Rapid Implementation of Outpatient Teleneurology in Rural Appalachia

Abstract

Objective:To describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States.Methods:A retrospective cohort of consecutive patients seen in the first four weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video and when unable phone-only visits were scheduled. Patients were divided into two groups based on the telehealth visit type: video or phone-only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured post-visit telephone call.Results:Of 1011 telehealth patient-visits, 44% were video and 56% phone-only. Patients who completed a video visit were younger (39.7 vs 48.4 years, p<0.001), more likely to be female (63% vs 55%, p<0.007), be White or Caucasian (p=0.024), and not have Medicare or Medicaid insurance (p<0.001). The most common barrier to scheduling video visits was technology limitations (46%). While patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%, p=0.05).Conclusion:Rapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, black patients with Medicare or Medicaid insurance were less likely to adopt video visits.

Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation

“…To further support this pivot and maintain health care access, the United States loosened previously stringent federal regulations on reimbursements, licensing, and Health Insurance Portability and Accountability Act (HIPAA) compliance [ 22 , 23 ]. In neurology specifically, the urgent need to provide care safely to patients with chronic illnesses while preventing disease transmission during clinic visits, led to rapid implementation of video visits across all subspecialties [ 24 - 29 ].…”

Telehealth as a new care delivery model: The headache provider experience

“…Choosing telemedicine was significantly associated with age (patients ≥65 years were less likely than patients aged 18–44 years to choose telemedicine) as well as with technology access (patients in neighborhoods with high rates of residential internet access were more likely to choose a video visit than patients whose neighborhoods had limited internet access) 19 . Disparities were also found in a telehealth study of neurology patients where older, male, and Black patients with Medicare or Medicaid insurance were less likely to adopt video visits over phone visits 20 . Similarly in pediatric neurology patients, access to Wi‐Fi, ability to use cell phones for video, and lower activation of the patient portal contributed to a significant reduction in scheduled appointments by patients of underrepresented minority groups in the early months of the pandemic 21 .…”

Global & Community Health: Implementation of and Patient Satisfaction With the First Neurologic Telemedicine Program in Mexico During COVID-19

“…e7,8 In response to the pandemic, the use of telemedicine has increased worldwide. 5,6,8 In neurology, the strongest evidence supporting its use derives from the experience in managing acute ischemic stroke, where it has proven to be as effective as an in-person evaluation.…”