Appointment completion in pediatric neurology telemedicine clinics serving underserved patients

Abstract

BackgroundTo determine whether telemedicine improves access to outpatient neurology care for underserved patients, we compared appointment completion between urban, in-person clinics and telemedicine clinics held in rural and underserved communities where neurology consultations are provided remotely.MethodsIn this retrospective study, we identified patients scheduled for outpatient care from UCDH pediatric neurologists between January 1, 2009, and July 31, 2017, in person and by telemedicine. Demographic and clinical variables were abstracted from electronic medical records. We evaluated the association between consultation modality and visit completion in overall and matched samples using hierarchical multivariable logistic regression.ResultsWe analyzed 13,311 in-person appointments by 3,831 patients and 1,158 telemedicine appointments by 381 patients. The average travel time to the site of care was 45.8 ± 52.1 minutes for the in-person cohort and 22.3 ± 22.7 minutes for the telemedicine cohort. Telemedicine sites were located at an average travel time of 217.1 ± 114.8 minutes from UCDH. Telemedicine patients were more likely to have nonprivate insurance, lower education, and lower household income. They had different diagnoses and fewer complex chronic conditions. Telemedicine visits were more likely to be completed than either “cancelled” or missed (“no show”) compared with in-person visits (OR 1.57, 95% CI: 1.34–1.83; OR 1.66, 95% CI: 1.31–2.10 matched on travel time to the site of care; OR 2.22, 95% CI: 1.66–2.98 matched on travel time to UCDH).ConclusionsThe use of telemedicine for outpatient pediatric neurology visits has high odds of completion and can serve as an equal adjunct to in-person clinic visits.

Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic

“…Priority questions for future studies include determining whether previously documented benefits of telemedicine such as reduction in no-show burden, 12 , 19 in costly emergency department visits, 6 or in miles traveled for patients 20 , 21 occur when telemedicine is implemented more broadly in child neurology practice. While many of our patients travel far for subspecialty care, those who live in our primary catchment region may also benefit from telemedicine child neurology services.…”

“…[5][6][7][8][9][10][11] Reports of pediatric neurology telemedicine delivery have been limited to programs for under-served populations. 12,13 Here, we analyzed the implementation of telehealth services in our large pediatric neurology care network, including scheduled telephone encounters and newly implemented audio-video telemedicine encounters. As audio-video telemedicine encounters represented a new modality of patient care, we performed a quality improvement study to determine the effectiveness of telemedicine encounters as assessed by the clinicians, the utility of telemedicine for future care, the need for short-term in-person follow-up, and patient/caregiver satisfaction with the telemedicine experience.…”

“… 5 – 11 Reports of pediatric neurology telemedicine delivery have been limited to programs for underserved populations. 12 , 13 …”

Into the Storm: a Mixed Methods Evaluation of Reasons for Non-attendance of Appointments in the Free Clinic Setting

“…Finally, telemedicine may be a promising approach to address issues related to travel and competing demands from work, family, and other sources, and particularly with the COVID-19 pandemic, though this study was conducted for the start of the pandemic. Telemedicine has increased appointment attendance among underresourced patients [20,21]. This area warrants further study.…”

Impact of the Coronavirus Pandemic on Pediatric Palliative Care Team Structures, Services, and Care Delivery

“…20 Implementable approaches for promoting team resilience and workforce well-being, such as the Promoting Resilience in Stress Management at Work Program and the signposting of discipline-specific resilience initiatives, represent essential priorities. 21,22 Ideally this translates into sustainable models within hospitals and community settings for integrated support for health care workers. 23 While this study is informative in providing an overview of the impact of the coronavirus pandemic on palliative care services for children and families, there are noted limitations.…”