ABSTRACT
Background: Utilization of teleneurology for MS care rapidly expanded during the COVID-19 pandemic to maintain healthcare access. Disparities in telehealth use have been described in other health conditions, but not in a MS population. Objectives/Aims: To evaluate longitudinal utilization of teleneurology across age, race, geographic factors, and insurance categories to identify potential disparities in utilization at a single academic MS center (Cleveland Clinic). Method(s): MS patients attending a specialty clinic in Cleveland, a medium-sized city, who completed >=2 visits at least 24 months apart from 1/2019 to 6/2021 were studied. Patients with fully inperson care were compared to patients with <50% or >50% teleneurology care. Categories of age, race, geographic factors, and insurance were compared using Kruskal-Wallis tests and pairwise Wilcoxon rank sum tests with Bonferroni correction for multiple comparisons. Result(s): 892 patients met the inclusion criteria and completed 3710 visits during the study timeframe: mean age 49.1+/-11.7 years, 73.7% female, 85.6% white, median disease duration 11.2 years [0.15;60.3], and relapsing-remitting 62.3%. 37% patients were fully in-person, 37.2% patients had <50% teleneurology care, and 25.8% patients had >50% teleneurology care. There were no significant differences for race (white, black, other), insurance type (Medicare, Medicaid, private, non/other), area deprivation index (ADI), and residence location (rural vs metropolitan) in the use of teleneurology. Use of teleneurology care varied based by age, with older patients utilizing more in-person care. In person care was 23.4% for ages 18-39, 38.5% for ages 40-60, and 47.8% for those greater than 60 (p<0.001). Patients residing in greater Cleveland had significantly more in-person care (55.3%) compared to residents residing in Ohio outside of the greater Cleveland area (34.7%) and outside of Ohio (10.1%) (p=0.031). Conclusion(s): There were no significant differences in teleneurology utilization across race, insurance, ADI or rural vs metropolitan residence, suggesting it is a broadly accessible tool to overcome disparities in access to MS care. Utilization of teleneurology care for older and local patients was lower, which may be due to decrease demand in these groups. Future studies should assess the optimal integration of teleneurology and in-person visits in MS management.
ABSTRACT
The worldwide incidence of multiple sclerosis (MS) is estimated at 0.5-10 cases per 100.000 personyears and is probably increasing. Incidence in Uruguay was estimated in 1.2 cases per 100.000 personyears in a 2015 study. Following the EMELAC protocol (MS in Latin America and Caribbean region), we conducted an observational, prospective, population-based study to determine MS incidence in Uruguay. The population under study included people living in Uruguay between 7-1-2019 and 6-30- 2021, with18 years and above. The diagnosis was based on the 2017 McDonald criteria. Multiple data sources were employed. All possible cases of MS were reviewed by the research team. Cases with diagnostic uncertainty were re-reviewed by an outside co-author (D.O.). Results: 155 new MS cases were confirmed after review including 111 females (71.6 %). 99 of them were examined directly by the research team (63.9 %). The sex ratio was 2.5:1 female/male. Age range was 18 to 62. Median age was 33 years and the standard deviation 11.4 years. 111 (71.6 %) cases were relapsing-remitting MS, 9 (5.8 %) primary progressive MS and 2 secondary progressive MS. We have no data in 33 cases (21 %). Global incidence rate was 2.88 cases per 100.000 person-years, 3.95 in females and 1.72 in males. The highest incidence was observed in the group with 35-39 years (5.28 cases per 100.000 personyears). Discussion: According to MS Atlas, Uruguay has a low incidence rate (2.0-3.99). Despite this, the MS incidence in Uruguay is one of the highest in Latin America. Age and gender distribution were similar to other studies. We found a lower proportion of primary progressive MS. COVID19 pandemic raised methodological problems which could have led to an underestimation of the incidence.
ABSTRACT
Introduction: The worldwide incidence of multiple sclerosis (MS) is estimated to be 0.5-10 cases per 100.000 person-years and is probably increasing. Incidence in Uruguay was estimated in 1.2 cases per 100.000 person-years in a 2015 study. Objectives: To determine MS incidence in Uruguay Methods: Following the EMELAC protocol (MS in Latin America and Caribbean region), we conducted an observational, prospective, population based study to determine MS incidence in Uruguay. The population studied included people living in Uruguay, older than 18 years of age, between 7-1-2019 and 6-30-2021. The diagnosis was based on the 2017 McDonald criteria. Multiple data sources were employed. All possible cases of MS were reviewed by the research team. Cases with diagnostic uncertainty were re-reviewed by an outside coauthor (D.O.). Results: 137 new MS cases were confirmed after review including 100 females (73%). 65 of them were examined directly by the research team (47%). The sex ratio was 2.7:1 female/male. Age range was 18 to 62 with a median of 35 and an interquartile range of 16.5 (26.5-43). 129 (94%) cases were relapsing-remitting MS, 7 (5%) primary progressive MS and 1 secondary progressive MS. Global incidence rate was 2.55 cases per 100.000 person-years, 3.55 in females and 1.45 in males. The highest incidence was observed in the 35-39 years old group (5.28 cases per 100.000 person-years). Conclusions: According to MS Atlas, Uruguay has a low incidence rate (2.0-3.99). Despite this, the MS incidence in Uruguay is one of the highest in Latin America. Age and gender distribution were similar to other studies. We found a lower proportion of primary progressive MS. COVID19 pandemic raised methodological problems which could have led to an underestimation of the incidence. These preliminary results will be completed in upcoming publications.
ABSTRACT
Background: Utilization of teleneurology rapidly expanded during the COVID-19 pandemic for multiple sclerosis (MS) care to maintain healthcare access. Feasibility and high patient satisfaction with virtual care has been studied, but there are no data regarding the impact of teleneurology on clinical outcomes. Objectives/Aims: To examine the impact of teleneurology care on MS outcomes at a single academic MS center (Cleveland Clinic). Methods: MS patients who completed ≥2 in-person visits 12 months apart (+/- 6 months) from 1/2019 to 12/2020 were studied. Patients with fully in-person care were compared to patients with a combination of teleneurology and in-person care during this timeframe. Multiple linear regression models were created to assess differences in clinical outcomes between groups, adjusting for age, sex, race, employment status, disease duration, education, MS course (relapsing remitting (RRMS), progressive), disability level measured by Patient Determined Disease Steps (PDDS), number of visits, and time from baseline. Significance was set at p<0.05. Results: For 2131 patients meeting the inclusion criteria: median time between the first and last in-person visits 366 days, mean age 49.5±12.6 years, 72.4% female, 81.4% white, 55.3% employed, disease duration 15.9±11.5, RRMS 58.5%, and 71.2% PDDS <=4, distance from center 65.3 [22.9, 409] ). 1905 (89.4%) had only in-person visits and 226 (10.6%) had both teleneurology and in-person visits. The teleneurology group had shorter disease duration (14.4±10.3 vs 16.1±11.6 years), higher disability score (32.3% vs 25.1% PDDS >4), greater interval between first and last visit (412 [367, 497] vs 363 [253, 424] days), lived closer to the center (34.8 [17.3, 83.0] vs 68.9 [23.3, 2081] miles), and higher total number of visits (4 [3, 4] vs 3 [2, 3] visits) (p<0.05 for all). The groups did not differ for age, sex, race, employment status, education, or MS course (p>0.05). Patients with teleneurology care had no significant difference in manual dexterity, processing speed, or walking speed compared to patients with only in-person care after adjustment for demographic and disease characteristics (p>0.05 for all). Conclusions: This study demonstrates that teleneurology care did not appear to have an effect on clinical outcomes in MS. These data support the continued use of teleneurology in MS care. Future studies are needed to elucidate the optimal combination of teleneurology and in-person visit types for MS patients.