Survey: Telemedicine became 'essential tool' for headache care during COVID-19 pandemic

Telemedicine enabled headache care for “many patients” during the COVID-19 pandemic, with high rates of patient satisfaction, according to findings from a survey with more than 1,000 respondents.

Researchers presented the findings at the American Headache Society Virtual Annual Scientific Meeting.

“In March 2020, many health care institutions in the United States cancelled elective, non-urgent clinics and procedures in response to the national emergency of COVID-19,” Chia-Chun Chiang, MD, assistant professor of neurology and headache specialist at Mayo Clinic in Rochester, Minn., said during her presentation. “Telemedicine was quickly implemented and has now become essential, as it minimizes the geographic and physical barriers, preserves personal protective equipment and prevents the spread of COVID-19.”

Chiang and colleagues conducted an online survey to examine the patient perspective on telemedicine for headache care throughout the COVID-19 pandemic and patients’ desire to continue to use telemedicine as the pandemic continues and once it ends. The electronic questionnaire included 15 survey questions that reviewed patients’ experience using telemedicine for headache care between March and September of 2020. Researchers distributed the survey electronically through an American Migraine Foundation community support group on Facebook and its email contact database of 80,000 contacts, according to Chiang. They kept the survey open for 18 days.

The researchers collected 1,172 responses. Mean age of the survey respondents was 49.5 years and most respondents were women (86.8%). Most respondents (95.6%) self-reported a headache diagnosis of migraine that was obtained prior to telemedicine use.

Chiang and colleagues asked patients whether they used telemedicine visits for their headache disorder during the COVID-19 pandemic. More patients said yes (57.5%) than no (42.5%). Among those who did not use telemedicine during the pandemic, more than half of respondents (56.1%) said they had no reason for a visit, while 25.2% said they did not know it was an option. For those who did report using telemedicine, the majority (85.5%) used it for follow-up care. Additionally, most survey respondents (92.6%) did not receive a new headache diagnosis during the COVID-19 pandemic, according to Chiang.

Nearly half of the providers listed in the survey results (43.7%) were headache specialists. Other providers included general neurologists, primary care providers, headache nurse practitioners and headache nurses. The number of patients prescribed new treatment through telemedicine was nearly evenly split, with 52.4% of patients stating that they did receive a prescription for a new treatment and 43.7% saying no.

The survey results demonstrated that patients had positive experiences using telemedicine for the treatment of a headache disorder, Chiang noted, with 62.1% of patients rating their experience as very good and 20.7% reporting it as good. The researchers also asked patients whether they would continue to use telemedicine for headache visits; 44.8% said yes, while 45% said yes but not for all visits.

“Our results indicate that telemedicine has become an essential tool for patients and a wide variety of clinicians. Telemedicine provides patients with opportunities to gain better control of their headache disorders while not having to commit to the time to travel and risk exposure to COVID-19,” Chiang said. “Our study also showed the different levels of care involved in the real-life practice of headache medicine that utilized and benefited from telemedicine.”

Chiang noted that, should a rollback of insurance coverage for telemedicine occur, “patients and multiple levels of health care providers would be significantly affected.”

She also highlighted “several barriers” to care that became evident in the survey results. Respondents who did not report using telemedicine cited various reasons, including not knowing that telemedicine was an option, wanting to use it but not being offered the option by their provider, not having it covered by insurance or not having the necessary technology to connect with a clinician.

“We can address these challenges and improve our ability to provide care to patients by taking a few specific steps,” Chiang said.

Examples of these steps highlighted by Chiang included the expansion of insurance coverage for telemedicine even after the COVID-19 pandemic ends and greater promotion of the use of telemedicine so patients know it is available to them. She also noted that telemedicine is limited to those “who have reliable internet service” and that society should view internet access “as a necessity” while working to expand service.

“Telemedicine facilitated headache care for many patients during the COVID-19 pandemic, resulting in high patient satisfaction rates and a desire to continue to utilize telemedicine for future headache care for those who responded to the online survey,” Chiang said. “We hope this survey also serves as an appeal to insurers to continue to support telemedicine for headache care during and after the pandemic.”