Teleneurology program linked to more efficient care, high level of veteran satisfaction

Key takeaways:

• US military veterans underwent synchronous telehealth consults at seven sites within the VA Health Administration.
• Scheduling and completion of telehealth consults was significantly faster than community care.

Utilization of a teleneurology program by U.S. military veterans resulted in more efficient care compared with the community standard, and resulted in a high level of satisfaction, per research from the Journal of General Internal Medicine.

“Accessing neurological care presents numerous challenges for patients often facing chronic, disabling conditions,” Linda S. Williams, MD, FAHA, FAAN, study co-author and research scientist at the William M. Tierney Center for Health Services at the Regenstrief Institute, based in Indiana, and colleagues wrote. “Studies show that access to neurological care improves clinical outcomes, and therefore increasing and facilitating access is imperative.”

As gaps exist in the sphere of telemedicine, researchers sought to address those in neurology care by developing and implementing the first outpatient National Teleneurology Program (NTNP) in 12 Veterans Administration medical centers with seven neurologists in fiscal year 2021.

Their study involved synchronous telehealth visits via video links to a home or outpatient clinic to veterans who had a choice of care that included NTNP as well as Community Care Networks (CCN). A total of 259 veterans participated at seven control sites, resulting in 1,521 consults with 1,084 (71.3%) completed. Data on NTNP and CCN consults were obtained from the VA Corporate Data Warehouse. Veterans who completed an NTNP consult within the first 6 months of NTNP activity at their chosen site were eligible for a patient satisfaction interview.

Primary diagnosis for the NTNP visit was assessed by ICD-10 codes, then grouped into common neurological disease categories based on clinical review; ICD-10 codes indicating a symptom and not a specific diagnosis were grouped into a separate category. Patient location was classified using VHA designation as Urban or Rural/Highly Rural.

The primary measures for the study were volume of consults before and after implementation between NTNP and CCN, as well as time to schedule and complete consults and overall veteran satisfaction.

According to results, NTNP consults were scheduled (10.1 days vs. 29.0 days) and completed (44.0 days vs. 96.9 days) significantly faster than CCN consults. Veterans reported a high level of satisfaction with NTNP care, registering a mean overall satisfaction score of 6.3 on a 7-point Likert scale.

Researchers also found, after NTNP initiation, monthly CCN consult volume was unchanged at NTNP sites compared with pre-implementation (mean change of 4.6 consults per month, [95% CI; 4.3, 13.6]), but control sites had a significant increase (mean change of 24.4 [5.2, 43.7]).

“Our study suggests that teleneurology care not only improves access to care but is feasible and acceptable to patients,” Williams and colleagues wrote.