ABSTRACT
Objective: To investigate adoption and perceived utility of video visits for new and return patients across neurologic subspecialties. Background: Prior to the COVID-19 pandemic, utilization of teleneurology for ambulatory patients was limited. The pandemic presented an opportunity to evaluate ambulatory teleneurology visits for new and return patients in a suburban academic multi-subspecialty practice at a large scale. Design/Methods: Adoption of video visits was assessed using clinician-level scheduling data from 3/22-5/16/2020. Perceived utility of video visits was explored via clinician survey and semi-structured interviews with clinicians and patients/caregivers. Findings were compared across 5 subspecialties (epilepsy, headache, memory, movement disorders, and neuromuscular) and 2 visit types (new versus return). Results: Video visits were adopted rapidly;all clinicians (n=65) integrated video visits into their workflow With in the 6 weeks and 92% of visits were conducted via video. Utility of video visits was higher for return than new patient visits, as indicated by surveyed (n=48) and interviewed clinicians (n=30). Headache and memory had the highest adoption of video visits for both return and new patient visits. Neuromuscular had the lowest adoption of video for new patient visits and movement disorders for return patient visits. Clinicians felt it was easier to achieve similar physical exam, patient-clinician rapport, and perceived quality of care over video for return rather than new patient visits. Most patients/caregivers interviewed were satisfied with the care provided via video regardless of visit type, with the main limitation being the physical exam. Conclusions: Teleneurology was robustly adopted for both new and return patients during the COVID-19 pandemic. Return visits were preferred over new patient visits, but both were feasible. Headache and memory disorders had the highest levels of adoption between visit types potentially related to less dependence on physical examinations. We provide a foundation for developing targeted guidelines for sustaining teleneurology in ambulatory care post-pandemic.