Researchers examine the impression of teleneurology program on timeliness of entry to neurological care

Accessing neurologic care usually presents bodily, geographical and monetary challenges to sufferers, lots of whom face continual and disabling circumstances. With a nationwide shortage of neurologists within the U.S., particularly in rural areas, disparities in entry to well timed neurological evaluation and therapy are usually not unusual. Telehealth addresses entry to care in addition to different inequity points.

To fulfill the necessity for prompter care and to decrease disparity for rural veterans, the U.S. Division of Veterans’ Affairs (VA) Nationwide Teleneurology Program was funded in 2019 by the VA’s Workplace of Rural Well being. This system is a patient-centered, versatile, cost-effective digital hub mannequin that makes use of synchronous (video) and asynchronous applied sciences.

In one of many first and largest research of outpatient normal teleneurology care, a analysis crew, led by Linda S. Williams, M.D., a VA and Regenstrief Institute clinician-researcher, evaluated the modern program which serves sufferers with many frequent circumstances together with headache, seizures, a number of sclerosis, current stroke and again ache.

The researchers studied the impression the teleneurology program had on the timeliness of entry to neurological care, in addition to this system’s impact on the quantity of veteran neurology consultations accomplished outdoors the VA system -; the one possibility for many veterans previous to this new program.

“Telehealth is a method that the VA helps veterans obtain care wherever they’re. They do not even have to go away their dwelling,” mentioned Dr. Williams. “And this is essential for some sufferers with circumstances like epilepsy that may make driving troublesome and for older sufferers, who might battle to drive to a bigger metropolis that has a neurologist.

Within the VA teleneurology program, clinicians noticed many frequent neurological issues analogous to these seen in any normal neurology clinic. I believe our outcomes are seemingly relevant to non-VA teleneurology packages, though the VA has a really strong infrastructure for teleneurology care and for telehealth care normally, in contrast to many well being techniques.”

Dr. Linda S. Williams, M.D., a VA and Regenstrief Institute clinician-researcher

The researchers in contrast wait instances for appointments at VA websites that had carried out telecare for normal neurology sufferers versus websites that had not but carried out it and located shorter wait instances for telehealth appointments than in-person visits. Additionally they investigated wait instances for eligible veterans to obtain appointments with a group neurologist as a consequence of lack of ability to obtain an in-person appointment with a VA clinician. The researchers discovered that websites which had carried out the teleneurology program didn’t see an increase within the quantity of group care requests within the yr after program implementation and that wait time for teleneurology was considerably lower than wait instances for an appointment with a group neurologist. Websites that didn’t implement telehealth for continual neurologic circumstances had a big enhance over time within the month-to-month variety of group care neurology consults they positioned.

Since passage by Congress of the Mission Act of 2018, veterans dwelling greater than 60 miles from a VA facility or those that should wait greater than 28 days to obtain care from a VA clinician are eligible to obtain that care in the neighborhood. Nevertheless, wait time for an appointment with a group neurologist is commonly fairly lengthy, particularly in rural areas, the place solely about 3 p.c of U.S. neurologists observe. 4 out of 5 rural counties within the U.S. would not have a minimum of one neurologist.

“If you implement a brand new program, you might want to ask: Does it actually make a big distinction within the consequence that you just’re attempting to succeed in,” notes Dr. Williams. “With this program we had been attempting to enhance the velocity at which veterans may obtain neurologic care, and we had been additionally attempting to know, from the healthcare system perspective, whether or not implementing this new telehealth program actually made a dent in the neighborhood care quantity that the VA has been sending out to non-VA physicians, which has been growing over the previous few years.”

The authors conclude, “Because the mismatch between the proportion of the inhabitants with neurologic circumstances and the variety of neurologists grows, Teleneurology outpatient care, as demonstrated by NTNP [VA National Tele-neurology Program], is one technique of bettering affected person entry to neurologic specialists. This care overcomes some necessary boundaries to entry, together with rural residence and shortage of native neurologists, and could be supplied with excessive satisfaction amongst sufferers and their referring major care suppliers. Though little randomized trial proof exists to evaluate the efficacy of telehealth take care of continual circumstances, and most of this literature is in sufferers with diabetes, our examine means that Teleneurology care not solely improves entry to care however is possible and acceptable to sufferers; future research ought to assess the efficacy of Teleneurology care in comparison with in-person take care of ongoing administration of sufferers with neurologic circumstances.”