Clinician and patient experience of neurology telephone consultations during the COVID-19 pandemic

Abstract

BackgroundTelephone 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.ObjectivesWe explored patient and clinician experience of telephone consultations; and whether telephone consultations might be preferable for preidentifiable subgroups of patients after the pandemic.MethodsClinicians 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.ResultsThe 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.ConclusionTelephone 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.

A comparison of telemedicine and in-person neurology visits: what are the factors that patients consider when selecting future visit type?

“…These patients were most likely to cite their unfamiliarity with telemedicine, explaining, “It [an in-person visit] is how I’ve always done it.” This may be related to the significantly older age of patients who completed in-person visits compared to those who completed video visits. A recent study found that patients reported lower success rates with their telephone visit when it was an initial consultation, suggesting that familiarity with the virtual medium may limit satisfaction [ 12 ]. Previously, familiarity has been shown to improve with the utilization of web-based applications that support appointment scheduling, online consultation, test result follow-up, prescription completion, medication delivery, and most importantly, health insurance coverage [ 13 ].…”

“…Online portals can support scheduling via a decision tree to guide selection of appropriate visit type based on diagnosis or current situation, which may optimize telemedicine’s use for follow-up visits of stable, less severe conditions. One study suggests that these “Situational Factors” such as stability and severity may influence visit satisfaction, as patients and neurologists were more likely to perceive that their visit goals were achieved when the telemedicine visit was a follow-up consultation as opposed to a new visit [ 12 ]. To improve access, administrative staff, caregivers, and travel nurses can provide support with technology to attenuate user limitations.…”

Academic Neurology and the COVID-19 Pandemic

“…"Telephone only" consultations were also offered in some regions. In a study performed in the United Kingdom, of 430 respondents, 78% of clinicians and 78% of patients stated that telephone-based consultations met their care needs 15 .…”

“…In a study performed in the United Kingdom, of 430 respondents, 78% of clinicians and 78% of patients stated that telephone-based consultations met their care needs. 15 Telehealth not only offered a means for safe neurology care in the height of the pandemic but also liberalized work hours for many providers. Telehealth clinic days, performed from home, eliminated commute times.…”

Comment on “Patients' Postjudice of Tele‐Neurology for Movement Disorders”

“…Nakornchai shows that depending on the initial complaint for new consultation or follow-up, the goals of consultation can be achieved over the phone. 5 Follow-up telephone consultations for patients with epilepsy and multiple sclerosis can be very efficient. However, telephone consultation misses the greatest improvements of technology in telemedicine.…”