Factors associated with utilization of telemedicine during the COVID-19 pandemic among patients with myasthenia gravis: A retrospective regional cohort study

ABSTRACT

Objective: 1. Describe telemedicine utilization (TMU) during the COVID-19 pandemic among neurology outpatients with myasthenia gravis (MG);2. Analyze characteristics of patients completing virtual video visits (VVV) compared to audio visits only (AVO). Background: TMU data by patients with MG are limited. Effects of demographic characteristics on MG patients' TMU and choice between VVV and AVO are unknown. Design/Methods: We performed a retrospective cohort study using Mass General Brigham's (MGB) data warehouse. Inclusion criteria were 1) adult patients with autoimmune MG (ICD10 code = G70.∗);2) ≥ 1 outpatient neurology encounter for MG among 4 MGB hospitals April 1, 2020 - March 31, 2021. Chart review excluded congenital myasthenic syndromes, LambertEaton myasthenic syndrome and patients without a confirmed MG diagnosis. Primary outcome was any TMU. Secondary outcome was proportion of telemedicine users achieving ≥ 1 VVV. EMR portal status was a proxy for digital literacy and access. Analyses included descriptive statistics, Chi Square test, and multivariable logistic regression. Results: 459 MG patients completed 1083 neurology encounters 451 (41.6%) in-person, 481 (44.4%) VVV and 151 (13.9%) AVO. 336/459 (73.2%) achieved telemedicine utilization (TMU). Baseline patient characteristics (age, sex, race/ethnicity, language, state of residence, insurance, distance to neurologist, portal access) were not associated with TMU. Patients with a MGB PCP were less likely to participate in telemedicine (OR 0.60 [0.36-0.99]). Of 336 patients with TMU, 259 (77.1%) had ≥ 1 VVV, while 77 (22.9%) had AVO. The AVO group had a smaller proportion of white patients (76.6% vs.84.3%, p=0.031). In adjusted analysis, no characteristics remained associated with VVV achievement. Conclusions: During 1 year of COVID-19, this MG cohort had high utilization rates of TM (73.2%) and VVV (77.1%). Older age, non-English language and portal inactivity were not associated with lower rates of TMU and VVV. Future studies should assess regional variation and outcomes of TMU in MG.