A Longitudinal Comparison of Ambulatory Neurology Patient Experiences with Telehealth during the COVID-19 Pandemic: How have telehealth interest and satisfaction changed over time?

Objective: To compare patient satisfaction and preference for future telemedicine following in-person and virtual visits (telephone and video) in an ambulatory neurology practice. Background: During the COVID-19 pandemic, care shifted from exclusively telemedicine to hybrid models with in-person, video, and telephone visits. We sought to understand how patient satisfaction and visit preferences have changed. Design/Methods: Patients who completed a virtual visit in March 2020 (early pandemic, exclusive telemedicine), May 2020 (mid pandemic, in-person optional), and March 2021 (late pandemic, hybrid model) were contacted by telephone. Assenting patients were assessed for visit satisfaction (% reporting “all needs met”) and desire for future telemedicine (% reporting “definitely interested”). Results: 3,991 ambulatory visits were performed (1,004 early;478 mid;2,509 late);1,725 patients (43%) assented to post-visit feedback;mean age 45.8±24.4 years, 42% male, 79% white, and 56% with Medicare/Medicaid insurance. Patient satisfaction significantly increased (73% early, 79% mid, 81% late pandemic, p=0.008). Interest in telemedicine also increased for patients completing telephone visits (40% early, 50% mid, 59% late, p=0.027) and video visits (52% early, 59% mid, 62% late, p=0.035). Patients reporting “all needs met” were younger (44 years vs 51, p<0.001). There was no difference in satisfaction by race (p=0.09), sex (p=0.82), or insurance (p=0.82). However, white patients were more interested in future telemedicine (p=0.037). Multivariable analysis showed that older, male, black patients, with Medicare/Medicaid insurance were less likely to complete a video visit early pandemic. Male sex was no longer a predictor late pandemic whereas older patients were 2% less likely (for each 1 year older), black patients 45% less likely, and patients with Medicare/Medicaid 54% less likely to complete a video visit. Conclusions: Patients, especially younger ones, have become more satisfied and more interested in hybrid care models. Barriers to conducting video visits persist including for older, black patients with Medicare or Medicaid insurance.

A Comparison of Telehealth and In-Person Visits in Ambulatory Neurology:What are the factors that patients consider when selecting future visit type?

Objective: To identify factors that patients consider when selecting future visit type (in-person vs video vs telephone). Background: Telehealth has rapidly integrated into ambulatory medicine in response to the COVID-19 pandemic. In our clinic, telemedicine comprises approximately 30% of visits. Design/Methods: Consecutive patients who had an ambulatory neurology visit in March 2021 were contacted by telephone. Assenting patients completed (1) a survey quantifying likelihood of scheduling a future telemedicine visit and (2) a semi-structured interview. Qualitative responses were analyzed using principles of thematic analysis. Results: 2,493 ambulatory visits were performed;962 patients (39%) assented to post-visit feedback;74% were in-person visits, 13% video, and 13% telephone. Patients with video and telephone visits were more likely than in-person to consider telemedicine in the future (59% vs 62% vs 36% respectively, p<0.001). Five themes were identified that influence patient visit preferences: “Pros of Visit Type,” “Barriers to Telehealth,” “Situational Context,” “Inherent Patient Beliefs,” and “Extrinsic Variables.” Telemedicine patients considered convenience as “Pros of Visit Type,” while in-person patients valued improved communication and quality of medical care. “Barriers to Telehealth” such as accessibility and user familiarity were prevalent among in-person and telephone patients, whereas system limitations such as poor internet connection were prevalent among video patients. “Situational Context” varied: all patients agreed that stable conditions can be monitored via telemedicine;all patients considered physical examination a driving factor for in-person visits;telephone patients cited worsening symptoms as warranting in-person visits more frequently than video patients. The “Inherent Belief” that telemedicine is equivalent to in-person care was cited more by telephone than video patients. “Extrinsic Variables” such as patient awareness of telemedicine must be addressed. Conclusions: Patients view telemedicine as an adjunct to, and not replacement for, in-person visits. Future care delivery models should incorporate patient perspectives to guide improved access to care and reduction of healthcare spending.

Differences in Ambulatory Neurology Patient Experiences According to Distance Traveled: How do telephone and video visits compare to in-person?

Objective: To compare patient satisfaction and preference for future telemedicine visit following in-person and virtual visits (telephone and video) based on distance from a neurology ambulatory clinic. Background: Due to the COVID-19 pandemic, ambulatory neurology shifted to both in-person and telemedicine visits. Understanding how patient satisfaction and visit preferences differ by distance traveled can inform care post-pandemic. Design/Methods: Patients who completed a virtual visit in March 2020 (early pandemic) and virtual or in-person visit in March 2021 (late pandemic) were contacted by telephone within 3 months. Assenting patients completed quantitative assessment of satisfaction and desire for future telemedicine visit. Distance was measured “as-the-crow-flies” between patients' home and clinic zip-codes. Patients were stratified into groups: >60mi, 60-30mi, 30-15mi, and <15mi away. Results: 3,610 ambulatory visits were performed (1,101 early, 2,509 late);1,235 patients (34%) assented to feedback. Of these, 57% were in-person, 18% video, and 23% telephone. In general, >70% of patients reported “all needs met” regardless of visit type. Patient satisfaction was significantly greater with in-person visits for intermediate distances (60-15mi) and with telemedicine visits for the closest (<15mi) and farthest distances (>60mi, p<0.048). Satisfaction with in-person visits exceeded video and telephone visits only for patients at 30-15mi (89%, 76%, and 69% respectively;p<0.011). In the late pandemic, patients desired future virtual visits significantly less following in-person visits compared to video and telephone at all distances (p<0.037). Satisfaction did not change from early to late pandemic;however, desire for future virtual visits significantly increased for telephone visits (29-39% early to 58-71% late, p<0.05) and remained high for video (50-67% early and 54-67% late, P>0.05). Conclusions: Patients have become more receptive to telemedicine and in particular to telephone visits. Satisfaction with virtual visits is comparable to in-person visits at all distances and is particularly high for patients traveling the longest and shortest distances.

A new vision in headache medicine: A survey of headache specialists ' utilization of telehealth in their practice

Objective: To assess the practice of telehealth for headache visits in the US. Background: The rapid roll-out of telehealth during the COVID-19 pandemic impacted headache specialists. Design/Methods: American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth. Results: 225 of 1348 (16.7%) AHS members responded. Most were female (59.8%;113/189). Mean age was 47.4±11.8 (N=154). The vast majority were MD/DOs (83.2%;158/190) and NP/PAs (14.7%;28/190), and most (65.1%;123/189) were in academia. Years in practice were: 0-3: 28;4-10: 58;11-20: 42;20+: 61. Mean number of telehealth visits was 199.4 ± 214.8 in prior 3 months. Respondents were "comfortable" or "very comfortable" treating via telehealth a (a) new patient with a chief complaint of headache (137/185);(b) follow-up for migraine (184/186);(c) follow-up for secondary headache (116/182). About half (51.1%;97/190) offer urgent telehealth. Beyond being unable to perform in-person procedures, top barriers cited were conducting parts of the neurologic exam (157/189), absence of vital signs (116/189), and socioeconomic/technologic barriers (88/189). The top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby(103/190). Only 20% (31/155) of providers said that telehealth visit length differed compared to in person visits and 55.3% (105/190) believe the no-show rate improved. Providers were "interested"/"very interested" (128/188) in digitally prescribing headache apps and "interested"/"very interested" (121/189) in the remote monitoring of patient symptoms. Conclusions: Respondents were comfortable treating migraine patients via telehealth They note positive attributes for patients and how access to care may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest for headache specialists and warrant future research.