Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic

Aim: To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method(s): We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Result(s): We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8;R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8;OR 0.7, 95% CI 0.7-0.8). Interpretation(s): Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.Copyright © 2022 Mac Keith Press.

Designing a New Social Infrastructure to Combat Loneliness in Aging Adults

Loneliness in older adults is shaped by social context, which compounds personal vulnerabilities associated with aging. This article argues that while practitioners need to understand loneliness to better support those who are lonely now, because loneliness is a social issue, it cannot be solved one person at a time in a clinical context. This article demonstrates that some types of loneliness in older adults are socially constructed, a product of change in family structure and valuation of roles, ageism and age segregation, social norms, policies, and a social infrastructure created in the twentieth century that is not suited to twenty-first century realities.

The Rapid Adaption of Telemedicine: A Neurology Division's Perception of Effects on Care Delivery and Provider Wellness

Objective: To evaluate provider perceptions of telemedicine as an effective method of care delivery and to characterize its impact on provider wellness With in a pediatric tertiary care center's neurology division. Background: Assessing provider wellness has become increasingly relevant given that neurologists have the second highest burnout rate among all specialists. Prior to the COVID-19 pandemic, the institution was building telemedicine infrastructure and tools to assess its effectiveness in care delivery and effects on provider wellness. In March 2020, the COVID-19 pandemic prompted an abrupt switch from in-person visits to exclusively telemedicine visits. Because rapid deployment of telemedicine was critical to sustaining high quality patient care, determining feasibility, acceptability, and impact on provider wellness occurred in real time. Design/Methods: From March to July 2020, neurology providers that completed a telemedicine visit were sent periodic REDCap surveys to elicit feedback on technology feasibility and impact on patient care, work-life balance, and professional fulfillment. Provider data was de-identified and analyzed for trends for over time. Results: There were four cycles of survey collection with 102 responses. The majority of providers reported that telemedicine was an adequate alternative to in-person exams. Technical issues were commonly reported, including communication interruptions (53%) and problematic video (61%) or audio (74%) quality. The reported frequency of problematic video and audio quality decreased from March to July (22% and 43% respectively). There was considerable reduction in provider commute. From March/April to June/July, providers reported improved professional fulfillment (32 % to 49%) and work life balance (51% to 77%) with telemedicine use. Nearly all providers (97%) would consider some form of telemedicine in the future despite the occurrence of technical difficulties. Conclusions: Despite the rapid deployment of telemedicine, providers reported that it was a feasible and acceptable method of care delivery that may improve provider wellness.