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Rowe Ferrara M, Chapman SA. Rural Patients' Experiences with Synchronous Video Telehealth in the United States: A Scoping Review. Telemed J E Health 2024; 30:1357-1377. [PMID: 38265694 DOI: 10.1089/tmj.2023.0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Telehealth can help increase rural health care access. To ensure this modality is accessible for rural patients, it is necessary to understand rural patients' experiences with telehealth. Objectives of this scoping review were to explore how rural patients' telehealth experiences have been measured, assess relevant research, and describe rural telehealth patient experiences. Methods: We searched five databases for articles published from 2016 through 2022. Primary research reports assessing rural adult patient experiences with synchronous video telehealth in the United States in any clinical area were included. Data collected pertained to study characteristics and patient experience assessment characteristics and outcomes. Quality of included studies was assessed using the Quality Assessment with Diverse Studies tool. Review findings were presented in a narrative synthesis. Results: There were 740 articles identified for screening, and 24 met review inclusion criteria. Most studies (70%, n = 16) assessed rural telehealth patient experience using questionnaires; studies employed interviews (n = 11) alone or in combination with surveys. The majority of surveys were study developed and not validated. Quantitative patient experience outcomes fell under categories of patient satisfaction, telehealth care characteristics, patient-provider rapport, technology elements, and access. Qualitative themes were most often presented as telehealth benefits or facilitators, and drawbacks or barriers. Conclusions: Available research indicates positive patient experiences with rural telehealth services. However, study weaknesses limit generalizability of findings. Future research should apply established definitions for participant rurality and clearly group samples by rurality. Efforts should be made to use validated telehealth patient experience measures.
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Affiliation(s)
- Meghan Rowe Ferrara
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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2
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Thawani SP, Minen MT, Grossman SN, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Stainman RS, Seixas A, Galetta SL, Balcer LJ, Busis NA. A Comparison of Patients' and Neurologists' Assessments of their Teleneurology Encounter: A Cross-Sectional Analysis. Telemed J E Health 2024; 30:841-849. [PMID: 37624656 DOI: 10.1089/tmj.2023.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Background and Objectives: To better understand patients' and neurologists' assessments of their experiences regarding effectiveness of teleneurology encounters. Methods: Following an audio-video telehealth visit, neurologists asked patients to participate in a survey-based research study about the encounter, and then, the neurologists also recorded their own evaluations. Data were analyzed using standard quantitative and qualitative techniques for dichotomous and ordered-category survey responses in this cross-sectional analysis. Results: The study included unique encounters between 187 patients and 11 general neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of the patients (66.8%, 125/187) were female. One third (33.2%; 62) were patients new to the NYU Langone Health neurology practices. The most common patient chief complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Most patients (94.7%, 177/187) reported that the teleneurology encounter satisfied their needs. Patients and their neurologists agreed that the experience was effective in 91% (162/178) of encounters, regardless of whether the visit was for a new or established patient visit. Discussion: More than 90% of new and established patients and their neurologists agreed that teleneurology encounters were effective despite some limitations of the examination, the occasional need for patient assistance, and technical difficulties. Our results provide further evidence to justify and to expand the clinical use of teleneurology.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mia T Minen
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott N Grossman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Steven Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Nina H Kim
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Elina Zakin
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Arielle M Kurzweil
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Lisena Hasanaj
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Azizi Seixas
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven L Galetta
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Neil A Busis
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
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Kaufman MC, Xian J, Galer PD, Parthasarathy S, Gonzalez AK, McKee JL, Prelack MS, Fitzgerald MP, Helbig I. Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic. Dev Med Child Neurol 2023; 65:406-415. [PMID: 38767061 DOI: 10.1111/dmcn.15406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
AIM To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. METHOD We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. RESULTS We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8; R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8; OR 0.7, 95% CI 0.7-0.8). INTERPRETATION Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.
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Affiliation(s)
- Michael C Kaufman
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Julie Xian
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Peter D Galer
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
| | - Shridhar Parthasarathy
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Alexander K Gonzalez
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jillian L McKee
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Marisa S Prelack
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Mark P Fitzgerald
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Ingo Helbig
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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4
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Thawani SP, Minen MT, Stainman RS, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Galetta SL, Balcer LJ, Busis NA. Neurologists' Evaluations of Experience and Effectiveness of Teleneurology Encounters. Telemed J E Health 2023; 29:442-453. [PMID: 35834603 DOI: 10.1089/tmj.2021.0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: To better understand neurologists' assessments of the experiences and effectiveness of teleneurology encounters. Methods: After completing an audio-video telehealth visit with verbally consenting patients, neurologists recorded their evaluations of the encounter. Data were analyzed using standard quantitative and qualitative techniques. Results: The study included unique encounters between 187 patients and 11 neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of patients (66.8%, 125/187) were female. One third of patients (33.2%; 62) were new patients. The most common patient complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Neurologists reported that they completed a virtual examination that provided enough information for medical decision-making in 94.9% of encounters (169/178, 9 missing responses). Fourteen of 25 examination elements important for medical decision-making could be performed sufficiently during virtual encounters. Examination assistance was needed for 16.4% (30/183) of patients, who were, on average, 17.3 years older than those who did not require assistance (62.9 years vs. 45.6 years, p = 0.0002). In 19.1% (34/178) of encounters, neurologists learned clinically relevant information from seeing patients in their homes. Neurologists' assessments of the effectiveness of encounters were not related to the presence (97.2%, 35/36 effective) or absence (95%, 134/141 effective) of technical difficulties (p = 0.5729) in 177 encounters (10 missing responses). Discussion: Neurologists reported that nearly 95% of teleneurology encounters were effective despite limitations of the virtual examination, occasional need for patient assistance, and technical difficulties.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Mia T Minen
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Steven Friedman
- Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Nina H Kim
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Elina Zakin
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | | | - Lisena Hasanaj
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Steven L Galetta
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Neil A Busis
- Department of Neurology and NYU Langone Health, New York, New York, USA
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5
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Prelack M, Fridinger S, Gonzalez AK, Kaufman MC, Xian J, Galer PD, Craig S, Abend NS, Helbig I. Visits of concern in child neurology telemedicine. Dev Med Child Neurol 2022; 64:1351-1358. [PMID: 35514061 PMCID: PMC9998265 DOI: 10.1111/dmcn.15256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023]
Abstract
AIM To characterize child neurology telemedicine visits flagged as requiring in-person evaluation during the COVID-19 pandemic. METHOD We analyzed 7130 audio-video telemedicine visits between March and November 2020. Visits of concern (VOCs) were defined as telemedicine visits where the clinical scenario necessitated in-person follow-up evaluation sooner than if the visit had been conducted in-person. RESULTS VOCs occurred in 5% (333/7130) of visits for 292 individuals (148 females, 144 males). Providers noted technical challenges more often in VOCs (40%; 133/333) than visits without concern (non-VOCs) (28%; 1922/6797) (p < 0.05). The median age was younger in VOCs (9 years 3 months, interquartile range [IQR] 2 years 0 months-14 years 3 months) than non-VOCs (11 years 3 months, IQR 5 years 10 months-15 years 10 months) (p < 0.05). Median household income was lower for patients with VOCs ($74 K, IQR $55 K-$97 K) compared to non-VOCs ($80 K, IQR $61 K-$100 K) (p < 0.05). Compared with all other race categories, families who self-identified as Black were more likely to have a VOC (odds ratio 1.53, 95% confidence interval 1.21-2.06). Epilepsy and headache represented the highest percentages of VOCs, while neuromuscular disorders and developmental delay had a higher proportion of VOCs than other neurological disorders. INTERPRETATION These findings suggest that telemedicine is an effective platform for most child neurology visits. Younger children and those with neuromuscular disorders or developmental delays are more likely to require in-person evaluation. WHAT THIS PAPER ADDS It is possible to successfully flag patients who need in-person assessment. Providers can manage issues arising during telemedicine in 95% of visits. Visits flagged as concerning were likely unrelated to modality of patient care. Provider concern was independent of technical difficulties for most telehealth visits. Younger age may be correlated with need for in-person assessment.
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Affiliation(s)
- Marisa Prelack
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Sara Fridinger
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Alexander K Gonzalez
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael C Kaufman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie Xian
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter D Galer
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sansanee Craig
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicholas S Abend
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Anesthesia & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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6
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Faheem F, Zafar Z, Razzak A, Kalia JS. Implementing Virtual Care in Neurology - Challenges and Pitfalls. J Cent Nerv Syst Dis 2022; 14:11795735221109745. [PMID: 35795886 PMCID: PMC9252001 DOI: 10.1177/11795735221109745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Virtual care is here to stay. The explosive expansion of telehealth caused by the SARS-CoV-2 pandemic is more than a necessary measure of protection. The key drivers of this transition in healthcare delivery to a virtual setting are changes in patient behavior and expectations and societal attitudes, and prevailing technologies that are impossible to ignore. The younger population - Generation Z - is increasingly connected and mobile-first. We are heading to a world where we expect to see healthcare in general and neurology, in particular, delivered virtually. The medical community should prepare for this overhaul; proper implementation of virtual care from the ground up is the need of the hour. In an era of virtualization, it is up to the medical community to ensure a well-informed patient population, overcome cultural differences and build digital infrastructure with enhanced access and equity in care delivery, especially for the aging neurological patient population, which is not technologically savvy. Virtual care is a continuum of care that needs deeper integration at systematic levels. The design principles of a patient's journey need to be incorporated while simultaneously placing physician satisfaction with a better user experience at the center of implementation. In this paper, we discuss common challenges and pitfalls of virtual care implementation in neurology - logistical, technical, medicolegal, and those faced in incorporating health and medical education into virtual care - intending to provide solutions and strategies.
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Affiliation(s)
| | | | - Aisha Razzak
- University of Texas at Dallas, Richardson, TX, USA
| | - Junaid Siddiq Kalia
- Founder, NeuroCare.AI.,Editor-in-Chief, neurologypocketbook.com.,Founder, Institute of Health Innovation and Education
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Cowan RP, Rapoport AM, Blythe J, Rothrock J, Knievel K, Peretz AM, Ekpo E, Sanjanwala BM, Woldeamanuel YW. Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi‐center study. Headache 2022; 62:870-882. [PMID: 35657603 PMCID: PMC9378575 DOI: 10.1111/head.14324] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
Objective This study assesses the concordance in migraine diagnosis between an online, self‐administered, Computer‐based, Diagnostic Engine (CDE) and semi‐structured interview (SSI) by a headache specialist, both using International Classification of Headache Disorders, 3rd edition (ICHD‐3) criteria. Background Delay in accurate diagnosis is a major barrier to headache care. Accurate computer‐based algorithms may help reduce the need for SSI‐based encounters to arrive at correct ICHD‐3 diagnosis. Methods Between March 2018 and August 2019, adult participants were recruited from three academic headache centers and the community via advertising to our cross‐sectional study. Participants completed two evaluations: phone interview conducted by headache specialists using the SSI and a web‐based expert questionnaire and analytics, CDE. Participants were randomly assigned to either the SSI followed by the web‐based questionnaire or the web‐based questionnaire followed by the SSI. Participants completed protocols a few minutes apart. The concordance in migraine/probable migraine (M/PM) diagnosis between SSI and CDE was measured using Cohen’s kappa statistics. The diagnostic accuracy of CDE was assessed using the SSI as reference standard. Results Of the 276 participants consented, 212 completed both SSI and CDE (study completion rate = 77%; median age = 32 years [interquartile range: 28–40], female:male ratio = 3:1). Concordance in M/PM diagnosis between SSI and CDE was: κ = 0.83 (95% confidence interval [CI]: 0.75–0.91). CDE diagnostic accuracy: sensitivity = 90.1% (118/131), 95% CI: 83.6%–94.6%; specificity = 95.8% (68/71), 95% CI: 88.1%–99.1%. Positive and negative predictive values = 97.0% (95% CI: 91.3%–99.0%) and 86.6% (95% CI: 79.3%–91.5%), respectively, using identified migraine prevalence of 60%. Assuming a general migraine population prevalence of 10%, positive and negative predictive values were 70.3% (95% CI: 43.9%–87.8%) and 98.9% (95% CI: 98.1%–99.3%), respectively. Conclusion The SSI and CDE have excellent concordance in diagnosing M/PM. Positive CDE helps rule in M/PM, through high specificity and positive likelihood ratio. A negative CDE helps rule out M/PM through high sensitivity and low negative likelihood ratio. CDE that mimics SSI logic is a valid tool for migraine diagnosis.
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Affiliation(s)
- Robert P. Cowan
- Division of Headache and Facial Pain, Department of Neurology and Neurological Sciences Stanford University School of Medicine Stanford California USA
| | | | - Jim Blythe
- Information Sciences Institute University of Southern California Los Angeles California USA
| | - John Rothrock
- Neurology The George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Kerry Knievel
- Neurology Barrow Neurological Institute Phoenix Arizona USA
| | - Addie M. Peretz
- Division of Headache and Facial Pain, Department of Neurology and Neurological Sciences Stanford University School of Medicine Stanford California USA
| | - Elizabeth Ekpo
- Neurology University of California Davis Davis California USA
| | - Bharati M. Sanjanwala
- Division of Headache and Facial Pain, Department of Neurology and Neurological Sciences Stanford University School of Medicine Stanford California USA
| | - Yohannes W. Woldeamanuel
- Division of Headache and Facial Pain, Department of Neurology and Neurological Sciences Stanford University School of Medicine Stanford California USA
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8
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Nakornchai T, Conci E, Hensiek A, Brown JWL. Clinician and patient experience of neurology telephone consultations during the COVID-19 pandemic. Postgrad Med J 2022; 98:533-538. [PMID: 37066507 PMCID: PMC8720641 DOI: 10.1136/postgradmedj-2021-141234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Telephone consultations are already employed in specific neurological settings. At Cambridge University Hospitals, the COVID-19 pandemic initially prompted almost all face-to-face appointments to be delivered by telephone, providing a uniquely unselected population to assess. OBJECTIVES We explored patient and clinician experience of telephone consultations; and whether telephone consultations might be preferable for preidentifiable subgroups of patients after the pandemic. METHODS Clinicians delivering neurological consultations converted to telephone between April and July 2020 were invited to complete a questionnaire following each consult (430 respondents) and the corresponding patients were subsequently surveyed (290 respondents). The questionnaires assessed clinician and patient goal achievement (and the reasons for any dissatisfaction). Clinicians also described consultation duration (in comparison to face to face) while patients detailed comparative convenience and preference. RESULTS The majority of clinicians (335/430, 78%) and patients (227/290, 78%) achieved their consultation goals by telephone, particularly during follow-up consultations (clinicians 272/329, 83%, patients 176/216, 81%) and in some disease subgroups (eg, seizures/epilepsy (clinicians 114/122 (93%), patients 71/81 (88%)). 95% of telephone consultations were estimated to take the same or less time than an equivalent face-to-face consultation. Most patients found telephone consultations convenient (69%) with 149/211 (71%) indicating they would like telephone or video consultations to play some role in their future follow-up. CONCLUSION Telephone consultations appear effective, convenient and popular in prespecified subgroups of neurological outpatients. Further work comparing telephone, video and face-to-face consultations across multiple centres is now needed.
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Affiliation(s)
- Tagore Nakornchai
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elena Conci
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anke Hensiek
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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9
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Murphey DK, Anderson ER. The Past, Present, and Future of Tele-EEG. Semin Neurol 2022; 42:31-38. [PMID: 35576928 DOI: 10.1055/s-0041-1742242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Tele-electroencephalogram (EEG) has become more pervasive over the last 20 years due to advances in technology, both independent of and driven by personnel shortages. The professionalization of EEG services has both limited growth and controlled the quality of tele-EEG. Growing data on the conditions that benefit from brain monitoring have informed increased critical care EEG and ambulatory EEG utilization. Guidelines that marshal responsible use of still-limited resources and changes in broadband and billing practices have also shaped the tele-EEG landscape. It is helpful to characterize the drivers of tele-EEG to navigate barriers to sustainable growth and to build dynamic systems that anticipate challenges in any of the domains that expand access and enhance quality of these diagnostic services. We explore the historical factors and current trends in tele-EEG in the United States in this review.
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10
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Saadi A, Mendizabal A, Mejia NI. Teleneurology and Health Disparities. Semin Neurol 2022; 42:60-66. [PMID: 35576930 DOI: 10.1055/s-0041-1742194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The disparate access to, and use of, telemedicine reflects those of in-person health. These disparities are perpetuated as a result of individual, social, and structural factors like low digital literacy, unequal availability of broadband services, and systemic racism. This review focuses on extant literature on disparities in teleneurology, including racial or ethnic disparities, language inequities, and the global context. Understanding social and structural barriers to equitable access to quality teleneurology is critical to addressing and preventing health disparities, ensuring effective and equitable neurological care for all patients.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Adys Mendizabal
- Department of Neurology, University of California Los Angeles, Los Angeles, California
| | - Nicte I Mejia
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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11
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Tropea TF, Fuentes A, Roberts Z, Spindler M, Yuan K, Perrone C, Do D, Jacobs D, Wechsler L. Provider Experience with Teleneurology in an Academic Neurology Department. Telemed J E Health 2022; 28:374-383. [PMID: 34077285 PMCID: PMC9022168 DOI: 10.1089/tmj.2021.0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Teleneurology has become widely adopted during severe acute respiratory syndrome coronavirus 2 pandemic. However, provider impressions about the teleneurology experience are not well described. Methods: A novel questionnaire was developed to collect provider impressions about video teleneurology encounters. All providers in the University of Pennsylvania Health System (UPHS) Neurology Department (N = 162) were asked to complete a questionnaire after each video teleneurology patient encounter between April and August 2020. Individual patient and encounter-level data were extracted from the electronic medical record. Results: One thousand six hundred three surveys were completed by 55 providers (response rate of 10.12%). The history obtained and the ability to connect with the patient were considered the same or better than an in-person visit in almost all encounters. The quality of the physician-patient relationship was good or excellent in 93%, while the overall experience was the same as an in-person visit in 73% of visits and better in 12%. Sixty-eight percent of respondents reported that none of the elements of the neurological examination if performed in person would have changed the assessment and plan. Assessment of the visit as the same or better increased from 83% in April to 89% in July and 95% in August. Headache (91%), multiple sclerosis and neuroimmunology (96%), and movement disorder (89%) providers had the highest proportion of ratings of same or better overall experience and neuromuscular providers the lowest (60%). Conclusions: Provider impressions about the teleneurology history, examination, and provider-patient relationship are favorable in the majority of responses. Important differences emerge between provider specialty and visit characteristics groups.
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Affiliation(s)
- Thomas F. Tropea
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Fuentes
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zachary Roberts
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meredith Spindler
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy Yuan
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Perrone
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Do
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dina Jacobs
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence Wechsler
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to: Lawrence Wechsler, MD, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, 330 S. 9th St, Philadelphia, PA 19107, USA
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12
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Bentivegna E, Tassorelli C, De Icco R, Sances G, Martelletti P. Tele-healthcare in migraine medicine: from diagnosis to monitoring treatment outcomes. Expert Rev Neurother 2022; 22:237-243. [PMID: 35196206 DOI: 10.1080/14737175.2022.2045954] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION : Primary headaches represent a huge cost in terms of decreased productivity and migraine occupies the first position among disabilities in working population. Migraine has a high incidence, disproportionate to the available primary care centres. In most cases, migraine can be managed through the simple and accurate collection of clinical history, which makes it an ideal candidate for tele-healthcare. AREAS COVERED : In this narrative review we retrace the most important scientific evidence regarding use of tele-healthcare in headache medicine. Over the last few years, it has proved to be a valid and useful tool for the management of migraine. Furthermore, current pandemic has imposed a drastic change in the way of thinking and setting up medicine, forcing clinicians and patients to a huge expansion of telemedicine. EXPERT OPINION : We should permanently insert the culture of telemedicine in the headache care not only in academies and scientific societies, but extend it to specialized hospitals for the treatment of headaches. Only by broadening the old book-based strategy, we will be able to open the door to the multidimensional culture of headache medicine. Experts of excellence centres should set an example and pave the way for the rest of the clinicians.
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Affiliation(s)
- Enrico Bentivegna
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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13
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Abstract
The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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14
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Amin CA, Mayela RV, Yamil M, Yazmín RS, Arturo AC, Daniel MR, Lorena ZV, Karla SB, Manuel DR. Satisfaction With Telemedicine Consultation as Follow-Up Visit in Patients with Parkinsonism and Essential Tremor in during the Covid-19 Pandemic. Neurol India 2022; 70:2003-2008. [DOI: 10.4103/0028-3886.359193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Crocker J, Liu K, Smith M, Nakamoto M, Mitchell C, Zhu E, Ma E, Morden FT, Chong A, Van N, Dang N, Borman P, Carrazana E, Viereck J, Liow KK. Early Impact of the COVID-19 Pandemic on Outpatient Neurologic Care in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:6-12. [PMID: 35028589 PMCID: PMC8742305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In March 2020, Hawai'i instituted public health measures to prevent the spread of Coronavirus disease 2019 (COVID-19), including stay-at-home orders, closure of non-essential businesses and parks, use of facial coverings, social distancing, and a mandatory 14-day quarantine for travelers. In response to these measures, Hawai'i Pacific Neuroscience (HPN) modified practice processes to ensure continuity of neurological treatment. A survey of patients was performed to assess the impact of the COVID-19 pandemic and pandemic-related practice processes for quality improvement. Overall, 367 patients seen at HPN between April 22, 2020, and May 18, 2020, were surveyed via telephone. Almost half (49.6%) participated in a telemedicine appointment, with the majority finding it easy to use (87.4%) and as valuable as face-to-face appointments (68.7%). Many (44.5%) patients said they would have missed a health care appointment without the availability of telemedicine, and 47.3% indicated they might prefer to use telemedicine over in-person appointments in the future. Many reported new or worsening mental health problems, including depression (27.6%), anxiety (38.3%), or sleep disturbances (37.4%). A significant number reported worsening of their condition, with 33.1% of patients who experience migraines reporting increased symptom severity or frequency, 45.8% patients with Alzheimer's disease reporting worsened symptoms, 38.5% of patients with Parkinson's disease who had a recent fall, and 50.0% of patients with multiple sclerosis experiencing new or worsened symptoms. Insights from this survey applied to the practice's pandemic-related processes include emphasizing lifestyle modification, screening for changes in mental health, optimizing treatment plans, and continuing the option of telemedicine.
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Affiliation(s)
- Julie Crocker
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Keke Liu
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Maiya Smith
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Max Nakamoto
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Catherine Mitchell
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Ena Zhu
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Enze Ma
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Frances Tiffany Morden
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Ariel Chong
- University of Hawai‘i at Manoa, Honolulu, HI (AC, NV)
| | - Nicholas Van
- University of Hawai‘i at Manoa, Honolulu, HI (AC, NV)
| | - Nong Dang
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Pat Borman
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Enrique Carrazana
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Jason Viereck
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
- Clinical & Translational Research, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JV, KKL)
| | - Kore Kai Liow
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
- Clinical & Translational Research, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JV, KKL)
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16
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Bekkelund SI, Müller KI. One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial. J Med Internet Res 2021; 23:e30151. [PMID: 34898455 PMCID: PMC8713100 DOI: 10.2196/30151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/04/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023] Open
Abstract
Background Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177
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Affiliation(s)
- Svein Ivar Bekkelund
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Kai Ivar Müller
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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17
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Kling SMR, Falco-Walter JJ, Saliba-Gustafsson EA, Garvert DW, Brown-Johnson CG, Miller-Kuhlmann R, Shaw JG, Asch SM, Yang L, Gold CA, Winget M. Patient and Clinician Perspectives of New and Return Ambulatory Teleneurology Visits. Neurol Clin Pract 2021; 11:472-483. [PMID: 34992955 PMCID: PMC8723969 DOI: 10.1212/cpj.0000000000001065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the adoption and perceived utility of video visits for new and return patient encounters in ambulatory neurology subspecialties. METHODS Video visits were launched in an academic, multi-subspecialty, ambulatory neurology clinic in March 2020. Adoption of video visits for new and return patient visits was assessed using clinician-level scheduling data from March 22 to May 16, 2020. Perceived utility of video visits was explored via a clinician survey and semistructured interviews with clinicians and patients/caregivers. Findings were compared across 5 subspecialties and 2 visit types (new vs return). RESULTS Video visits were adopted rapidly; all clinicians (n = 65) integrated video visits into their workflow within the first 6 weeks, and 92% of visits were conducted via video, although this varied by subspecialty. Utility of video visits was higher for return than new patient visits, as indicated by surveyed (n = 48) and interviewed clinicians (n = 30), aligning with adoption patterns. Compared with in-person visits, clinicians believed that it was easier to achieve a similar physical examination, patient-clinician rapport, and perceived quality of care over video for return rather than new patient visits. Of the 25 patients/caregivers interviewed, most were satisfied with the care provided via video, regardless of visit type, with the main limitation being the physical examination. DISCUSSION Teleneurology was robustly adopted for both new and return ambulatory neurology patients during the COVID-19 pandemic. Return patient visits were preferred over new patient visits, but both were feasible. These results provide a foundation for developing targeted guidelines for sustaining teleneurology in ambulatory care.
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Affiliation(s)
- Samantha M R Kling
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Jessica J Falco-Walter
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Erika A Saliba-Gustafsson
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Donn W Garvert
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Cati G Brown-Johnson
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Rebecca Miller-Kuhlmann
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Jonathan G Shaw
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Steven M Asch
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Laurice Yang
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Carl A Gold
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
| | - Marcy Winget
- Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA
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18
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Boisvert-Plante V, Noutsios CD, Perez J, Ingelmo P. The Telemedicine-Based Pediatric Examination of the Neck and Upper Limbs: A Narrative Review. J Pain Res 2021; 14:3173-3192. [PMID: 34675645 PMCID: PMC8519790 DOI: 10.2147/jpr.s336168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
With the COVID-19 pandemic hastening the adoption of telemedicine into clinical practice, it has also prompted an abundance of new literature highlighting its capabilities and limitations. The purpose of this review is to summarize the current state of the literature on telemedicine applied in the context of a musculoskeletal examination of the neck and upper limbs for children 3 to 18 years old. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. General examination components including inspection, guided self-palpation, range of motion, sensory and motor examination, as well as special testing are described. Although the literature is focused mainly on adult populations, we describe how each component of the exam can be reliably incorporated into a virtual appointment specific to pediatric patients. Caregivers are generally needed for most consultations, but certain maneuvers can be self-performed by older children and adolescents alone. There is general feasibility, validity, and substantial reliability in performing most examination components of the upper limbs remotely, except for the shoulder exam. Compared to those made in person, clinical diagnoses established virtually were found to be either the same or similar in most cases, and management decisions also had high agreement. Despite this, there is evidence that some pediatric providers may not be able to collect all the information needed from a telemedicine visit to make a complete clinical assessment. Lastly, currently available smartphone applications measuring joint range of motion were found to have high reliability and validity. This narrative review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase physicians' confidence in incorporating telemedicine into their standard of care.
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Affiliation(s)
| | | | - Jordi Perez
- Alan Edwards Pain Management Unit, Montreal General Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
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19
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Noutsios CD, Boisvert-Plante V, Laberge E, Perez J, Ingelmo P. The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review. J Pain Res 2021; 14:2959-2979. [PMID: 34584449 PMCID: PMC8464344 DOI: 10.2147/jpr.s329173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic has accelerated the transition to virtual healthcare while also prompting an abundance of new literature highlighting telemedicine's capabilities and limitations for various medical applications, notably musculoskeletal examinations. Telemedicine provides an opportunity to deliver timely patient- and family-centred care while maintaining physical distancing and improving access to remote communities. This review aims to narrate the current state of the literature on telemedicine applied in the context of a musculoskeletal examination for children aged 3 to 18 years. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. The general examination components relevant to the back and lumbosacral spine, hip, knee, ankle/foot, and gait are described. These components include inspection, palpation, range of motion, motor, and sensory examination as well as special testing. There is general feasibility, validity, and substantial reliability in performing most examination components, and primary diagnoses established virtually were found to be either the same or similar in the vast majority of cases. Despite the current literature focusing mainly on adult populations, we describe how each aspect of the exam can be reliably incorporated into a virtual appointment specific to the pediatric population. Currently available smartphone-based applications that measure joint range of motion were generally found to have high reliability and validity. Caregivers are needed for most of the consultation, especially in younger children, but select physical exam maneuvers can be self-performed by older children and adolescents alone. By providing an overview of the available smartphone tools as well as the reliability and validity of remote assessments, this review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase providers' confidence in incorporating telemedicine into their practice.
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Affiliation(s)
| | | | - Erika Laberge
- Edward’s Family Interdisciplinary Centre for Pediatric Complex Pain, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
| | - Jordi Perez
- Alan Edwards Pain Management Unit, Montreal General Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Edward’s Family Interdisciplinary Centre for Pediatric Complex Pain, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
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20
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Social determinants do not affect access to specialized epilepsy care in veterans. Epilepsy Behav 2021; 121:108071. [PMID: 34052631 DOI: 10.1016/j.yebeh.2021.108071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/09/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION It is well established that sociodemographic and neighborhood determinants impact access to healthcare. Veterans with epilepsy (VWE) face unique challenges that may limit access to specialized epilepsy care, though institutional initiatives have aimed to minimize disparities. We assessed the extent to which surrogate markers of access to quality care in VWE were impacted by sociodemographic and neighborhood determinants. METHODS The sample included 180 VWE. Surrogate markers included time between initial diagnosis and admission to epilepsy monitoring unit (EMU) (time to referral, TTR), and the number of CT, MRI, and EEGs conducted prior to initial EMU evaluation. Sociodemographic and neighborhood determinants included age, sex, race, education, neighborhood advantage, rural status, distance from home to the nearest VAMC, and number of service connection (SC) conditions. Significant correlations across variables of interest were entered into a linear regression. Group differences between social factors were assessed for early and late TTR groups (based on 1st and 4th quartiles). RESULTS The mean TTR was 12 years (SD ± 13.18). Longer TTR was correlated to older age (p < 0.001) and fewer SC conditions (p = 0.03). None of the other factors were significantly correlated to TTR. Older age significantly predicted longer TTR on regression. The earlier TTR group was younger, had more SC conditions, lived closer to a VAMC, and was more likely to be female. Greater geographic distance was correlated with fewer CT scans (p = 0.01). A greater number of MRIs was correlated with older age (p = 0.04). Younger age (p < 0.01) and greater education (p = 0.01) were correlated with more SC. CONCLUSION Access to epilepsy care among VWE was largely unimpacted by social determinants, with the exception of older age leading to longer TTR. The TTR in VWE was considerably shorter than has been reported in the literature for civilian patients. The Veterans Health Administration model of care may harbor certain advantages in epilepsy treatment.
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21
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Noutsios CD, Boisvert-Plante V, Perez J, Hudon J, Ingelmo P. Telemedicine Applications for the Evaluation of Patients with Non-Acute Headache: A Narrative Review. J Pain Res 2021; 14:1533-1542. [PMID: 34103978 PMCID: PMC8179807 DOI: 10.2147/jpr.s309542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic has spurred a hasty transition to virtual care but also an abundance of new literature highlighting telehealth’s capabilities and limitations for various healthcare applications. In this review, we aim to narrate the current state of the literature on telehealth applied to migraine care. First, telemedicine in the context of non-acute headache management has been shown to produce non-inferior patient outcomes when compared to traditional face-to-face appointments. The assignment of patients to telehealth appointments should be made after referring more urgent cases to dedicated in-person clinics. During the virtual appointment, physicians can ask their patients about the “3 F’s” in order to perform a thorough assessment of their headaches: frequency of headache days, frequency of acute medication usage and functional impairment. Clinical assessment scores that have been studied and deemed feasible for telemedicine, safe and efficient include the HIT-6, VAS and MIDAS scores. Although MIDAS was found to be redundant and inadequate to use on a daily basis, we suggest that it can be useful in periodic remote follow-up appointments. Additionally, several mobile health apps have been studied including Migraine Buddy, Migraine Coach and Migraine Monitor. All of these are appropriate for use in telemedicine when combined with an adequate trial period with Migraine Buddy being rated the highest, as it captures the most detailed clinical picture. High satisfaction rates have been reported for virtual headache management which were shown to be equal to in-person consults. These are based on patients’ perceived increase in convenience due to avoided travel time, less disruption of their daily routine and feeling more comfortable in the environment of their choice. Despite this, limitations such as technological knowledge, access to videoconferencing modalities and having a more impersonal consultation with the physician may hinder some patients from adopting this service.
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Affiliation(s)
| | | | - Jordi Perez
- Alan Edwards Pain Management Unit. Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.,Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Jonathan Hudon
- Alan Edwards Pain Management Unit. Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.,Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada.,Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.,Faculty Lecturer (Clinical), Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Secondary Care, Department of Family Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada.,Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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22
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Solomon DL, Dirlikov B, Shem KL, Elliott CS. The Time Burden of Specialty Clinic Visits in Persons With Neurologic Disease: A Case for Universal Telemedicine Coverage. Front Neurol 2021; 12:559024. [PMID: 34017297 PMCID: PMC8130896 DOI: 10.3389/fneur.2021.559024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/31/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: Those with chronic neurologic disorders are often burdened not only by the condition itself but also an increased need for subspecialty medical care. This may require long distance travel, while even small distances can be a hardship secondary to impaired mobility and transportation. We sought to examine the burden of time associated with clinical visits for those with chronic neurologic disorders and their family/caregivers. These topics are discussed as an argument to support universal coverage for telemedicine in this population. Design: Cohort Study. Setting: Specialty clinic at community hospital. Participants: 208 unique patients with chronic neurologic disability at physical medicine and rehabilitation or neurourology clinic over a 3-month period. Main Outcome Measures: Patient survey on commute distance, time, difficulties, and need for caregiver assistance to attend visits. Results: Approximately 40% of patients were covered by Medicare. Many patients (42%) perceived it difficult to attend their clinic visit with transportation difficulties, commute time, and changes to their daily schedule being the most commonly cited reasons. Most patients (75%) lived within 25 miles of our clinics and experienced an average commute time of 79.4 min, though 10% required 3 h or more. Additional family/caregiver assistance was required for 76% of patients, which resulted in an inclusive average commute time of 138.2 min per patient. Conclusion: Chronically neurologically-disabled patients and their caregivers may be burdened by the commute to outpatient appointments. To minimize this burden, increased emphasis on telemedicine coverage for those with chronic neurologic disability should be considered by all payors.
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Affiliation(s)
- Daniel L Solomon
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Kazuko L Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Christopher S Elliott
- Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, United States.,Department of Urology, Stanford University School of Medicine, Stanford, CA, United States
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23
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Smith M, Nakamoto M, Crocker J, Tiffany Morden F, Liu K, Ma E, Chong A, Van N, Vajjala V, Carrazana E, Viereck J, Liow K. Early impact of the COVID-19 pandemic on outpatient migraine care in Hawaii: Results of a quality improvement survey. Headache 2020; 61:149-156. [PMID: 33316097 DOI: 10.1111/head.14030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A survey was implemented for early assessment of pandemic-related practice processes and quality improvement (QI). BACKGROUND In response to the public health measures in Hawaii to curtail the coronavirus 2019 pandemic, Hawaii Pacific Neuroscience (HPN) adapted their patient care to ensure continuity of neurological treatment. METHODS The telephone survey was conducted on patients seen at HPN during the period of April 22, 2020-May 18, 2020 to address four areas related to patients' outpatient experience: delivery of care, general well-being, experience with telemedicine, and disease-specific questions. RESULTS A total of 928 patients were contacted of which 429 (46.2%) patients responded and 367 (85.5%) agreed to participate. A total of 133 patients with migraine and 234 patients with other neurological conditions provided responses. Our migraine patients' survey responses suggest that their well-being was disproportionately negatively affected by the pandemic. Survey respondents with migraine were significantly more likely than their non-migraine peers to report worsening anxiety and sleep problems [62/132 (47.0%) vs. 78/234 (33.3%), χ2 = 6.64, p = 0.010, and 64/132 (48.5%) vs. 73/234 (31.2%), χ2 = 10.77, p = 0.001]; migraine patients also reported worsening of depression as a result of the pandemic more than patients with other diagnoses, though this was not statistically significant [44/132 (33.3%) vs. 57/234 (24.4%), χ2 = 3.40, p = 0.065]. In regard to access to healthcare, significantly more migraine patients reported running out of medications than those with other diagnoses [20/133 (15.0%) vs. 18/234 (7.7%), χ2 = 4.93, p = 0.026]. More avoided seeking medical help for new health problems because of the pandemic [30/133 (22.6%) vs. 30/234 (12.8%), χ2 = 5.88, p = 0.015]. Migraine patients were also significantly impacted economically by the pandemic; 43/132 (32.4%) of migraine patients reported losing their jobs as the result of the pandemic versus 34/234 (14.5%) of their peers (χ2 = 11.20, p < 0.001). An increase in headache severity or frequency was reported in 39/118 (33.1%) of respondents and 19/118 (16.1%) reported to using more abortive therapy than usual. Telemedicine was well received by almost all patients who took advantage of the option. Most of those patients found telemedicine to be easy to use and as valuable as an in-person visit. Migraine patients indicated with more frequency that without the telemedicine option, they would have missed their medical appointments [37/68 (54.4%) vs. 56/144 (38.6%), χ2 = 4.31, p = 0.038]; a majority would prefer or consider telemedicine for future appointments over in-person visits. CONCLUSIONS Insights gained from this QI survey to the practice's new pandemic-related processes include stressing lifestyle modification, optimizing treatment plans, and continuing the option of telemedicine.
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Affiliation(s)
- Maiya Smith
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Max Nakamoto
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Julie Crocker
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | | | - Keke Liu
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Enze Ma
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Ariel Chong
- Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Nicholas Van
- Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Vimala Vajjala
- Headache & Facial Pain Center, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Enrique Carrazana
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Jason Viereck
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Kore Liow
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
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24
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Saliba-Gustafsson EA, Miller-Kuhlmann R, Kling SMR, Garvert DW, Brown-Johnson CG, Lestoquoy AS, Verano MR, Yang L, Falco-Walter J, Shaw JG, Asch SM, Gold CA, Winget M. Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation. J Med Internet Res 2020; 22:e24328. [PMID: 33245699 PMCID: PMC7732357 DOI: 10.2196/24328] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology's ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. OBJECTIVE To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. METHODS Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. RESULTS Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient's technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. CONCLUSIONS Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.
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Affiliation(s)
- Erika A Saliba-Gustafsson
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Rebecca Miller-Kuhlmann
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Samantha M R Kling
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Donn W Garvert
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Anna Sophia Lestoquoy
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Mae-Richelle Verano
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Laurice Yang
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jessica Falco-Walter
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jonathan G Shaw
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Steven M Asch
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Marcy Winget
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
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25
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Constanzo F, Aracena-Sherck P, Peña L, Marrugo M, Gonzalez J, Vergara G, Alvarado C. Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano-Chile. Front Neurol 2020; 11:595577. [PMID: 33329347 PMCID: PMC7711163 DOI: 10.3389/fneur.2020.595577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Chile has a shortage of medical experts, including neurologists. The remote neurology program at Las Higueras Hospital in Talcahuano (HHT) was implemented in 2015 to decrease the number of patients waiting for their first appointment. Methods: This retrospective study analyzed a cohort of 2,904 ambulatory patients evaluated in the teleneurology program at the HHT between 2015 and 2019 who were referred from 16 primary and 3 tertiary healthcare centers. Results: Out of the 2,904 patients included in the study, 1,020 patients (35%) were male, and 1,884 (65%) were female. In total, 1,346 (46.0%) patients were under 60 years old (408 male and 938 female), and 1,558 (54%) were over 60 years old (612 male and 946 female). The patients were referred to a neurologist in the teleneurology program from different primary healthcare centers (93.5%) and tertiary healthcare centers (6.5%). The most common diseases diagnosed through teleneurology were, in decreasing order, headache (29.4%), Alzheimer's disease and other dementias (15.9%), and epilepsy (11.4%). From July 2018, we analyzed the patients' destination after the first teleneurology consultation. In the cohort of 634 patients who had their first consultation via the teleneurology program, 547 (86.3%) were instructed to continue follow-up via telemedicine. Conclusions: Data from this study show, for the first time in Chile, the significant contribution of the teleneurology program at the HHT to the diagnosis of a broad range of diseases in a substantial number of patients referred from primary and tertiary healthcare centers.
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Affiliation(s)
- Freddy Constanzo
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Paula Aracena-Sherck
- Department of Science, School of Medicine and Science, Universidad San Sebastián, Concepción, Chile
| | - Lorena Peña
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Mery Marrugo
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Jonathan Gonzalez
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Gerardo Vergara
- Unit of Teleprocesses, Hospital Las Higueras, Talcahuano, Chile
| | - Cristóbal Alvarado
- Department of Science, School of Medicine and Science, Universidad San Sebastián, Concepción, Chile
- Department of Basic Sciences, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
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26
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Al Kasab S, Almallouhi E, Holmstedt CA. Optimizing the Use Of Teleneurology During the COVID-19 Pandemic. Telemed J E Health 2020; 26:1197-1198. [DOI: 10.1089/tmj.2020.0109] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sami Al Kasab
- Department of Neurology and Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eyad Almallouhi
- Department of Neurology and Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christine A. Holmstedt
- Department of Neurology and Medical University of South Carolina, Charleston, South Carolina, USA
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27
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Sattar S, Kuperman R. Telehealth in pediatric epilepsy care: A rapid transition during the COVID-19 pandemic. Epilepsy Behav 2020; 111:107282. [PMID: 32759065 PMCID: PMC7386847 DOI: 10.1016/j.yebeh.2020.107282] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
Telehealth's first literature reference is an article in 1879 in the Lancet about using the telephone to reduce unnecessary office visits (Institute of Medicine & Board on Health Care Services, 2012). However, providers have been slow to adopt telehealth into their clinical practice secondary to barriers such as cost and reimbursement (Kane and Gillis, 2018) [2]. The advent of shelter in place orders combined with the ongoing need defined by the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma "for all Americans, and particularly vulnerable populations who are at heightened risk, to be able to access their providers" has resulted in the rapid implementation of telehealth across multiple specialties. The goal of this paper is to provide a practical framework for translating quality care in epilepsy as defined by the American Academy of Neurology (AAN) guidelines into a virtual care environment. We will also discuss the use and limitations of point of care testing in epilepsy management.
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Affiliation(s)
- Shifteh Sattar
- University of California, San Diego, Comprehensive Epilepsy Center, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, United States of America.
| | - Rachel Kuperman
- Eysz, Inc., 107 Sandringham Road, Piedmont, CA 94611, United States of America.
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28
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Young NP, Burkholder DB, Philpot LM, McKie PM, Ebbert JO. Synchronous neurology–primary care collaboration in a medical home. Neurol Clin Pract 2020; 10:388-395. [DOI: 10.1212/cpj.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022]
Abstract
BackgroundSynchronous collaboration as defined by a simultaneous encounter between primary care providers (PCPs), patients, and neurologists may improve access to neurologic expertise, care value, and satisfaction of PCPs and patients. We examined a series of synchronous collaborations and report outcomes, PCP satisfaction, downstream utilization, and illustrative case examples.MethodsWithin an outpatient collaborative primary care–neurology care model, we implemented synchronous video consultations from a central hub to satellite clinics while increasing availability of synchronous telephone and face-to-face collaboration. PCP experience was assessed by a postcollaboration survey. Individual cases were summarized. Clinical and utilization outcomes were assessed by a neurologist immediately after and by follow-up chart review.ResultsA total of 58 total synchronous collaborations were performed: 30 by telephone (52%), 18 face to face (31%), and 10 by video (17%) over 27 clinic half-days. The most frequent outcomes as assessed by the neurologist were reassurance of the PCP (23/58; 40%) and patient (22/59; 38%), and the neurologist changed the treatment plan (23/58; 40%). A subsequent face-to-face consultation was completed in 15% (6/58) of patients initially assessed by telephone or video. Test utilization was avoided in 40% (23/58). Unintended utilization occurred 9% (5/58). Most PCPs were very satisfied with the ease of access, quality of care, and reported high likelihood of subsequent use. PCPs perceived similar or less time spent during synchronous vs asynchronous collaboration and neurologist usually altered the testing (87.8%) and treatment plan (95.2%).ConclusionsSynchronous collaboration between neurologists and PCPs may improve timely access to neurologic expertise, downstream utilization, and PCP satisfaction.
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29
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Vilendrer S, Patel B, Chadwick W, Hwa M, Asch S, Pageler N, Ramdeo R, Saliba-Gustafsson EA, Strong P, Sharp C. Rapid Deployment of Inpatient Telemedicine In Response to COVID-19 Across Three Health Systems. J Am Med Inform Assoc 2020; 27:1102-1109. [PMID: 32495830 PMCID: PMC7314045 DOI: 10.1093/jamia/ocaa077] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To reduce pathogen exposure, conserve personal protective equipment, and facilitate health care personnel work participation in the setting of the COVID-19 pandemic, three affiliated institutions rapidly and independently deployed inpatient telemedicine programs during March 2020. We describe key features and early learnings of these programs in the hospital setting. METHODS Relevant clinical and operational leadership from an academic medical center, pediatric teaching hospital, and safety net county health system met to share learnings shortly after deploying inpatient telemedicine. A summative analysis of their learnings was re-circulated for approval. RESULTS All three institutions faced pressure to urgently standup new telemedicine systems while still maintaining secure information exchange. Differences across patient demographics and technological capabilities led to variation in solution design, though key technical considerations were similar. Rapid deployment in each system relied on readily available consumer-grade technology, given the existing familiarity to patients and clinicians and minimal infrastructure investment. Preliminary data from the academic medical center over one month suggested positive adoption with 631 inpatient video calls lasting an average (standard deviation) of 16.5 minutes (19.6) based on inclusion criteria. DISCUSSION The threat of an imminent surge of COVID-19 patients drove three institutions to rapidly develop inpatient telemedicine solutions. Concurrently, federal and state regulators temporarily relaxed restrictions that would have previously limited these efforts. Strategic direction from executive leadership, leveraging off-the-shelf hardware, vendor engagement, and clinical workflow integration facilitated rapid deployment. CONCLUSION The rapid deployment of inpatient telemedicine is feasible across diverse settings as a response to the COVID-19 pandemic.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Birju Patel
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Whitney Chadwick
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine & Information Services Department, Stanford Children's Health
| | - Michael Hwa
- Department of Medicine, County of Santa Clara Health System, 751 S. Bascom Ave, San Jose, CA 95128, USA
| | - Steven Asch
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.,VA Center for Innovation to Implementation, 795 Willow, Menlo Park, CA 94025, USA
| | - Natalie Pageler
- Division of Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine & Information Services Department, Stanford Children's Health
| | - Rajiv Ramdeo
- Technology and Digital Solutions, Stanford Medicine, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | | | - Philip Strong
- Administration, County of Santa Clara Health System, 751 S. Bascom Ave, San Jose, CA 95128, USA
| | - Christopher Sharp
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
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30
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Yang L, Brown-Johnson CG, Miller-Kuhlmann R, Kling SMR, Saliba-Gustafsson EA, Shaw JG, Gold CA, Winget M. Accelerated launch of video visits in ambulatory neurology during COVID-19: Key lessons from the Stanford experience. Neurology 2020; 95:305-311. [PMID: 32611634 DOI: 10.1212/wnl.0000000000010015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic has rapidly moved telemedicine from discretionary to necessary. Here, we describe how the Stanford Neurology Department (1) rapidly adapted to the COVID-19 pandemic, resulting in over 1,000 video visits within 4 weeks, and (2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to equipment/software, provider engagement, workflow/triage, and training. On reflection, the key drivers of our success were provider engagement and dedicated support from a physician champion, who plays a critical role understanding stakeholder needs. Before COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated postpandemic era.
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Affiliation(s)
- Laurice Yang
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA.
| | - Cati G Brown-Johnson
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Rebecca Miller-Kuhlmann
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Samantha M R Kling
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Erika A Saliba-Gustafsson
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Jonathan G Shaw
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Carl A Gold
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Marcy Winget
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
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Ross L, Bena J, Bermel R, McCarter L, Ahmed Z, Goforth H, Cherian N, Kriegler J, Estemalik E, Stanton M, Rasmussen P, Fernandez HH, Najm I, McGinley M. Implementation and Patient Experience of Outpatient Teleneurology. Telemed J E Health 2020; 27:323-329. [PMID: 32584654 DOI: 10.1089/tmj.2020.0032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Teleneurology has been well described for acute stroke, but outpatient use has been limited. At home, virtual visits have the potential to improve access to neurological care. Introduction: This study reports on the use of a personal device videoconferencing platform for outpatient neurologic follow-up visits. Materials and Methods: This is a cross-sectional study that identified all virtual neurologic follow-up visits completed by patients ≥18 years at a single institution over 4 years. Virtual visits were conducted by personal smartphone or computer via videoconferencing with a provider. Patients were asked to rate their overall experience with the visit and provider (five-point scale). Travel distance from the institution was calculated using patient's home addresses. Results: Three thousand nine hundred thirteen patients completed 5,581 virtual visits during the study (mean age 49.4 ± 17.0 years, 58.7% female). Number of virtual visits increased from 30 in year 1 to 4,468 in year 4. Virtual visits were completed in all outpatient neurologic subspecialties. A total of 30.1% of patients were local (<50 miles), 25.9% were near regional (50-150 miles), 21.7% were far regional (151-270 miles), and 22.2% were remote (>270 miles). A distance of 1,327,128 miles of travel was prevented across the 5,581 visits. On average, patients rated their overall virtual visit experience 4.7/5 ± 0.89 and rated their provider 4.9/5 ± 0.48. Discussion: Virtual visits prevented a substantial amount of travel and resulted in high patient satisfaction. The sizable proportion of local patients may indicate that teleneurology provides important access for reasons beyond travel distance. Conclusion: This study demonstrates the feasibility of implementing outpatient teleneurology services.
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Affiliation(s)
| | - James Bena
- The Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | | | | | | | - Imad Najm
- The Cleveland Clinic, Cleveland, Ohio, USA
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Rametta SC, Fridinger SE, Gonzalez AK, Xian J, Galer PD, Kaufman M, Prelack MS, Sharif U, Fitzgerald MP, Melamed SE, Malcolm MP, Kessler SK, Stephenson DJ, Banwell BL, Abend NS, Helbig I. Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic. Neurology 2020; 95:e1257-e1266. [PMID: 32518152 PMCID: PMC7538222 DOI: 10.1212/wnl.0000000000010010] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the rapid implementation of child neurology telehealth outpatient care with the onset of the coronavirus disease 2019 (COVID-19) pandemic in March 2020. Methods This was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters, including 2,093 audio-video telemedicine and 496 scheduled telephone encounters, between October 1, 2019 and April 24, 2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers. Results There were no differences in patient age and major ICD-10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1,200 of 1,286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1,144 of 1,286) of encounters. Technical challenges were reported in 40% (519 of 1,314) of encounters. In-person assessment was considered warranted after 5% (65 of 1,285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187 of 217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent among patients in racial or ethnic minority groups. Conclusions We effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest that telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine use.
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Affiliation(s)
- Salvatore C Rametta
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sara E Fridinger
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Alexander K Gonzalez
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Julie Xian
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Peter D Galer
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael Kaufman
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Marisa S Prelack
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Uzma Sharif
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mark P Fitzgerald
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Susan E Melamed
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Marissa P Malcolm
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sudha Kilaru Kessler
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Donna J Stephenson
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Brenda L Banwell
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Nicholas S Abend
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ingo Helbig
- From the Division of Neurology (S.C.R., S.E.F., A.K.G., J.X., P.D.G., M.K., M.S.P., U.S., M.P.F., S.E.M., M.P.M., S.K.K., D.J.S.., B.L.B., N.S.A., I.H.), Department of Biomedical and Health Informatics (A.K.G., J.X., P.D.G., M.K., I.H.), and The Epilepsy NeuroGenetics Initiative (A.K.G., J.X., P.D.G., M.K., M.P.F., S.K.K., N.S.A., I.H.), Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics (S.C.R., S.E.F., M.S.P., M.P.F., S.K.K., N.S.A., I.H.), Department of Biostatistics, Epidemiology and Informatics (N.S.A.), and Department of Anesthesia & Critical Care (N.S.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia.
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Góngora Alonso S, Fumero Vargas G, Morón Nozaleda L, Sainz de Abajo B, de la Torre Díez I, Franco M. Usability Analysis of a System for Cognitive Rehabilitation, "Gradior", in a Spanish Region. Telemed J E Health 2019; 26:671-682. [PMID: 31545150 DOI: 10.1089/tmj.2019.0084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The main aim of our research is to assess the use, satisfaction, and pedagogy of software for neuropsychological rehabilitation by computer, called "Gradior™," to obtain relevant information on the impact of information and communications technology on people with severe and prolonged mental illness. Methods: To evaluate the usability and satisfaction standards, the questionnaire "Usability survey on the use of the cognitive rehabilitation and assessment program by computer" was completed by 83 patients of the Rodríguez Chamorro Hospital. Results: The results of the study show that Gradior has 81.2% acceptance and 83.7% general assessment. This indicates that those who responded to the survey consider that the Gradior program improves cognitive functions and abilities in patients with severe and prolonged mental illness and therefore their quality of life. Conclusion: This research is oriented toward professionals of the Health Area and Systems Engineers, who develop software for neuropsychological rehabilitation with neurocognitive deficit. The purpose is to make the learning process more effective among the people who use it and to improve usability for specific groups. We hope that the reading of the work contributes to the activities, techniques and materials planned are in accordance with the needs of the population affected with cognitive disorders.
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Affiliation(s)
- Susel Góngora Alonso
- Department of Signal Theory and Communications, and Telematics Engineering University of Valladolid, Valladolid, Spain
| | | | | | - Beatriz Sainz de Abajo
- Department of Signal Theory and Communications, and Telematics Engineering University of Valladolid, Valladolid, Spain
| | - Isabel de la Torre Díez
- Department of Signal Theory and Communications, and Telematics Engineering University of Valladolid, Valladolid, Spain
| | - Manuel Franco
- Department of Psychiatry Service and Mental Health, Hospital Zamora, Zamora, Spain
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Dayal P, Chang CH, Benko WS, Ulmer AM, Crossen SS, Pollock BH, Hoch JS, Kissee JL, Warner L, Marcin JP. Appointment completion in pediatric neurology telemedicine clinics serving underserved patients. Neurol Clin Pract 2019; 9:314-321. [PMID: 31583186 DOI: 10.1212/cpj.0000000000000649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/04/2019] [Indexed: 11/15/2022]
Abstract
Background To determine whether telemedicine improves access to outpatient neurology care for underserved patients, we compared appointment completion between urban, in-person clinics and telemedicine clinics held in rural and underserved communities where neurology consultations are provided remotely. Methods In this retrospective study, we identified patients scheduled for outpatient care from UCDH pediatric neurologists between January 1, 2009, and July 31, 2017, in person and by telemedicine. Demographic and clinical variables were abstracted from electronic medical records. We evaluated the association between consultation modality and visit completion in overall and matched samples using hierarchical multivariable logistic regression. Results We analyzed 13,311 in-person appointments by 3,831 patients and 1,158 telemedicine appointments by 381 patients. The average travel time to the site of care was 45.8 ± 52.1 minutes for the in-person cohort and 22.3 ± 22.7 minutes for the telemedicine cohort. Telemedicine sites were located at an average travel time of 217.1 ± 114.8 minutes from UCDH. Telemedicine patients were more likely to have nonprivate insurance, lower education, and lower household income. They had different diagnoses and fewer complex chronic conditions. Telemedicine visits were more likely to be completed than either "cancelled" or missed ("no show") compared with in-person visits (OR 1.57, 95% CI: 1.34-1.83; OR 1.66, 95% CI: 1.31-2.10 matched on travel time to the site of care; OR 2.22, 95% CI: 1.66-2.98 matched on travel time to UCDH). Conclusions The use of telemedicine for outpatient pediatric neurology visits has high odds of completion and can serve as an equal adjunct to in-person clinic visits.
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Affiliation(s)
- Parul Dayal
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Celia H Chang
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - William S Benko
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Aaron M Ulmer
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Stephanie S Crossen
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Brad H Pollock
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Jeffrey S Hoch
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Jamie L Kissee
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Leslie Warner
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - James P Marcin
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
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Patel UK, Malik P, DeMasi M, Lunagariya A, Jani VB. Multidisciplinary Approach and Outcomes of Tele-neurology: A Review. Cureus 2019; 11:e4410. [PMID: 31205830 PMCID: PMC6561521 DOI: 10.7759/cureus.4410] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In rural and underserved areas, there are restrictions in healthcare due to the lack of availability of neurologists; patients have to travel long distances to receive the required care. Considering the fact that neurological conditions have large mortality and disability rates, there is a need for innovative services like tele-neurology. It is an important tool in improving the health and quality of life by using different ways of communication between neurologists and patients, or neurologists and other providers. We examine the current types of facilities available in tele-neurology, as well as outcomes, barriers, limitations, legal litigations, and the multidisciplinary nature based on prior studies. We have also suggested recommendations for the future of tele-neurology including effective-accessibility and inexpensive-utilization in developing countries. There are various tele-health programs created by The Veterans Health Administration including a clinical video tele-health (CVT) system. This system allows direct patient care of veterans by neurologists. The University of South Carolina implemented a web-based tele-stroke program in which acute ischemic stroke patients were treated in the Emergency Department (ED) of rural hospitals by neurologists, after consulting with rural ED physicians. With growing technology and popularity of tele-neurology, there are now international collaborative efforts in tele-medicine that are looking to be adapted to tele-neurology. Thus, tele-neurology can provide quality neurological care with patient satisfaction, as well as time and cost savings. The tele-stroke group established by TRUST-tPA trial (Therapeutic Trial Evaluating Efficacy of Telemedicine (TELESTROKE) of Patients With Acute Stroke) has 10 community hospital-emergency rooms that were connected to a stroke center. It was found that tele-stroke is appropriate in places where there is no way for a patient to access a stroke unit within a 4.5-hour time window. Like other tele-neurology subtypes, tele-epilepsy and pediatric tele-neurology also offer more follow-up care to people of remote areas which have limited access. There are other subtypes like mental health, chronic neurological care, and hospitalist which are very effective in improving outcome and quality of life of people living in remote areas. Tele-neurology has effectively reduced travel costs and times; there is high patient satisfaction and reduced disparity for general and specialized neurological care. But there are certain limitations like large equipment costs, certain bandwidth requirement, and trained staff to use the equipment. Transmission of patient information using public internet raises the concern of legality. There should be sufficient encryption to satisfy the Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure patient confidentiality and safety of personal data. The adaptation of tele-neurology is a powerful and innovative way to enhance healthcare in areas with a shortage of specialists. Implementation of this tool is limited due to cost burden, lack of expertise to implement necessary technology, legal litigations, and suitable financial and professional incentives for the users. This review focuses on the trajectory of utilization and the issues to be addressed in order to provide the full benefits of tele-neurology to undeserved communities in the future.
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Affiliation(s)
- Urvish K Patel
- Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Preeti Malik
- Pediatrics, The Children's Hospital at Montefiore, Bronx, USA
| | - Matthew DeMasi
- Internal Medicine, Albert Einstein College of Medicine, Bronx, USA
| | | | - Vishal B Jani
- Neurology, Creighton University School of Medicine, Omaha, USA
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