Barriers, access and management of paediatric epilepsy with telehealth

Abstract

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured telehealth visit feasibility, functionality and provider satisfaction. A provider focus group assessed facilitators and barriers to telehealth. Sixty-one unique patients completed 75 telehealth visits. Paired t-test analysis demonstrated that telehealth enhanced access to epilepsy care. It reduced self-reported out-of-pocket costs ( p<0.001), missed school hours ( p<0.001) and missed work hours ( p<0.001), with 94% equal parent/caregiver satisfaction. Focus groups indicated developing and maintaining partnerships, institutional infrastructure and education as facilitators and barriers to telehealth. Telehealth shortened travelling distance, reduced expenses and time missed from school and work. Further, it provides significant opportunity in an era when coronavirus disease 2019 limits in-person clinics.

Pediatric neurology and telehealth before and during SARS-CoV-2 pandemic

“…[8] Research by Gali et al reported 94% parental and 100% physician satisfaction from telemedicine interventions among total 61 respondents. [9] Study by Dayal et al discussed the differences between the over 13,000 in-person and over 1,000 telemedicine appointment groups. It has been noted, that telemedicine group came from nonprivate insurance, lower income and lower education.…”

Virtual epilepsy clinics – A Canadian Comprehensive Epilepsy Center experience pre-COVID and during the COVID-19 pandemic period

“…A multi-center study evaluating wait-times and improvement of access for pediatric patients with Epilepsy to specialists was conducted using a design similar to ours. A total of 73 visits completed by 61 patients/family members found telehealth visits to enhance access to physicians and reduce cost, missed school hours and missed work hours ( Gali et al, 2020 ). In a Spanish study, authors report their experience with telemedicine services for epilepsy care.…”

Telemedicine as a part of globalization and tool for innovation from the legal point of view

“…It is a digital solution in health care that can provide quality care, increase timely access, minimise travel distances and reduce costs. [2] The World Health Organization explains the concept of telemedicine as: "the provision of healthcare where distance is a decisive factor, all healthcare professionals using information and telecommunications technologies to exchange valid information for the diagnosis and prevention of disease and injury, research and evaluation, and other education of healthcare providers, all in order to improve the health of individuals and their communities. In view of definitions above, the World Health Organization further recognizes four characteristics of telemedicine: 1. the purpose of telemedicine is to provide clinical support; 2. the purpose of telemedicine is to overcome geographical barriers and connect users who are not in the same physical location; 3. telemedicine involves the use of different types of information and telecommunication technologies; and 4. the aim of telemedicine is to improve health care outcomes.…”