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

Abstract

Background Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology’s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. Objective To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. Methods Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. Results Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient’s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. Conclusions Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm

“…However, there are real limitations to a virtual examination, including the potential requirement of assistance from a caregiver, inadequate patient-home environment or space, poor lighting or discoloration with resultant poor visualization, increased time required to perform an assessment, and other technical issues [6,13,14]. In particular, the assessment of a patient's movement and motor function is limited, in part due to the need for a patient-assisted examination that can be challenging to capture on video [6,15,16]. Other aspects of a physical examination simply cannot be done via telehealth, such as auscultation of heart or lung sounds [17].…”

“…Although the world has become accustomed to online relationships, a trusting and personal connection between the patient and the health care provider, a vital aspect of health care, can be challenging to build with purely digital interaction. Multiple patient experience studies have consistently reported difficulties in communicating or connecting with providers during telehealth visits [3,6]. A desire for building an improved rapport with their providers is one of the most popular reasons why many patients prefer in-person visits [20].…”

“…Many applaud this change [2]. However, virtual patient care can bring unintended consequences that eclipse its benefits, including potentially limiting the patient-provider relationship, quality of examination, the efficiency of health care delivery, and overall quality of care [3][4][5][6]. As safety protocols for in-person evaluation have been developed, critical examination raises serious dilemmas about the harms of telehealth that can inform a new agenda for how to best utilize telehealth in the COVID-19 era.…”

Challenges of caregiving to neurological patients

“…For technical reasons, teleradiological consultations including video-visits may be challenging for elderly CG. However, the acceptance of video-visits was found to be high [ 33 ]. Strainful transfers to medical services can be minimized and patients and CGs can communicate with their doctors, psychologist, physiotherapist, nurse, or social worker in their usual familiar environment.…”

“…Video-visit-based home rehabilitation programs have been developed. Video-visits may be less favorable for patients with severe impairments or symptom fluctuations than for patients with stable disease [ 33 ]. In summary, video consultations save time and seem altogether helpful to attenuate CB.…”