Disparities in Access to Neurologic Telemedicine During the COVID-19 Pandemic

Gursky, Jonathan M.; Boro, Alex; S, Escalante; Ferastraoaru, Victor; Hanumanthu, Rajani; Haut, Sheryl R.; Jehle, Rana; Molinero, Isaac; Rick, Lindsay; Rosengard, Jillian L.; Saifeddine, Mohammad; Sugrue, William; Moshé, Solomon L.; Ballaban‐Gil, Karen

doi:10.1212/cpj.0000000000001028

Cited by 17 publications

(21 citation statements)

References 6 publications

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“…However, other studies also found that older persons were more likely to use telehealth than younger people [2,8]. Additionally, we found that the preference for telehealth among older patients was driven by telephone rather than video visits, which has been seen in studies of the general population as well [4,6,8,24]. Older patients' preference of telehealth over inperson visits could have resulted from early and persistent news coverage highlighting the risk of severe COVID-19 disease among older persons with comorbidities, as well as the unclear risk of contracting SARS-CoV-2 infection for PwH [25].…”

Section: Discussionsupporting

confidence: 57%

Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic

et al. 2022

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The COVID-19 pandemic resulted in widespread telehealth expansion. To determine telehealth uptake and potential sociodemographic differences in utilization among people with HIV (PwH), we examined HIV care appointments at the University of Chicago Medicine, an urban tertiary hospital. Visits between March 15th and September 9th for 2019 and 2020 were categorized as in-person, telehealth, and within telehealth, video, and phone. Differences in visit types were modeled using logistic regression to examine associations with demographics, insurance type, and HIV risk transmission category. Telehealth appointments were more likely for those aged 46-60 versus those [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] AOR 1.89 95% CI (1.14, 3.15)]. Black race and participants of other races were less likely to use telehealth compared to whites [Black: AOR 0.33 95% CI (0.16, 0.64), other: AOR 0.10 95% CI (0.02, 0.34)]. Future studies should continue to examine potential disparities in telehealth use among PwH, including age and racial differences.

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Section: Discussionsupporting

confidence: 57%

Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic

et al. 2022

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“…A video consultation was predicted to have enabled clinician goal achievement in 13 instances, bringing the total clinician success rate to 76/101 for all new consultations. However, some factors driving unsuccessful telephone consultations (particularly increasing age and lower socioeconomic status) will likely impair video consultations [11,12]. Future work comparing face-to-face, telephone and video consultations across all demographics and disease types is now required.…”

Section: Discussionmentioning

confidence: 99%

Clinician and patient experience of neurology telephone consultations during the COVID-19 pandemic

Nakornchai

Conci

Hensiek

et al. 2021

Preprint

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Background: Telephone consultations are already employed in specific neurological settings. At Cambridge University Hospitals, the COVID-19 pandemic initially prompted almost all face-to-face appointments to be delivered by telephone, providing a uniquely unselected population to assess. Objectives: We explored patient and clinician experience of telephone consultations; and whether telephone consultations might be preferable for pre-identifiable subgroups of patients after the pandemic. Methods: Clinicians delivering neurological consultations converted to telephone between April-July 2020 were invited to complete a questionnaire following each consult (430 respondents) and the corresponding patients were subsequently surveyed (290 respondents). The questionnaires assessed clinician and patient goal achievement (and the reasons for any dissatisfaction). Clinicians also described consultation duration (in comparison to face-to-face) while patients detailed comparative convenience and preference. Results: The majority of clinicians (335/430, 78%) and patients (227/290, 78%) achieved their consultation goals by telephone, particularly during follow-up consultations (clinicians 272/329, 83%, patients 176/216, 81%) and in some disease subgroups (e.g. seizures/epilepsy (clinicians 114/122 (93%), patients 71/81 (88%)). 95% of telephone consultations were estimated to take the same or less time than an equivalent face-to-face consultation. Most patients found telephone consultations convenient (69%) with 149/211 (71%) indicating they would like telephone or video consultations to play some role in their future follow-up. Conclusion: Telephone consultations appear effective, convenient and popular in prespecified subgroups of neurological outpatients. Further work comparing telephone, video and face-to-face consultations across multiple centres is now needed.

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“…The rapid adaptation of telemedicine in child neurology care due to the COVID-19 pandemic has been assessed in several studies, 13,15,[20][21][22][23][24][25] but beyond the initial implementation, the impact on care had not been fully assessed. Analyzing trends of telemedicine, a heterogeneous picture emerges with regards to patients suitable for telemedicine care and the effects of health disparities.…”

Section: Discussionmentioning

confidence: 99%

One year of child neurology telemedicine: a data-driven analysis of 14,820 encounters

Kaufman

Xian

Galer

et al. 2021

Preprint

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IntroductionDetermining the long-term impact of telemedicine in care across the diagnostic and age spectrum of child neurology during the COVID-19 pandemic and with the re-opening of outpatient clinics.MethodsAn observational cohort study of 34,837 in-person visits and 14,820 telemedicine outpatient pediatric neurology visits between October 1, 2019 and April 9, 2021. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates and demographic factors.Results26,399 patients were observed in this study (median age 11.4 years [interquartile range, 5.5-15.9]; 13,209 male). We observed a higher proportion of telemedicine for epilepsy (ICD10 G40: OR 1.4, 95% CI 1.3-1.5) and a lower proportion for movement disorders (ICD10 G25: OR 0.7, 95% CI 0.6-0.8; ICD10 R25: OR 0.7, 95% CI 0.6-0.9). Infants were more likely to be seen in-person after re-opening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 0.6, 95% CI 0.6-0.7). Racial and ethnic minority populations and those with highest social vulnerability had lower rates of telemedicine participation throughout the pandemic (OR 0.8, 95% CI 0.8-0.8; OR 0.7, 95% CI 0.7-0.8).DiscussionTelemedicine implementation was followed by continued use even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young children and patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.

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Disparities in Access to Neurologic Telemedicine During the COVID-19 Pandemic

Cited by 17 publications

References 6 publications

Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic

Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic

Clinician and patient experience of neurology telephone consultations during the COVID-19 pandemic

One year of child neurology telemedicine: a data-driven analysis of 14,820 encounters

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