Synchronous neurology–primary care collaboration in a medical home

Abstract

BackgroundSynchronous collaboration as defined by a simultaneous encounter between primary care providers (PCPs), patients, and neurologists may improve access to neurologic expertise, care value, and satisfaction of PCPs and patients. We examined a series of synchronous collaborations and report outcomes, PCP satisfaction, downstream utilization, and illustrative case examples.MethodsWithin an outpatient collaborative primary care–neurology care model, we implemented synchronous video consultations from a central hub to satellite clinics while increasing availability of synchronous telephone and face-to-face collaboration. PCP experience was assessed by a postcollaboration survey. Individual cases were summarized. Clinical and utilization outcomes were assessed by a neurologist immediately after and by follow-up chart review.ResultsA total of 58 total synchronous collaborations were performed: 30 by telephone (52%), 18 face to face (31%), and 10 by video (17%) over 27 clinic half-days. The most frequent outcomes as assessed by the neurologist were reassurance of the PCP (23/58; 40%) and patient (22/59; 38%), and the neurologist changed the treatment plan (23/58; 40%). A subsequent face-to-face consultation was completed in 15% (6/58) of patients initially assessed by telephone or video. Test utilization was avoided in 40% (23/58). Unintended utilization occurred 9% (5/58). Most PCPs were very satisfied with the ease of access, quality of care, and reported high likelihood of subsequent use. PCPs perceived similar or less time spent during synchronous vs asynchronous collaboration and neurologist usually altered the testing (87.8%) and treatment plan (95.2%).ConclusionsSynchronous collaboration between neurologists and PCPs may improve timely access to neurologic expertise, downstream utilization, and PCP satisfaction.

Utilization of Telemedicine in neurological disorders in primary care

“…Processed data can be wirelessly transmitted to smartphones, where user-friendly applications allow patients and physicians to access and interpret the information. (50) Smartwatch applications sensitive to seizure activity are available for epilepsy patients. These applications can detect epileptic activity during tonic-clonic seizures using sensors that are responsive to involuntary muscle movements.…”

Robot doctors

“…As the landscape of health care changes, it is important for neurologists to explore and embrace new practice models and technologies for meeting the needs of patients and referring providers. In the issue of Neurology: Clinical Practice, Young et al 1 assessed a way to improve immediate access to a consulting neurologist and explored how this affected care, costs, and patient/ provider satisfaction. This is a great first step at looking at these issues, and benefits were indeed suggested by their results.…”

“…3 Most models of care for teleconsultation have focused on traditional office visits just done remotely-seeing the patient at an appointed time and writing a note back to the referring provider. Young et al 1 used the technology to be available to the provider in real time while they were seeing patients in their offices and to answer questions on diagnosis, testing, and treatment. This is another innovative way to improve care and limit unneeded services, as their results suggest.…”

“…No one felt that it was worse than a live consult. 1 Others have shown this as well that patients appreciate the rapid access to our expertise and do not mind the format to get that access. 4,5 Early studies showed no difference in outcomes with using telehealth vs live care in patients with stroke in emergency settings, but data are limited in other settings, and this should be explored further.…”