Teleneurology clinics for polyneuropathy: a pilot study

• Published in: Journal of neurology Vol. 267; no. 2; pp. 479 - 490
• Main Authors: Wilson, Andrew M., Jamal, Nasheed I., Cheng, Eric M., Inkelas, Moira, Saliba, Debra, Hanssen, Andrea, Torres, Jorge A., Ong, Michael K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2020; Springer Nature B.V
• Subjects: Clinics; Medicine; Medicine & Public Health; Morbidity; Narcotics; Neurology; Neuroradiology; Neurosciences; Original Communication; Patients; Physical therapy; Polyneuropathy; Telemedicine; Neuropathy; Evidence-based; Telemedicine; Polyneuropathy; Teleneurology; Guidelines
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-019-09553-0

Introduction Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System. Methods For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics. Results The average tele-PN encounter and exam times were 28.5 and 9.1 min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic’s success, saving an average of 231 min per patient in round-trip travel. The medical team’s caring and collaborative spirit received high praise. While the clinic’s efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement. Conclusion In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter.