Presence of Caregivers at Telehealth Visits Significantly Improves Virtual Assessment of Drug-Induced Movement Disorders

Objective: To highlight the importance of caregivers based on results from TeleSCOPE, a real-world study of telehealth during COVID-19 in patients with tardive dyskinesia (TD) and other drug-induced movement disorders (DIMDs). Background: Given the importance of engaging caregivers (family members or other persons of support) when treating patients with TD [1], TeleSCOPE included items related to the effects of caregiver presence during virtual visits. neurology (Neuro) and psychiatry (Psych) physicians and advanced practice providers who met the following criteria: ≥3 years of practice with ≥70% of time spent in clinic;prescribed a vesicular monoamine transporter two inhibitor or benztropine for DIMD at least once in the past six months;and conducted telehealth visits with ≥15% of their patients from Dec-2020 to Jan-2021. Participants responded to items regarding DIMD assessment and management, including the impact of caregivers in these areas. Results: 277 clinicians responded (Neuro = 109, Psych = 168). For both specialties, caregiver participation was greater in video versus phone-only visits (Neuro = 51% vs 37%, Psych = 29% vs 15%). Any mention of tics/ movements by caregivers was the top prompt for further DIMD evaluation (Neuro = 82%, Psych = 89%), followed by trouble with gait/falls/walking/ standing (Neuro = 77%, Psych = 85%) and difficulty swallowing/eating (Neuro = 69%, Psych = 78%). Furthermore, patients without a participating caregiver had the highest risk of a missed DIMD diagnosis (Neuro = 89%, Psych = 83%). Other at-risk patients were lower functioning (Neuro = 86%, Psych = 80%), primarily lived in a group home (Neuro = 68%, Psych = 37%), or were new to the practice (Neuro = 28%, Psych = 51%). Conclusion: Although caregivers were not often present during telehealth visits (especially phone-only visits), active caregiver participation alleviated some of the challenges of virtual DIMD assessment. Caregiver mention of tics/movements or physical impact increased the likelihood of DIMD evaluation and reduced the risk of missed diagnosis. In-person visits remain the gold standard for assessing and treating DIMDs. However, when telehealth is necessary, caregivers can significantly improve the quality of virtual visits. Given this potential for improved outcomes, the role of caregivers in DIMD management merits more research and support.

TeleSCOPE: A Real-World Study of Telehealth for the Detection and Treatment of Drug-Induced Movement Disorders

Introduction. As a result of COVID-19, patients and clinicians rapidly shifted to telehealth. An observational survey study, Real- World Tele-Health Evaluation of Tardive Dyskinesia (TD) Symptoms Communication/Observation Procedure Evaluation in Outpatient Clinical Settings (TeleSCOPE), was conducted to better understand how this shift affected the evaluation of druginduced movement disorders (DIMDs), including TD. Methods. Twenty-minute online quantitative surveys were conducted with neurology and psychiatry specialists (physicians and advanced practice providers) who met the following criteria: ≥3 years of practice with ≥70% of time spent in a clinic;prescribed a vesicular monoamine transporter 2 (VMAT2) inhibitor or benztropine for DIMD at least once in the past 6 months;and conducted telehealth visits with ≥15% of their patients from December 2020 to January 2021. Results. Respondents included 277 clinicians (neurology = 109, psychiatry = 168). Telehealth visits increased after COVID-19, with significantly greater increases in psychiatry vs neurology: phone (38% vs 21%);video (49% vs 42%). Across both specialties, top drivers/prompts for further DIMDevaluation were as follows: mention of tics or movements by family members or others (86%);trouble with gait, falls, walking, or standing (82%);difficulty swallowing or eating (74%);and difficulty writing, using phone, computer (71%). However, in the 6 months prior to June 2021, virtual evaluation, diagnosis, and monitoring of patients were challenging. For both specialties, many at-risk patients (ie, taking a dopamine receptor blocking agent) were not evaluated for DIMDs via video-based visits (psychiatry = 45%, neurology = 70%) or phone-only visits (psychiatry = 76%, neurology = 91%). Clinicians listed evaluation of gait/falls/walking/ standing as the most challenging aspect of virtual assessment for phone-only visits (psychiatry = 53%, neurology = 57%) and video-based visits (psychiatry = 26%, neurology = 31%). Additional challenges included limited access to computers, insufficient training for clinicians and staff, and greater difficulty obtaining reimbursements (especially for complex telehealth visits). Patients without a participating caregiver, along with lower functioning patients, were at the highest risk of a missed DIMD diagnosis. Conclusions. During the COVID-19 pandemic, telehealth significantly reduced clinicians' ability or willingness to evaluate, diagnose, and monitor DIMDs. Clinicians stated multiple factors increased the risk of a missed or incorrect diagnosis. Challenges to optimal telehealth effectiveness included lack of patient access to computers, need for more clinician/staff training, lack of awareness of coverage, need for sufficient fee reimbursement. In-person evaluation continues to be the gold standard for assessing and treating DIMDs. However, if telehealth is necessary, the use of specific questions and directions is recommended for better communication and more accurate assessments.

TeleSCOPE: A Real-World Study of Telehealth for the Detection and Treatment of Drug-Induced Movement Disorders

INTRODUCTION: As a result of COVID-19, patients and clinicians rapidly shifted to telehealth. An observational survey study, Real-World Tele-Health Evaluation of Tardive Dyskinesia (TD) Symptoms Communication/Observation Procedure Evaluation in Outpatient Clinical Settings (TeleSCOPE), was conducted to better understand how this shift affected the evaluation of drug-induced movement disorders (DIMDs), including TD. METHODS: Twenty-minute online quantitative surveys were conducted with neurology and psychiatry specialists (physicians and advanced practice providers) who met the following criteria: >=3 years of practice with >=70% of time spent in a clinic;prescribed a vesicular monoamine transporter 2 (VMAT2) inhibitor or benztropine for DIMD at least once in the past 6 months;and conducted telehealth visits with >=15% of their patients from December 2020 to January 2021. RESULTS: Respondents included 277 clinicians (neurology = 109, psychiatry = 168). Telehealth visits increased after COVID-19, with significantly greater increases in psychiatry vs neurology: phone (38% vs 21%);video (49% vs 42%). Across both specialties, top drivers/prompts for further DIMD evaluation were as follows: mention of tics or movements by family members or others (86%);trouble with gait, falls, walking, or standing (82%);difficulty swallowing or eating (74%);and difficulty writing, using phone, computer (71%). However, in the 6 months prior to June 2021, virtual evaluation, diagnosis, and monitoring of patients were challenging. For both specialties, many at-risk patients (ie, taking a dopamine receptor blocking agent) were not evaluated for DIMDs via video-based visits (psychiatry = 45%, neurology = 70%) or phone-only visits (psychiatry = 76%, neurology = 91%). Clinicians listed evaluation of gait/falls/walking/standing as the most challenging aspect of virtual assessment for phone-only visits (psychiatry = 53%, neurology = 57%) and video-based visits (psychiatry = 26%, neurology = 31%). Additional challenges included limited access to computers, insufficient training for clinicians and staff, and greater difficulty obtaining reimbursements (especially for complex telehealth visits). Patients without a participating caregiver, along with lower functioning patients, were at the highest risk of a missed DIMD diagnosis. CONCLUSIONS: During the COVID-19 pandemic, telehealth significantly reduced clinicians' ability or willingness to evaluate, diagnose, and monitor DIMDs. Clinicians stated multiple factors increased the risk of a missed or incorrect diagnosis. Challenges to optimal telehealth effectiveness included lack of patient access to computers, need for more clinician/staff training, lack of awareness of coverage, need for sufficient fee reimbursement. In-person evaluation continues to be the gold standard for assessing and treating DIMDs. However, if telehealth is necessary, the use of specific questions and directions is recommended for better communication and more accurate assessments. FUNDING: Neurocrine Biosciences, Inc.