Telehealth in Outpatient Neurology: Physician and Patient Perspectives

ABSTRACT

Objective: To evaluate patient and physician perceptions of aspects of telehealth including ease of use, convenience, effectiveness for communication, and overall quality of care. Background: At the start of the COVID19 pandemic, telehealth was rapidly integrated into outpatient neurology at Yale School of Medicine, allowing continued delivery of non-acute, outpatient care while minimizing the risk of potential disease spread. From March 2020 through March 2021, almost half of outpatient appointments were telehealth visits. Design/Methods: Anonymous surveys were administered to patients and physicians in six neurology subspecialty clinics from October to December 2020. Items were scored on a 5-point Likert scale (1=strongly disagree;5 =strongly agree), with an option for additional comments. Results: 120 consecutive patients responded to the survey (20 each in 6 different subspecialty clinics). Most patients strongly agreed that the technology was user-friendly and high quality (70.0%), telehealth is more convenient than face-to-face appointments (76.7%), and facilitates adequate communication of concerns (70.0%) and appropriate care (73.3%). Fewer than half of patients (45.8%) felt that telehealth provides the same overall quality of care due to lack of physical examination and personal rapport with their neurologist, among other reasons. There were no statistically significant differences in patient responses from each subspecialty clinic. 29/44 (65.9%) of physicians responded to the survey. Physicians had more negative overall perceptions about the ease of use/quality of technology (mean Likert score 3.52 vs 4.47, p<0.001), communication of concerns (mean 3.69 vs 4.58, p<0.001), and quality of care (mean 3.14 vs 3.92, p=0.002). Conclusions: Telehealth in outpatient neurology is perceived as convenient and effective by patients, and less so by physicians. A majority of physicians and patients perceive that telehealth facilitates a lower overall quality of care compared to in-person visits. Further studies may help identify situations where telehealth is most useful in neurological care.