Background The adoption of teleconsultation for outpatient neurology services was limited until the onset of the COVID-19 pandemic which forced many outpatient neurology services to rapidly switch to virtual models. However, it remains unclear how this change has impacted patients’ and clinicians’ perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients’ and clinicians’ experiences of outpatient teleconsultation services during COVID-19. Methods Arksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health Organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’ perception of teleconsultation services. Results A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients’ and clinicians’ experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support. Conclusions Our findings identified six key service process factors affecting the patients’ and clinicians’ teleconsultation experiences in outpatient neurology services. The need for improvement of triage process and standardizing administrative virtual care pathway are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID era. More research is needed to assess outpatient neurology teleconsultation service quality from patients’ and clinicians’ perspectives.

Purpose: Cardiovascular rehabilitation programs (CRPs) are effective in secondary stroke prevention, yet the enrollment rate is suboptimal. This study aims to identify demographic and clinical factors and patient-reported reasons for non-enrollment in a center-based outpatient CRP among patients with transient ischemic attack (TIA) or mild stroke. Methods: This mixed-method retrospective chart review was conducted in an outpatient CRP affiliated with a tertiary care hospital in Canada from January 2009 to October 2017. A total of 621 patients with TIA or mild stroke were included. Multiple logistic regression was used to determine the relationship between demographic and clinical predictors with non-enrollment. A thematic analysis of multidisciplinary progress notes was done for the non-enrollment subgroup of patients to understand the patient-reported reasons. Results: The non-enrollment rate was 42%. Travel distance to CRP (OR = 1.024; 95% CI, 1.010-1.038), age (OR = 1.023; 95% CI, 1.004-1.042), and current smoking status (OR = 1.935; 95% CI, 1.230-3.042) were associated with non-enrollment. The patient-reported reasons for non-enrollment were occurrence of new medical events and comorbidities, their perceptions of health and CRP, transportation, work/time conflict, and distance. Conclusions: This study found that patients with TIA or mild stroke who were older, lived farther from the CRP center, or were current smokers were less likely to enroll in a CRP. The present findings may help clinicians identify patients unlikely to enroll in a CRP and allow the implementation of interventions focused on health education and physical activity to improve enrollment. Future research should validate these factors in multiple settings using prospective mixed methods so that interventions can be developed to address non-enrollment in the CRP.

BackgroundPrior to the COVID-19 outbreak, the adoption of teleconsultation for outpatient neurology services was limited. Since the COVID-19 pandemic, many outpatient neurology services have rapidly switched to teleconsultation worldwide. However, it remains unclear how this change has impacted patients' and clinicians' perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients' and clinicians' experiences of outpatient teleconsultation services during COVID-19.MethodsArksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’’ perception of teleconsultation services. Results A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients' and clinicians' experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support. Conclusions Our findings identified six key service process factors affecting the patients' and clinicians' teleconsultation experiences in outpatient neurology services. The need for a new triage system and standardizing administrative virtual care workflow are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID. More research is needed to assess outpatient neurology teleconsultation service quality from patients' and clinicians' perspectives.

BACKGROUND Ontario stroke prevention clinics held primarily in-person visits prior to COVID-19, then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient satisfaction. OBJECTIVE This study sought to understand patients' satisfaction with Ontario stroke prevention clinics' rapid shift to a home-based teleconsultation delivery model used during COVID-19. The research question explored explanatory factors affecting patient satisfaction. METHODS Utilizing a cross-sectional service performance (SERVPERF) model, we surveyed patients who received telephone or video consultations at one of two Ontario stroke prevention clinics in 2021. This survey included closed and open-ended questions. We employed logistic regression and qualitative content analysis to understand factors affecting patients’ satisfaction with the quality of home-based teleconsultation services. RESULTS The overall response rate for the online survey was 37.2 % (128/344). The quantitative analysis was based on 110 responses, while the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (P<.001, AOR .034, 95% CI, .006-.188) and empathy (P=.029; AOR .116, 95% CI, .017-.800) were significant factors negatively associated with low satisfaction (scored 1, or 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision-maker (P=.015, AOR 6.592, 95% CI 1.452-29.927). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same dissatisfied service factors (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high satisfaction group offered more positive feedback on assurance, reliability and empathy along with a competent clinician, appropriate patient selection, and excellent communication and empathy skills. CONCLUSIONS The insights gained from this study can be considered when designing and enhancing home-based teleconsultation services to enhance patient experiences in stroke prevention care.

BackgroundPrior to the COVID-19 outbreak, the adoption of teleconsultation for outpatient neurology services was limited. Since the COVID-19 pandemic, many outpatient neurology services have rapidly switched to teleconsultation worldwide. However, it remains unclear how this change has impacted patients' and clinicians' perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients' and clinicians' experiences of outpatient teleconsultation services during COVID-19.MethodsArksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’’ perception of teleconsultation services. Results A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients' and clinicians' experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support. Conclusions Our findings identified six key service process factors affecting the patients' and clinicians' teleconsultation experiences in outpatient neurology services. The need for a new triage system and standardizing administrative virtual care workflow are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID. More research is needed to assess outpatient neurology teleconsultation service quality from patients' and clinicians' perspectives.