Improving Patient Outreach by Defining Telehealth Suitability in a Tertiary Huntington’s Disease Clinic

Abstract

Background: The COVID-19 pandemic has increased the need for remote healthcare options among patients with Huntington’s disease (HD). However, since not every HD patient is suitable for telehealth, it is important to differentiate who can be seen virtually from who should remain as in-person. Unfortunately, there are no clinical guidelines on how to evaluate HD patients for telehealth eligibility. Objective: To standardize the teleneurology selection process in HD by implementing a screening tool that accounts for patient-specific factors. Methods: We organized various indications and contraindications to teleneurology into a flowchart. If any indications or contraindications were met, patients were assigned to telehealth or maintained as in-person, respectively. If no indications or contraindications were met, patients were given the option of telehealth or in-person for their upcoming appointments. In two implementation cycles, we tested this screening tool among all HD patients scheduled for clinic visits, aided by chart review and phone interview. Results: In a cohort of 81 patients, telehealth acceptance among eligible patients increased from 45.0%to 83.3%. Frequency of telehealth visits increased from a pre-intervention baseline of 12.8%to 28.2%. Conclusion: Teleneurology utilization among HD patients more than doubled across our study. Our intervention promotes consistency and patient-centeredness in HD clinical care and streamlines the overall telehealth selection process. Future studies can seek to reduce telehealth no-shows and also evaluate the utility of the motor and psychiatric criteria included in our screening tool.

Patient experiences receiving rehabilitation care via telehealth: Identifying opportunities for remote care

“…The majority of the respondents (54%) had neurological conditions, including Parkinson's disease, Lewy body dementia, Huntington's disease, and other neurological disorders. Although not specifically delivered in rehabilitation or in multidisciplinary settings, there has been growing evidence for the use of telemedicine for Parkinson's disease in clinical neurological care and research including its use preceding the pandemic though with heightened response to COVID-19 ( 1 , 4 , 32 – 35 ), as well as study of its use for Huntington's disease pre-pandemic ( 36 ), in relation to COVID-19 ( 37 , 38 ), and in two settings of multidisciplinary care ( 39 , 40 ). Those with chronic pain disorders who often require a multi-disciplinary approach may be well-served with virtual telehealth team care models.…”

Neurology Access Clinic

“…However, there are accumulating data on telehealth for neurologic conditions with promising findings with regard to feasibility, outreach, and patient satisfaction. [21][22][23][24][25][26] Such models should be explored in future iterations.…”