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      Telehealth utilization and patient satisfaction in an ambulatory movement disorders center during the COVID-19 pandemic

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          Abstract

          Introduction

          Studies suggest that patients are satisfied with telehealth in ambulatory settings. However, tele-neurology satisfaction data are limited by a small sample size and COVID-19-era data is not specific to movement disorders clinics. In this prospective observational study, telehealth utilization during the COVID-19 pandemic was assessed, and patient satisfaction was compared between telehealth and in-person visits in an outpatient movement disorders center.

          Methods

          Patients ≥18 years who completed an appointment at Northwestern's Movement Disorders Clinic were invited to complete a post-visit Medallia survey. The primary outcomes of the survey were likelihood to recommend (LTR) provider, LTR location, and ‘spent enough time,’ on a 0–10 scale. Responses were categorized into in-person vs. telehealth groups.

          Results

          Telehealth utilization significantly increased from a pre-COVID timeframe rate of 0.3% (Nov 2019 to Feb 2020) to 39.5% during the COVID-19 pandemic (March 2020 through April 2021) ( p-value < 0.001). During the COVID-19 pandemic, 621 patients responded to the post-visit Medallia survey (response rate = 30%), including 365 in-person and 256 telehealth visits. No significant differences were observed between in-person and telehealth encounters in LTR provider ( p = 0.892), LTR location ( p = 0.659), and time spent ( p = 0.395). Additional subgroup multivariable analysis did not support differences in satisfaction between different age groups.

          Discussion

          With its large sample size, our study demonstrates that in the setting of increased TH utilization in movement disorders clinic during the COVID-19 pandemic, patients reported similar satisfaction with telehealth compared to in-person visits. This study supports the utility of telehealth to provide specialized neurologic clinic care.

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          Most cited references34

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          Is Open Access

          Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

          The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.
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            Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030.

            Based on published prevalence studies, we used two different methodologies to project the number of individuals with Parkinson disease (PD) in Western Europe's 5 most and the world's 10 most populous nations. The number of individuals with PD over age 50 in these countries was between 4.1 and 4.6 million in 2005 and will double to between 8.7 and 9.3 million by 2030.
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              National randomized controlled trial of virtual house calls for Parkinson disease

              Objective: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable. Methods: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire–39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings. Results: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] −2.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70–120; p < 0.0001) and 38 miles per visit (95% CI 36–56; p < 0.0001). Conclusions: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience. ClinicalTrials.gov identifier: NCT02038959. Classification of evidence: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.
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                Author and article information

                Journal
                J Telemed Telecare
                J Telemed Telecare
                JTT
                spjtt
                Journal of Telemedicine and Telecare
                SAGE Publications (Sage UK: London, England )
                1357-633X
                1758-1109
                27 December 2022
                27 December 2022
                : 1357633X221146819
                Affiliations
                [1 ]Department of Neurology, Ringgold 12244, universityNorthwestern University Feinberg School of Medicine; , Chicago, IL, USA
                [2 ]Department of Preventive Medicine-Biostatistics, Ringgold 12244, universityNorthwestern University Feinberg School of Medicine; , Chicago, IL, USA
                Author notes
                [*]Danielle N Larson, Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N Lakeshore Dr Suite 1115, Chicago, IL 60657, USA. Email: danielle.larson@ 123456northwestern.edu
                Author information
                https://orcid.org/0000-0001-7883-5022
                https://orcid.org/0000-0002-8505-6614
                Article
                10.1177_1357633X221146819
                10.1177/1357633X221146819
                9805996
                36575616
                ccb7a3e8-1c60-4cde-b60d-18e59c3d848c
                © The Author(s) 2022

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                : 8 September 2022
                : 2 December 2022
                Categories
                RESEARCH/Original Article
                Custom metadata
                corrected-proof
                ts19

                Medicine
                telemedicine,patient satisfaction,ambulatory clinic,movement disorders,covid-19,pandemic,telehealth

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