Implementation and Patient Experience of Outpatient Teleneurology

Abstract

Background:Teleneurology has been well described for acute stroke, but outpatient use has been limited. At home, virtual visits have the potential to improve access to neurological care.Introduction:This study reports on the use of a personal device videoconferencing platform for outpatient neurologic follow-up visits.Materials and Methods:This is a cross-sectional study that identified all virtual neurologic follow-up visits completed by patients ≥18 years at a single institution over 4 years. Virtual visits were conducted by personal smartphone or computer via videoconferencing with a provider. Patients were asked to rate their overall experience with the visit and provider (five-point scale). Travel distance from the institution was calculated using patient's home addresses.Results:Three thousand nine hundred thirteen patients completed 5,581 virtual visits during the study (mean age 49.4 ± 17.0 years, 58.7% female). Number of virtual visits increased from 30 in year 1 to 4,468 in year 4. Virtual visits were completed in all outpatient neurologic subspecialties. A total of 30.1% of patients were local (<50 miles), 25.9% were near regional (50-150 miles), 21.7% were far regional (151-270 miles), and 22.2% were remote (>270 miles). A distance of 1,327,128 miles of travel was prevented across the 5,581 visits. On average, patients rated their overall virtual visit experience 4.7/5 ± 0.89 and rated their provider 4.9/5 ± 0.48.Discussion:Virtual visits prevented a substantial amount of travel and resulted in high patient satisfaction. The sizable proportion of local patients may indicate that teleneurology provides important access for reasons beyond travel distance.Conclusion:This study demonstrates the feasibility of implementing outpatient teleneurology services.

Keywords: access to care; patient experience; telemedicine; teleneurology; virtual visits.

Conflict of interest statement

L.R., J.B., L.M., H.G., and N.C. have nothing to disclose. R.B. has served as a consultant for Biogen, Genzyme, Genentech, and Novartis and receives research support from Biogen, Genentech, and Novartis. Z.A. has a research grant from Teva and serves as a consultant for Lilly and Amgen and serves on the Supernus advisory board. J.K. has unrestricted education grants from Allergan and Amgen and has performed consulting, writing, and editing work for DynaMed Plus. E.E. serves as a faculty adviser to Lilly and is part of the speaker's bureau for Teva. P.R. serves on the medical advisory board for Teladoc and American Well. H.H.F. has received research support from Acorda Therapeutics, Michael J. Fox Foundation, Movement Disorders Society, NIH/NINDS, Parkinson Study Group, and Sunovion. He receives honoraria from the American Osteopathic Association, Cleveland Clinic, South Alabama Medical Science Foundation, Thoraxx Clinical Communications, UMA Education as a speaker for CME events. He receives honoraria from Acorda Therapeutics, Denali Therapeutics, Pfizer, Partners Health Care System, Sunovion Research and Development Trust as a consultant and from Elsevier as an editor. He receives royalty payments from Demos Publishing and Springer for authorship and editing. He has contractual services with Teva for research and serves as a publication committee member for Acorda Pharmaceuticals and Sunovion Pharmaceuticals. I.N. has served on the scientific advisory board and is part of the speaker's bureau for Eisai. M.M. has served on scientific advisory boards for Genzyme and Genentech.

Figures

Fig. 1.

Total utilization (A) and utilization by subspecialty (B).

Fig. 2.

Location of patients completing virtual visits. Open circle = single visit, closed circle = repeat visit.

Fig. 3.

Density plot of virtual visits completed in the state of Ohio, by county.