus and outlying is-land ferry routes exceed ten dollars, elderly passengers and eligible persons with disabilities no longer pay a flat rate of two dollars.8 Instead, they are required to pay 20% of the adult fare, meaning older patients bear extra travel costs for every clinic visit.8 Previous local health service surveys have confirmed that expensive, time-consuming transit directly in-creases appointment default rates, disrupting consistent monitoring of chronic urological conditions and potentially worsening long-term patient outcomes.6,9

Cross-border residents face separate logistical barriers. Border control restrictions implemented during the pandemic severely limited frequent back-and-forth medical trips, and many patients delayed routine urinary symptom reviews for years due to travel complexity and quarantine requirements.10 Even after pandemic restrictions lifted, regular cross-border specialist follow-ups remain inconvenient and costly for this population group.10

Internationally, a substantial body of research published over the past decade has confirmed that virtual telemedicine consultations effectively cut patient travel time, transport fees and indirect work losses for urology outpatient care.3,11–13 However, existing studies are predominantly conducted in North America and Europe, where private motor vehicles form the primary mode of patient travel, and rural service gaps differ vastly from islands and cross-border transit challenges.3,11–13 To date, no consolidated narrative review has collected all available quantitative cost-reduction evidence from teleurology trials and reinterpreted these findings within Hong Kong’s local medical and transport context.

This review addresses this clear regional research gap by systematically retrieving, appraising and synthesizing 11 eligible global primary studies focused on patient travel costs under teleurology models. Beyond evidence summarization, the core original contribution of this work is a custom tiered teleconsultation pathway designed specifically to fit Hong Kong’s public hospital workflow, which can be submitted as a feasibility assessment document to support future digital service expansion by local healthcare administrators. The central research question guiding this narrative synthesis is: Compared with fully in-person urological clinic follow-up, can telemedicine effectively reduce direct travel expenses and indirect opportunity costs for Hong Kong’s urology patients?

Materials and Methods

Literature Search Strategy

Three medical databases were selected for comprehensive retrieval: PubMed, CINAHL Complete and MEDLINE. The search window covered publications released between 1 January 2012 and 31 December 2022, balancing sufficient sample volume while limiting overly outdated research with obsolete telemedicine technology standards. Combined Boolean search logic was applied across title and abstract fields only, to minimize irrelevant low-relevance hits drawn from full-text body paragraphs. The core search string was structured as follows: (urolog*) AND (telemedicine OR telehealth OR virtual clinic OR video consultation) AND (cost OR expense OR travel fee OR transport charge). Wildcard notation urolog* captured all relevant variants including urology, urological and urologist within search results. Separate preliminary keyword tests were conducted for each data-base to adjust term combinations and optimize retrieval yield.

Eligibility and Exclusion Criteria

All retrieved articles were screened against pre-defined inclusion standards before full-text assessment: Original quantitative primary research (cohort, randomized controlled trial, cross-sectional survey); Focused on adult patients receiving urological outpatient care; Telemedicine intervention clearly described as part of routine follow-up; Measurable numerical data on patient travel-related costs or travel time recorded; Full-text articles available in English language.

Exclusion criteria were applied to remove non-compliant records at both title/abstract and full-text screening stages: Systematic reviews, narrative reviews, conference abstracts, editorials and short correspondence; Pediatric urology trials targeting patients under 18 years old; Studies evaluating hospital operational costs without patient-side travel expenditure metrics; Research focused solely on surgical inpatient procedures without outpatient follow-up analysis; Manuscripts with incomplete, unquantified descriptions of travel-related patient burdens.

Study Screening and Quality Appraisal

A standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Figure 1) was constructed to document the full screening workflow, recording total initial database hits, duplicate removals, abstract-level exclusions and final full-text retained articles. A two-stage screening process was completed: first rapid title and abstract filtering, followed by detailed full-text reading for remaining candidate papers.

Figure 1.

PRISMA flow diagram of study selection and inclusion process.

All 11 fully eligible primary studies underwent formal critical appraisal to evaluate internal validity, measurement reliability and generalizability. Two established appraisal frameworks were utilized: the Critical Appraisal Skills Programme (CASP) checklists for randomized controlled trials and cohort studies, alongside the Joanna Briggs Institute (JBI) cross-sectional study appraisal tool for survey-based research.14,15 Key quality markers assessed included clear participant recruitment methods, consistent cost measurement protocols, appropriate control for confounding factors, transparent statistical analysis and complete reporting of study limitations.

A two-tier quality rating was applied based on overall checklist compliance scores:14,15 “Good” represents studies that met over 80% of the appraisal criteria, with clear study design, well-defined outcome measures and low risk of bias. “Acceptable” represents studies that met 60–79% of the appraisal criteria, with minor methodological limitations but sufficiently robust findings for inclusion in narrative synthesis. Studies scoring below 60% were excluded from the final analysis.

Data Synthesis and Analytical Approach

Narrative thematic synthesis was selected as the core analytical method for this review, suitable for aggregating quantitative outcome data across heterogeneous primary trials with slightly different measurement standards. Standardized data extraction tables were created to systematically record each study’s sample size, geographical setting, tele-medicine model, travel cost metrics and key numerical savings outcomes. Four unified thematic categories were inductively generated from consistent outcome variables reported across the literature: travel time savings, direct travel expenditure reduction, travel distance cutbacks and lost work opportunity cost mitigation. Comparative analysis was conducted between Western study travel assumptions and Hong Kong’s local public transit infrastructure to identify critical contextual limitations of existing international evidence.

Ethical Disclosure Statements

This narrative synthesis exclusively analyses previously published peer-reviewed secondary literature and contains no original human participant recruitment, clinical testing or animal research. No Institutional Review Board ethical approval or patient in-formed consent documentation was required for the scope of this study.

Results

Overview of Included Research

A total of 74 records were initially retrieved from the three target databases after combined keyword searching. Duplicate records were first identified and removed via EndNote reference management software, followed by manual cross-checking of titles and author names to eliminate any remaining duplicate entries. Thirty‑six records were eliminated at the title and abstract screening stage, including review-type articles, pediatric-focused urology research and studies with no telemedicine intervention component.

The remaining 38 full-text articles were downloaded and assessed against the pre-specified eligibility criteria. 27 papers were further excluded at full-text review for four main reasons:

• iNo measurable patient travel cost or travel time data reported (11 studies)
• iiIntervention not specific to urological outpatient follow-up (7 studies)
• iiiStudy design not original quantitative primary research (6 studies)
• ivIncomplete or unvalidated outcome data (3 studies)

At the completion of PRISMA screening (Figure 1), 11 original quantitative studies were confirmed as suitable for thematic synthesis (Table 1), consisting of 9 cohort studies (5 retrospective cohort studies and 4 prospective cohort studies), 1 randomized controlled trial and 1 cross-sectional patient satisfaction survey.3,5,11,12,16–22 All 11 included trials were conducted in North America and the United Kingdom. No published teleurology cost research originating from Hong Kong or wider East Asia was identified within the January 2012 to December 2022 search timeframe. The evidence base is entirely drawn from Western healthcare and transport contexts, and does not include more recent post-2022 teleurology studies published after the search cut-off date.

Table 1.

Basic Characteristics of the Included Literature

Authors	Year	Type of Research	Sample Size	Key Findings	Literature Quality
Miah et al3	2019	Prospective cohort	409	The operational cost of virtual clinic and face-to-face clinic were GBP 8250 (USD 11156.5) and GBP 26994 (USD 36504) respectively. Telemedicine saved travel distance for each patient was 3.8 miles.	Good
Croghan et al5	2021	Prospective cohort	736	Each patient living in a rural area avoided average 93.8 miles round‑trip journey, while rural patients who travelled by car achieved an average cost saving of GBP 25.91 (USD 35). Eliminating travel and clinic waiting time also saved each patient an estimated 1.71 hours in total.	Good
Viers et al11	2015	RCT	70	Video visits saved 95 miles of travel distance, 1.6 hours of travel time, USD 48 in travel expenditure and 1 full day of missed work per patient.	Good
Zholudev et al12	2018	Retrospective cohort	400	A total cost savings of telemedicine was USD 124.07 per single encounter. Telemedicine can help patients to save median 58 miles of travel distance, 1.6 hours of travel time, USD 24.62 travel expenses, and USD 24.41 opportunity costs.	Good
Viers et al16	2015	Retrospective cohort	1378	Participants were likely to participate in video visit if travel cost over USD 250, or travel time spent over 0.75 hours, or needed to away from work for over half day.	Good
Turcotte et al17	2022	Prospective cohort	356	Clients were higher satisfaction scores with telemedicine if the travel time is 1–3 hours to hospital.	Good
Shin et al18	2021	Cross‐sectional	187	48.1% clients reported at least 1 hour travelling hours saved and 28.9% saved over USD 25 transportation fees.	Good
Safir et al19	2016	Prospective cohort	150	98% clients preferred tele-consultation for their initial assessment because of transportation-related barriers, for example parking problem (66.7%), traffic jam (61.9%), long travelling hours and distance (59.2%)	Acceptable
Andino et al20	2021	Retrospective cohort	56	Video visit saved travel time and travel cost which is 1.6 hours round trip per visit and USD 47 per visit respectively. Andino et al (2021) estimated USD 149 (half day) to USD 252 (full day) wages were saved if not request day-off.	Good
Demaerschalk et al21	2021	Retrospective cohort	376	Use of video telemedicine for postoperative follow‑up, as an alternative to in‑person clinic attendance, yielded average patient savings of USD 887.8 per visit. The lost wages were USD 177.40 per patient per missed work day.	Good
Chu et al22	2015	Retrospective cohort	97	Telemedicine saved 277 miles of travel distance, 4.8 hours of travel time, USD 67 in travel expenses, and USD 126 in opportunity costs per visit. Over 80% of patients rated their outpatient clinic experience as excellent.	Good

Four Core Cost-Related Thematic Findings

Consistent quantifiable outcomes were extracted from the 11 papers clustered into four distinct patient burden themes, with clear variance in the volume of supporting research evidence for each dimension (Table 2).

Table 2.

Summary of Travel-Related Cost Outcomes Across 11 Included Teleurology Studies

Cost-Related Theme	Number of Studies Reporting (Out of 11)	Proportion of Included Studies	Range of Reported Savings	Key Notes
Travel time savings5,11,12,16–20,22	9	81.8%	0.75–4.8 hours per round-trip consultation	Most widely validated outcome; patients with 1–3 hours of one-way travel show significantly higher satisfaction with virtual visits.
Direct travel expenditure reduction5,11,12,16,18,20–22	8	72.7%	USD 24.62-USD 887.8 per visit	Covers petrol fees, public transit fares and parking charges.
Travel distance reduction3,5,11,12,19,22	6	54.5%	3.8–277 miles per round trip	Calculated based on private vehicle mileage; low applicability to Hong Kong’s ferry-dominated transit system.
Opportunity cost (lost working income)12,16,20–22	5	45.5%	USD 24.41-USD 252 per visit	Weakest evidence base; measurement limited by inconsistent regional minimum wage standards.

Travel time savings (81.8% of all studies, 9 out of 11 studies): This represented the most widely validated benefit of teleurology services. Recorded round-trip time savings per patient consultation ranged from 0.75 hours up to 4.8 hours across Western trial datasets.5,11,12,16–20,22 Multiple surveys additionally confirmed patients with 1–3 hours of one-way hospital travel recorded statistically significantly higher satisfaction scores for virtual follow-up, as lengthy commutes represented the primary source of medical access frustration for rural and remote participants.17,19

Direct travel expenditure reduction (72.7%, 8 out of 11 studies): All eight relevant trials calculated concrete monetary savings on petrol, public transit fares and parking fees for patients choosing video consultations instead of in-person visits.5,11,12,16,18,20–22 Average per-visit savings fell within a band of USD 24.62 to USD 887.8, with variance driven by regional fuel pricing and distance from residential areas to hospital outpatient facilities.5,11,12,16,18,20–22

Travel distance reduction (54.5%, 6 out of 11 studies): Web mapping software was the standard tool used across these six papers to calculate mileage cutbacks, with recorded reductions ranging from 3.8 miles up to 277 miles per patient round trip.3,5,11,12,19,22 This metric translates poorly to islands geography in Hong Kong, where short physical distances are offset by slow ferry transit schedules rather than long driving routes.

Opportunity cost or lost working income (45.5%, 5 out of 11 studies): This was the weakest-supported theme with fewer published quantitative datasets. Studies that measured indirect wage losses estimated savings between USD 24.41 and USD 252 per consultation, corresponding to half or full working days patients avoided taking off work for hospital appointments.12,16,20–22 Several authors noted this metric is frequently omitted from telemedicine evaluation frameworks due to difficulty standardizing local minimum wage baselines across different regions.12,20,21

Regional Limitation of Western Cost Calculation Models

A consistent methodological limitation shared by all 11 included papers is their reliance on private vehicle travel as the baseline patient transport mode. Cost and time calculations are calibrated around petrol prices, driving mileage and roadside parking charges, which do not align with Hong Kong’s dominant public transit ecosystem. The majority of local patients rely on buses, minibuses and inter-island ferries rather than private cars, with separate fare structures, travel timetables and government subsidy exclusions that shift the magnitude of telemedicine’s financial benefit. No existing literature adjusts cost-saving calculations for ferry surcharges or elderly public transport scheme restrictions, creating an evidence gap specific to Hong Kong’s population that this review addresses through contextual comparative discussion.

Discussion

Synthesis of International Teleurology Cost Evidence

The aggregated results from this narrative review provide cross-country support that virtual urological follow-up may alleviate two primary patient burdens: wasted travel time and direct out-of-pocket transit payments. These two dimensions receive consistent statistical support across over 70% of the retrieved primary trials, suggesting a potential replicable advantage of telemedicine over mandatory in-person clinic attendance for stable urinary condition monitoring.5,11,12,16–20,22 However, it is important to note that the tiered consultation pathway proposed later in this paper is a contextual adaptation of this existing evidence and has not been clinically validated or piloted in a Hong Kong public hospital setting.

For Hong Kong’s islands and cross-border patient groups, these global findings carry meaningful practical relevance despite transit model mismatches. Even if per-mile cost savings recorded in Western trials cannot be directly transferred, the core mechanism remains identical: remote consultations eliminate the need for multi-stage, time-consuming trips to urban specialist centres.11,22 Elderly patients with mobility limitations, who face the steepest physical and financial barriers to hospital attendance, stand to gain the largest quality-of-life improvements from structured teleurology pathways.2,6

Current Deficiencies in Hong Kong’s Urological Service Workflow

Under the existing standard consultation model (Figure 2), every new and follow-up urological appointment requires mandatory in-person hospital attendance. No tiered differentiation exists between patients requiring physical examination, imaging or invasive testing and those with stable, low-risk conditions suitable for remote symptom review. This uniform in-person rule creates unnecessary travel burdens for a large subset of patients with controlled chronic urological illnesses who only require routine medication adjustment and symptom discussion without clinical physical assessment. At the time of writing, Hong Kong’s public healthcare system lacked a formal, documented teleurology framework, with pandemic-era virtual services limited exclusively to COVID symptom management rather than specialist chronic disease follow-up. This service gap creates clear room for evidence-based reform supported by the international cost evidence summarized within this review.

Figure 2.

Current pathway of urological consultation.

Proposed Tiered Telemedicine Consultation Pathway for Hong Kong Urology Clinics

As the core practical contribution of this narrative review, this paper proposes a customized two-stage tiered consultation pathway (Figure 3) designed specifically to fit Hong Kong’s public hospital workflow and local patient transit constraints. This framework is built on the international evidence synthesized above, but remains a theoretical operational model. Its clinical effectiveness, actual cost-saving magnitude and real-world uptake in Hong Kong would require formal pilot evaluation prior to widespread service implementation.

Figure 3.

Modified urological consultation pathway.

The pathway is structured as follows:

Initial diagnostic consultation - All new urology patients are required to attend an in-person clinic visit for baseline physical examination, ultrasound imaging and full clinical risk assessment. This stage cannot be replaced by virtual consultation, as specialist physical evaluation forms the foundation of accurate diagnosis and risk stratification.

Eligible remote follow-up stage - After initial in-person assessment, patients meeting three clear pre-set criteria are offered a voluntary choice between virtual telemedicine review or continuing face-to-face follow-up:

• iStable urinary condition with no recent disease deterioration;
• iiNo requirement for physical examination or invasive procedures at the next scheduled review;
• iiiPatient owns compatible digital devices and consents to virtual consultation protocols.

Patients failing to satisfy all three criteria remain scheduled for standard in-person clinic appointments. This tiered design balances clinical safety with patient convenience, directly targeting the travel cost and time burdens highlighted throughout the international literature synthesis. The full pathway flowchart can be submitted to local administrative teams as supporting feasibility evidence for future telehealth pilot rollouts focused on urological outpatient care.

Alignment with Hong Kong Hospital Authority Digital Healthcare Strategic Plan (2022–2027)

The tiered teleurology consultation pathway proposed in this review directly aligns with the four core strategic pillars laid out in the Hospital Authority (HA) five-year strategic plan (2022–2027): delivering Smart Care, building Smart Hospitals, nurturing a skilled digital workforce, and expanding equitable healthcare supply across Hong Kong’s geographic divides.23 A central policy priority of the HA framework is to break the geographical limits of traditional clinic-based care by scaling telemedicine and community remote follow-up services, with the HA Go mobile application and integrated eHealth platforms designated as core delivery channels for virtual patient support.23 At present, HA telehealth implementations do not have standardized, risk-stratified workflow for stable chronic urology patients, despite documented high appointment default rates driven by lengthy ferry and public transit journeys.1,23

This review’s two-stage teleurology model fills this policy implementation gap. The pathway strictly separates mandatory in-person baseline assessments (requiring physical examination) from optional virtual follow-up for low-risk stable patients, fully matching the HA’s official telehealth eligibility principle that remote consultation is only appropriate for patients without demand for on-site clinical testing or invasive intervention. From a public health policy perspective, widespread rollout of this stratified workflow would advance two key HA strategic objectives. First, it reduces avoidable patient travel expenditure and time loss, addressing transport problem for elderly and mobility-limited residents. Second, it optimizes public outpatient capacity by diverting low-complexity routine reviews to virtual channels, freeing in-person clinic slots for new cases and patients re-quiring physical diagnostics, which supports the HA’s sustainability goal of balancing service demand amid constrained clinical manpower.

The HA’s 2025–26 annual operational plans further prioritize iterative refinement of telehealth workflows and targeted pilot schemes for underserved regional patient groups.24 The evidence synthesized within this review, alongside the bespoke urology consultation framework, can serve as a feasible policy reference for HA cluster clinical teams. Current HA telehealth evaluation metrics primarily track consultation volume and patient satisfaction;24 this paper adds a patient-cost economic dimension absent from existing internal service assessments, offering local policymakers quantitative international benchmarks to measure the financial equity gains of expanded virtual urology care.

Notably, the HA digital strategy acknowledges persistent implementation barriers including variable patient digital literacy, fragmented cross-border healthcare access, and lack of specialty-specific telemedicine protocols.23 The recommendations outlined in this review including targeted public education for elderly users and structured clinician telehealth training directly respond to these policy challenges, making the proposed pathway not merely a theoretical workflow but an actionable evidence-based tool aligned with Hong Kong’s long-term public digital healthcare transformation agenda.

Limitations of This Narrative Review

Several key limitations of this synthesis require acknowledgement when interpreting its findings for local policy use. First, all included primary studies are based on Western populations, with no matching Hong Kong empirical datasets integrated into the thematic analysis. Transit cost calculation frameworks used overseas cannot be perfectly extrapolated to Hong Kong’s ferry and public bus network, meaning the exact magnitude of local patient savings remains unquantified without future regional primary research. Second, the review’s search window only covers publications up to the end of 2022, excluding more recent post-pandemic teleurology trials published after this cut-off date. Third, this narrative synthesis does not incorporate clinic-side operational expenditure analysis, focusing solely on patient-level travel costs; institutional administrative and equipment-related savings from virtual clinics are not evaluated within the scope of this work. Finally, only English language articles were retrieved, potentially omitting relevant Asian regional research published in non-English journals that were not indexed within the three selected databases.

Clinical Practitioner and Hospital Service Recommendations

At present, the HA only provides generic COVID telehealth guidelines without standardized risk-stratified workflows for stable urological disorders. This review’s eligibility criteria for virtual visits can be referenced to develop official HA teleurology operation manuals, clarifying which patient groups qualify for remote review and which re-quire mandatory on-site physical assessment.

Hospital clusters should deliver structured e-learning training on virtual consultation operation, patient digital assessment and risk stratification rules outlined in the pro-posed pathway. Training modules can be embedded into existing HA continuous education platforms to improve clinicians’ confidence and compliance with telemedicine eligibility screening.

Medical wards and outpatient lobbies should distribute simplified pamphlets and hold on-site briefings introducing teleurology services. Special support for older residents unfamiliar with digital devices, such as family-assisted registration and clinic volunteer guidance, can lift patient uptake of virtual follow-up and lower appointment default rates caused by long-distance travel.

Future Local Research Recommendations

All included international studies rely on private vehicle travel models incompatible with local ferry and bus transit. Future cross-sectional surveys should measure real-world round-trip ferry or bus expenses, travel duration and lost hourly wages among Hong Kong Island and cross-border urology patients to generate region-specific cost-saving bench-marks. Subsequent systematic or narrative reviews can extend the search cut-off date beyond December 2022 and include non-English indexed Asian medical databases to capture emerging post-pandemic teleurology research conducted in East Asian populations. This review only analyses patient-side travel expenditure without measuring hospital administrative, manpower and equipment costs. Follow-up mixed-method studies should combine patient economic outcomes with institutional operational budgets to deliver full cost-benefit analysis for HA policy-makers.

Conclusion

This narrative review systematically synthesizes quantitative cost outcomes from 11 international teleurology primary studies, confirming remote virtual consultations deliver consistent reductions in patient travel time and direct transport fees, with weaker supporting evidence for lost work opportunity cost mitigation. Western cost evaluation models rely heavily on private vehicle travel assumptions that do not fully translate to Hong Kong’s islands, ferry and cross-border transit environment, creating a clear regional evidence gap addressed by this paper’s contextual comparative discussion.

The tiered telemedicine follow-up pathway proposed exclusively for Hong Kong’s public urology clinics represents the core original output of this synthesis, separating mandatory initial in-person diagnostic visits from eligible virtual routine reviews for stable low-risk patients. This framework provides actionable evidence to support local hospital authorities in expanding specialist telehealth services beyond temporary pandemic response program, reducing appointment default rates and easing the financial and physical travel burdens faced by remote island and cross-border Hong Kong urology patients. Although this study focuses on the public healthcare setting in Hong Kong, the proposed telemedicine consultation pathway serves as a valuable clinical and cost-saving blueprint for other highly urbanized regions with outlying islands or cross-border patient demographics globally. Further local primary research measuring region-specific travel cost metrics is recommended to strengthen future evidence-based digital medical reform in Hong Kong.

Abbreviations

CASP, Critical Appraisal Skills Programme; HA, Hospital Authority; JBI, Joanna Briggs Institute; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, Randomized controlled trial.

Disclosure

The author declares no conflicts of interest relevant to this work.