Telemedicine effective, accepted by providers in large pediatric neurology network

The rapid implementation of telemedicine in a large pediatric neurology network due to the COVID-19 pandemic revealed that telemedicine is feasible and effective for “a large proportion” of this patient population.

The findings from the division of neurology at Children’s Hospital of Philadelphia – a pediatric specialty care network that includes an urban quaternary care hospital, an ambulatory center, and an additional 8 satellite locations offering child neurology care – were published in Neurology.

“Telemedicine in neurology care has been reported primarily in adult stroke care, rural health systems and specific disease populations such as epilepsy and headache. Reports of pediatric neurology telemedicine delivery have been limited to programs for underserved populations,” the researchers wrote. “Here, we analyzed the implementation of telehealth services in our large pediatric neurology care network, including scheduled telephone encounters and newly implemented audio-video telemedicine encounters.”

Salvatore C. Rametta, MD, a child neurology resident in the division of neurology at Children's Hospital of Philadelphia, and colleagues performed a cohort study with retrospective comparison of 14,780 in-person visits and 2,589 telehealth encounters, including 2,093 audio-video telemedicine visits and 496 scheduled telephone encounters, between Oct. 1, 2019, and April 24, 2020. The researchers compared patient demographics and diagnoses across in-person and telehealth encounters. They also analyzed responses to questionnaires regarding provider experience, follow-up plans, technical quality, need for in-person assessment and parent/caregiver satisfaction for audio-video telemedicine encounters. Manual reviews were conducted for encounters marked as concerning to providers.

The researchers observed no differences in patient age and major ICD-10 codes prior to, and following, the transition to telemedicine. The most frequent primary diagnoses in the in-person and telehealth cohorts included epilepsy (30%) and migraine (20%). The researchers observed a slightly greater prevalence of epilepsy diagnoses among the telehealth (30%) cohort compared with the in-person (27%) cohort (OR = 1.2; 95% CI, 1.1–1.3). The percentage of patients with migraine was 20% in both cohorts.

Clinicians reported telemedicine as satisfactory in 93% (1,200/1,286) of encounters and suggested telemedicine be a component for follow-up care in 89% (1,144/1,286) of encounters. Technical challenges were reported in 40% (519/1,314) of encounters. In-person assessment was considered warranted after 5% (65/1,185) of encounters.

Patients/caregivers expressed interest in telemedicine for upcoming visits in 86% (187/217) of encounters.

Participation in telemedicine encounters compared with telephone encounters occurred less often among patients in racial or ethnic minority groups. Patients who self-identified as Black comprised 21% of the group to select telephone encounters compared with 11% of the group to select telemedicine encounters (OR = 2.2; 95% CI, 1.7–3). Hispanic/Latino patients made up 14% of telephone encounters compared with 9% of telemedicine encounters (OR = 1.7; 95% CI, 1.2–2.3). The researchers observed similar results when they compared telephone encounters with in-person follow-up visits.

The researchers noted the relevance of these findings in the context of another finding of the study, which demonstrated that most providers said they would continue to use telemedicine after the pandemic if given the opportunity.

“In some instances, telemedicine may be able to remove barriers to care that result from in-person encounters. This benefit may be especially true for underserved patients whose caregivers cannot afford to miss work or travel to the clinic in person, who live far from our facilities, or who have complex transportation needs,” the researchers wrote. “However, this study uncovered disparities in the delivery of telemedicine care to patients in racial and ethnic minority groups, who received care in the same proportion as in-person encounters but were less likely to have access to the potentially more robust care that telemedicine encounters can provide compared to telephone encounters.”

Additional research to address these differences is ongoing, according to Rametta and colleagues. Other areas of focus for future research include determining whether documented benefits of telemedicine, such as reductions in the number of patients who don’t show up for visits, costly ED visits and miles patients travel to appointments, occur when telemedicine is used more widely in pediatric neurology.

“We effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters,” the researchers wrote. “We expect that further research into optimizing these technologies will show telemedicine to be even more valuable than demonstrated in our study.”