Initial experiences of US neurologists in practice during the COVID-19 pandemic via survey

Abstract

BackgroundThe current coronavirus disease of 2019 (COVID-19) pandemic has caused widespread disease and death. Rapid increases in patient volumes have exposed weaknesses in healthcare systems and challenged our ability to provide optimal patient care and adequate safety measures to healthcare workers (HCWs).ObjectiveTo test the hypothesis that US neurologists were experiencing significant challenges with lack of personal protective equipment (PPE), rapid changes in practice and varying institutional protocols, we conducted this survey study.MethodsA 36-item survey was distributed to neurologists around the US through various media platforms.ResultsOver a one-week period, 567 responses were received. Of these, 56% practiced in academia. A total of 87% had access to PPE with 45% being asked to reuse PPE due to shortages. The pandemic caused rapid changes in practice, most notably a shift towards providing care by teleneurology, although a third experienced challenges in transitioning to this model. Wide variations were noted both in testing and in the guidance provided for the exposed, sick or vulnerable HCWs. Notably, 59% of respondents felt that their practices were doing what they could, although 56% did not feel safe taking care of patients.ConclusionsResults from our survey demonstrate significant variability in preparedness and responsiveness to the COVID-19 pandemic in neurology, impacted by region, health care setting and practice model. Practice guidelines from professional societies and other national entities are needed to improve protection for physicians and their patients, promote recommended practice changes during a pandemic, and optimize future preparedness for public health emergencies.

Ten Eleven Things Not to Say to Healthcare Professionals During the Coronavirus Disease 2019 Pandemic

“…We recommend delivering messages with compassion locations, settings, or departments; pay cuts or other benefit reductions; lack of information or conflicting information; rapidly changing policies; lack of institutional support; workplace conflict; pivoting to telehealth for patient treatment and using other technologies; working from home; having no childcare or other support; and a wide range of other stressors. 5 The prolonged exposure to this stressful situation can result in psychiatric conditions as well as dysfunctional coping mechanisms, such as problematic substance use. A study of 1257 HCPs in China treating COVID-19 positive patients using validated instruments found that more than 50% had depression, more than 45% had anxiety, more than 34% were experiencing insomnia, and 71.5% reported distress.…”

“…The purpose of the group is to provide support, mentorship, and encouragement for members in their professional endeavors and to advocate for more visibility and inclusion, particularly for women. Hence, with the challenges that medical professionals are confronting during the COVID-19 pandemic, the enhanced role of medical professionals in society calls for amplifying voices like those of Greenhalgh 4 and Sharma et al, 5 who advocate for protective equipment for the public and HCPs. Greenhalgh,4 in her comprehensive narrative review, highlights the value of the widespread use of face coverings by the public.…”

“…Greenhalgh makes an insightful distinction between narrowly defined biomedical questions that can be answered using conventional systematic reviews compared with complex, multifaceted problems that require clarification and insight, for which a more interpretive and discursive synthesis is needed. This notion of placing due value on non-randomized-controlled trials is also important when one reviews the work of Sharma and colleagues, 5 whose survey provides insightful information regarding the initial experiences of US neurologists during this pandemic. Out of 567 survey responses obtained in 1 week, a total of 87% of respondents had access to PPE, with 45% being asked to reuse PPE because of shortages, a practice that would have been considered inappropriate in traditional circumstances.…”

“…Table 1 lists the challenging scenarios encountered and alternative responses. 1,2,[5][6][7][8][9][10][11][12][13][14][15] We recognize that awareness of these challenges is not enough. We value constructive feedback, innovation, and inclusion of ideas from experts in the provision of excellent healthcare.…”

Pandemic Prompted Pivoting to Virtual Multidisciplinary Care

“…4 However, in a recent survey of practicing neurologists, only 29% had access to a telehealth platform , and just 17% of practices had access to teleneurology in the outpatient setting. 5 The pandemic has also led to the closure of most outpatient therapy centers, creating further difficulties in patient access to treatments. 6 Despite these challenges, providing telehealth to patients with ALS has previously proven (at least on a smaller scale) to be feasible, provide high satisfaction, and maintain a quality of care similar to that of face-to-face visits.…”