Telemedicine Utilization and Perceptions of Multiple Sclerosis Health Care Providers

ABSTRACT

Background: Many patients with MS (PwMS) are separated by geographic distance and disability from MS clinical centers in the US with 30% not receiving specialty MS care. Telemedicine, defined broadly as the use of telehealth technologies to provide clinical care when distance separates patients and providers, has the potential to fill some of the gap in the provision of specialty MS services. The COVID-19 pandemic has forced providers to use telemedicine for most outpatient care to maintain social distancing. Objectives: To obtain a representative sample of opinions on the use of telemedicine among a diverse group of providers involved in the care of PwMS. Methods: A 34 question survey was created after reviewing the literature and piloting a set of questions with a small group of PwMS. The survey was placed on the Qualtrex web-platform, and then distributed to a multidisciplinary group of MS providers across the US. Responses were analyzed using Qualtrex web-analytical software and SAS. Results: A total of 100 participants signed on and began answering the survey with 91 completing the full survey. The breakdown of providers was neurologists (40.7%), nurse practitioners and Physicians Assistants (28.6%) nurses (14.3%), Psychologist/Neuropsychologist (7.7%), Social Workers (3.3%), Physiatrist 2.2%, Physical Therapist, Occupational therapist, and Pharmacist 1.1% each. The survey was open from November 2019 until September 2020. The majority of providers (75.8%) indicated they used telemedicine to care for PwMS with clinical video telemedicine (CVT) 87% being the most common platform, followed closely by telephone telemedicine 71%. Conversely, other forms of telemedicine were employed more rarely store and forward telemedicine (10.1%) and remote patient monitoring (1.4%). The rate of telemedicine utilization increased from 15% of practice encounters pre-COVID-19 pandemic to 72.8% of encounters during the COVID-19 pandemic. 92.8% of respondents were very or somewhat satisfied with their last telemedicine visit and 94.2% of providers reported a desire to continue to use telemedicine. The most common drawback of telemedicine was not being able to complete a full neurological exam according to 84.6% of respondents. Conclusions: MS health care providers predominately utilized CVT as their main form of telemedicine and were satisfied with its use. There was an increase in CVT and telephone-based platforms during the COVID-19 pandemic and more limited use of other forms of telemedicine. telemedicine can provide a valid alternative to in person visits. Further study is needed to evaluate how opinions on telemedicine have continued to evolve as providers become more and more accustomed to its use and what barriers may exist that are limiting the utilization of store and forward and remote patient monitoring.