Telehealth in Outpatient Neurology: Physician and Patient Perspectives

Objective: To evaluate patient and physician perceptions of aspects of telehealth including ease of use, convenience, effectiveness for communication, and overall quality of care. Background: At the start of the COVID19 pandemic, telehealth was rapidly integrated into outpatient neurology at Yale School of Medicine, allowing continued delivery of non-acute, outpatient care while minimizing the risk of potential disease spread. From March 2020 through March 2021, almost half of outpatient appointments were telehealth visits. Design/Methods: Anonymous surveys were administered to patients and physicians in six neurology subspecialty clinics from October to December 2020. Items were scored on a 5-point Likert scale (1=strongly disagree;5 =strongly agree), with an option for additional comments. Results: 120 consecutive patients responded to the survey (20 each in 6 different subspecialty clinics). Most patients strongly agreed that the technology was user-friendly and high quality (70.0%), telehealth is more convenient than face-to-face appointments (76.7%), and facilitates adequate communication of concerns (70.0%) and appropriate care (73.3%). Fewer than half of patients (45.8%) felt that telehealth provides the same overall quality of care due to lack of physical examination and personal rapport with their neurologist, among other reasons. There were no statistically significant differences in patient responses from each subspecialty clinic. 29/44 (65.9%) of physicians responded to the survey. Physicians had more negative overall perceptions about the ease of use/quality of technology (mean Likert score 3.52 vs 4.47, p<0.001), communication of concerns (mean 3.69 vs 4.58, p<0.001), and quality of care (mean 3.14 vs 3.92, p=0.002). Conclusions: Telehealth in outpatient neurology is perceived as convenient and effective by patients, and less so by physicians. A majority of physicians and patients perceive that telehealth facilitates a lower overall quality of care compared to in-person visits. Further studies may help identify situations where telehealth is most useful in neurological care.

Risk and Protective Factors of College Students' Psychological Well-Being During the COVID-19 Pandemic: Emotional Stability, Mental Health, and Household Resources

Colleges and universities have increasingly worried in recent decades about college students' well-being, with the COVID-19 pandemic aggravating these concerns. Our study examines changes to undergraduate emotional sentiments and psychological well-being from before to after the onset of the pandemic. In addition, we explore whether certain risk factors (i.e., prior mental health impairments, trait emotional stability) and protective factors (i.e., subjective socioeconomic status, parental education, household resources) predicted students' emotions and their intraindividual changes due to the pandemic onset. We compared experience sampling method data from 120 students from before and after the pandemic onset, examining intraindividual trajectories. There was only little change in students' emotions. Prior mental health impairment and trait emotional stability predicted students' emotions, averaged across time points, but not emotion changes. Few associations with emotions were found for subjective socioeconomic status and parental education, but study-related household resources predicted levels and changes in emotions.