Over recent years there has been a shift in clinical practice to support care delivery via telemedicine. This study aims to highlight the patient and provider experience of telemedicine over 2.5 years within a Canadian Pediatric Neurology clinic.
Method
A REDCap survey was sent to all patients/parents and providers with a telemedicine appointment between March 2020 and September 2022.
Results
Seven providers and 272 patients responded. Ninety-one percent of patients and 100% of providers were satisfied with telemedicine. Ninety percent of patients and 100% of providers found telemedicine more convenient. Eighty-seven percent of patients and 100% of providers were interested in future telemedicine appointments. Main challenges were with performing a physical examination and technological issues.
Conclusion
Our survey shows that the majority of patients and providers had highly positive experiences with telemedicine and were interested in continuing care via telemedicine. This study supports incorporating telemedicine into future pediatric neurology practice.
Hatcher-MartinJMBusisNACohenBH, et al.American Academy of Neurology telehealth position statement. Neurology. 2021;97(7):334-339. doi:https://doi.org/10.1212/WNL.0000000000012185
2.
WosikJFudimMCameronB, et al.Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc.2020;27(6):957-962. doi:https://doi.org/10.1093/jamia/ocaa067
3.
MannDMChenJChunaraRTestaPANovO. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc.2020;27(7):1132-1135. doi:https://doi.org/10.1093/jamia/ocaa072
4.
Alliance for Healthier Communities. Providing safe and high-quality virtual care: a guide for new and experienced users: Clinician Change Virtual Care Toolkit. Canada Health Infoway; 2022. www.infoway-inforoute.ca
5.
Hatcher-MartinJMAdamsJLAndersonER, et al.Telemedicine in neurology: Telemedicine work group of the American Academy of Neurology update. Neurology. 2020;94(1):30-38. doi:https://doi.org/10.1212/WNL.0000000000008708
6.
WirrellECGrinspanZMKnuppKG, et al.Care delivery for children with epilepsy during the COVID-19 pandemic: an international survey of clinicians. J Child Neurol. 2020;35(13):924-933. doi:https://doi.org/10.1177/0883073820940189
7.
GrefeAHsiehDJoshiC, et al.Pediatric neurological examination via telemedicine V2. 2020. https://www.childneurologysociety.org/wp-content/uploads/2021/08/Pediatric-Neuro-Exam-via-Telemedicine-Oct2020-v2.pdf
8.
American Medical Association. COVID-19 state policy guidance on telemedicine. AMA; 2020. https://www.ama-assn.org/system/files/2020-04/covid-19-state-policy-guidance-on-telemedicine.pdf
9.
GoldbloomEBBubaMBhattMSuntharalingamSKingWJ. Innovative virtual care delivery in a Canadian paediatric tertiary-care centre. Paediatr Child Health. 2022;27(Suppl 1):S9-S14. doi:https://doi.org/10.1093/pch/pxab104
10.
VersnelJPackerTWeeksLE, et al.The everyday experience of living with and managing a neurological condition (the LINC study): study design. BMC Neurol. 2013;13(1):30. doi:https://doi.org/10.1186/1471-2377-13-30
11.
BerryJGPoduriABonkowskyJL, et al.Trends in resource utilization by children with neurological impairment in the United States inpatient health care system: a repeat cross-sectional study. PLoS Med. 2012;9(1):e1001158. doi:https://doi.org/10.1371/journal.pmed.1001158
12.
AppireddyRJaliniSShuklaGBoissé LomaxL. Tackling the burden of neurological diseases in Canada with virtual care during the COVID-19 pandemic and beyond. Can J Neurol Sci.2020;47(5):594-597. doi:https://doi.org/10.1017/cjn.2020.92
13.
DayalPChangCHBenkoWS, et al.Hospital utilization among rural children served by pediatric neurology telemedicine clinics. JAMA Netw Open. 2019;2(8):e199364. doi:https://doi.org/10.1001/jamanetworkopen.2019.9364
14.
DayalPChangCHBenkoWS, et al.Appointment completion in pediatric neurology telemedicine clinics serving underserved patients. Neurol Clin Pract. 2019;9(4):314-321. doi:https://doi.org/10.1212/CPJ.0000000000000649
15.
GolebiowskaBGolebiowskaM. Pediatric neurology and telehealth before and during SARS-CoV-2 pandemic. J Educ Health Sport. 2021;11(12):254-272. doi:https://doi.org/10.12775/JEHS.2021.11.12.019
16.
LeeJSchraderDBoelmanCHuhLConnollyMB. Rapid implementation of virtual health in a pediatric neurology practice during COVID-19. Can J Neurol Sci.2021;48(4):575-577. doi:https://doi.org/10.1017/cjn.2020.241
17.
RamettaSCFridingerSEGonzalezAK, et al.Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic. Neurology. 2020;95(9):E1257-E1266. doi:https://doi.org/10.1212/WNL.0000000000010010
18.
KaufmanMCXianJGalerPD, et al.Child neurology telemedicine: analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic. Dev Med Child Neurol. 2023;65(3):406-415. doi:https://doi.org/10.1111/dmcn.15406
19.
JoshiCNYangMLEschbachK, et al.Quality and safety analysis of 2,999 telemedicine encounters during the COVID-19 pandemic. Neurol Clin Pract. 2021;11(2):e73-e82. doi:https://doi.org/10.1212/cpj.0000000000001025
20.
BainJMDyerCAGalvinM, et al.How providers in child neurology transitioned to telehealth during COVID-19 pandemic. Child Neurol Open. 2021;8:2329048X2110229. doi:https://doi.org/10.1177/2329048×211022976
21.
GolebiowskaBGolebiowskaM. Pediatric neurology and telehealth before and during SARS-CoV-2 pandemic. J Educ Health Sport. 2021;11(12):254-272. doi:https://doi.org/10.12775/jehs.2021.11.12.019
22.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. doi:https://doi.org/10.1016/j.jbi.2008.08.010
23.
HarrisPATaylorRMinorBL. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95. doi:https://doi.org/10.1016/j.jbi.2019.103208
24.
R Core Team. R: a language and environment for statistical computing. 2022.
25.
JoshiCJacobsonMSilveiraLSheaSYangMEschbachK. Risk of admission to the emergency room/inpatient service after a neurology telemedicine visit during COVID-19 pandemic. Pediatr Neurol. 2021;122:15-19. doi:https://doi.org/10.1016/j.pediatrneurol.2021.06.005
26.
PrelackMFridingerSGonzalezAK, et al.Visits of concern in child neurology telemedicine. Dev Med Child Neurol. 2022;64(11):1351-1358. doi:https://doi.org/10.1111/dmcn.15256
27.
RamettaSCFridingerSEGonzalezAK, et al.Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic. Neurology. 2020;95(9):E1257-E1266. doi:https://doi.org/10.1212/WNL.0000000000010010
28.
PatelUKMalikPDeMasiMLunagariyaAJaniVB. Multidisciplinary approach and outcomes of tele-neurology: a review. Cureus.2019;11(4):e4410. doi:https://doi.org/10.7759/cureus.4410
29.
Abu LibdehAFlaniganJHeinanK. Experience with pediatric neurology e-consults from a specialist perspective at an academic center. J Child Neurol. 2022;37(5):373-379. doi:https://doi.org/10.1177/08830738221077760
30.
FeslerJRStantonSMernerK, et al.Bridging the gap in epilepsy care: a single-center experience of 3700 outpatient tele-epilepsy visits. Epilepsia. 2020;61(8):e95-e100. doi:https://doi.org/10.1111/epi.16619
31.
AlkilanyRTarabichiYHongR. Telemedicine visits during COVID-19 improved clinic show rates. ACR Open Rheumatol. 2022;4(2):136-141. doi:https://doi.org/10.1002/acr2.11372
QubtyWPatniyotIGelfandA. Telemedicine in a pediatric headache clinic: a prospective survey. Neurology. 2018;90(19):E1702-E1705. doi:https://doi.org/10.1212/WNL.0000000000005482
35.
FortiniSEspecheACaraballoR. Telemedicine and epilepsy: a patient satisfaction survey of a pediatric remote care program. Epilepsy Res. 2020;165:106370. doi:https://doi.org/10.1016/j.eplepsyres.2020.106370
36.
BahraniKSinghMBBhatiaR, et al.Telephonic review for outpatients with epilepsy—a prospective randomized, parallel group study. Seizure. 2017;53:55-61. doi:https://doi.org/10.1016/j.seizure.2017.11.003
37.
GaliKJoshiSHuenekeS, et al.Barriers, access and management of paediatric epilepsy with telehealth. J Telemed Telecare. 2022;28(3):213-223. doi:https://doi.org/10.1177/1357633X20969531
38.
AlbertDVFDasRRAcharyaJN, et al.The impact of COVID-19 on epilepsy care: a survey of the American Epilepsy Society membership. Epilepsy Curr. 2020;20(5):316-324. doi:https://doi.org/10.1177/1535759720956994
StrasserLEOrrSLMcMillanHJDojaACallenDJA. Pediatric neurology workforce in Canada: a 5-year update. Can J Neurol Sci/Journal Canadien des Sciences Neurologiques. 2019;46(5):566-574. doi:https://doi.org/10.1017/cjn.2019.229
41.
WilmshurstJMCatsman-BerrevoetsCGilbertDL, et al.Access to pediatric neurology training and services worldwide. Neurology. 2023;101(18):798-808. doi:https://doi.org/10.1212/WNL.0000000000207633
42.
PeytonCGirvanOShellhaasRA, et al.Impact of COVID-19 pandemic on developmental service delivery in children with a history of neonatal seizures. Pediatr Neurol. 2022;129:14-18. doi:https://doi.org/10.1016/j.pediatrneurol.2022.01.004
43.
JesteSHydeCDistefanoC, et al.Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID-19 restrictions. J Intellect Disabil Res.2020;64(11):825-833. doi:https://doi.org/10.1111/jir.12776
44.
ReillyCMuggeridgeACrossJH. The perceived impact of COVID-19 and associated restrictions on young people with epilepsy in the UK: young people and caregiver survey. Seizure. 2021;85:111-114. doi:https://doi.org/10.1016/j.seizure.2020.12.024
45.
Van HeesSSiewe FodjoJNWijtvlietV, et al.Access to healthcare and prevalence of anxiety and depression in persons with epilepsy during the COVID-19 pandemic: a multicountry online survey. Epilepsy Behav.2020;112:107350. doi:https://doi.org/10.1016/j.yebeh.2020.107350
46.
CrossJHKwonCSAsadi-PooyaAA, et al.Epilepsy care during the COVID-19 pandemic. Epilepsia. 2021;62(10):2322-2332. doi:https://doi.org/10.1111/epi.17045
47.
KlotzKABorlotFScantleburyMH, et al.Telehealth for children with epilepsy is effective and reduces anxiety independent of healthcare setting. Front Pediatr. 2021;9:642381. doi:https://doi.org/10.3389/fped.2021.642381
48.
KummerBRAgarwalPSweetnamC, et al.Trends in the utilization of teleneurology and other healthcare resources prior to and during the COVID-19 pandemic in an urban, tertiary health system. Front Neurol. 2022;13:834708. doi:https://doi.org/10.3389/fneur.2022.834708
49.
RoselliniIVianelloMPalmieriA, et al.Patient satisfaction with televisit in chronic neurologic disorders during COVID-19 pandemic. Acta Neurol Belg. 2023;123(3):983-991. doi:https://doi.org/10.1007/s13760-023-02173-6
50.
KennellyAMMcIntyreBWoodACMonteiroSVoigtRG. Patient satisfaction in neurodevelopmental pediatrics: In-person vs telemedicine. J Child Neurol. 2022;37(3):181-185. doi:https://doi.org/10.1177/08830738221075451
51.
Dozières-PuyravelBAuvinS. Usefulness, limitations, and parental opinion about teleconsultation for rare pediatric epilepsies. Epilepsy Behav. 2021;115:107656. doi:https://doi.org/10.1016/j.yebeh.2020.107656
52.
ChadehumbeMCraigSStephensonDHelbigI. Child neurology telemedicine: understanding the data we have and finding the patients we do not see. Pediatr Neurol. 2021;116:84. doi:https://doi.org/10.1016/j.pediatrneurol.2020.11.010
53.
SattarSKupermanR. Telehealth in pediatric epilepsy care: a rapid transition during the COVID-19 pandemic. Epilepsy Behav. 2020;111:107282. doi:https://doi.org/10.1016/j.yebeh.2020.107282
54.
El-HassarLAmaraASansonB, et al.Telemedicine in neuromuscular diseases during COVID-19 pandemic: ERN-NMD European survey. J Neuromuscul Dis.2023;10(2):173-184. doi:https://doi.org/10.3233/jnd-221525
55.
PandaPKDawmanLPandaPSharawatIK. Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country. Seizure. 2020;81:29-35. doi:https://doi.org/10.1016/j.seizure.2020.07.013
56.
TrivisanoMSpecchioNPietrafusaN, et al.Impact of COVID-19 pandemic on pediatric patients with epilepsy—the caregiver perspective. Epilepsy Behav. 2020;113:107527. doi:https://doi.org/10.1016/j.yebeh.2020.107527
57.
GrinspanZMMytingerJRBaumerFM, et al.Management of infantile spasms during the COVID-19 pandemic. J Child Neurol. 2020;35(12):828-834. doi:https://doi.org/10.1177/0883073820933739
58.
MadaanPSahuJKWanigasingheJ, et al.Teleneurology based management of infantile spasms during COVID-19 pandemic: a consensus report by the South Asia Allied West syndrome research group. Epilepsy Behav Rep. 2021;15:100423. doi:https://doi.org/10.1016/j.ebr.2020.100423
59.
FredwallMTerryDEncisoLBurchMMTrottKAlbertDVF. Short-term outcomes in pediatric and adolescent patients with psychogenic nonepileptic events seen by telemedicine during the COVID-19 pandemic. Epilepsy Behav. 2021;117:107739. doi:https://doi.org/10.1016/j.yebeh.2020.107739
60.
KossoffEHTurnerZAdamsJ, et al.Ketogenic diet therapy provision in the COVID-19 pandemic: dual-center experience and recommendations. Epilepsy Behav. 2020;111:107181. doi:https://doi.org/10.1016/j.yebeh.2020.107181
61.
SemprinoMFasuloLFortiniS, et al.Telemedicine, drug-resistant epilepsy, and ketogenic dietary therapies: a patient survey of a pediatric remote-care program during the COVID-19 pandemic. Epilepsy Behav. 2020;112:107493. doi:https://doi.org/10.1016/j.yebeh.2020.107493
62.
ArmenoMCaballeroEVeriniA, et al.Telemedicine- versus outpatient-based initiation and management of ketogenic diet therapy in children with drug-resistant epilepsy during the COVID-19 pandemic. Seizure. 2022;98:37-43. doi:https://doi.org/10.1016/j.seizure.2022.03.023
63.
ClausenTCGreveNKMüllerKIKristoffersenESSchytzHW. Telemedicine in headache care: a systematic review. Cephalalgia. 2022;42(13):1397-1408. doi:https://doi.org/10.1177/03331024221111554
VargasBBShepardMHentzJGKutyreffCHersheyLGStarlingAJ. Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion. Neurology. 2017;88(16):1580-1583. doi:https://doi.org/10.1212/WNL.0000000000003841
66.
Cen S shan, Yu J, Wang Q, et al. Multidisciplinary telemedicine care for Tourette syndrome: minireview. Front Neurol. 2020;11:573576. doi:https://doi.org/10.3389/fneur.2020.573576
67.
GorterHLucasCGroothuis-OudshoornKMaathuisCvan Wijlen-HempelRElversH. The use of video clips in teleconsultation for preschool children with movement disorders. Pediatr Phys Ther.2013;25(3):323-329. doi:https://doi.org/10.1097/PEP.0b013e3182983399
68.
Ben-PaziHBeni-AdaniLLamdanR. Accelerating telemedicine for cerebral palsy during the COVID-19 pandemic and beyond. Front Neurol. 2020;11:746. doi:https://doi.org/10.3389/fneur.2020.00746
69.
ReyesSCunninghamALKalincikT, et al.Update on the management of multiple sclerosis during the COVID-19 pandemic and post pandemic: an international consensus statement. J Neuroimmunol. 2021;357:577627. doi:https://doi.org/10.1016/j.jneuroim.2021.577627
70.
Amir YazdaniPLouS-JMMatovicS, et al.Experience of parents of children with genetically determined leukoencephalopathies regarding the adapted health care services during the COVID-19 pandemic. J Child Neurol. 2022;37(4):237-245. doi:https://doi.org/10.1177/08830738211065317
71.
SaportaMAGranitVLewisRBenatarM. Yes, we can: neuromuscular examination by telemedicine. Muscle Nerve. 2020;62(6):E83-E85. doi:https://doi.org/10.1002/mus.27056
72.
CarrollKAdamsJde ValleK, et al.Delivering multidisciplinary neuromuscular care for children via telehealth. Muscle Nerve. 2022;66(1):31-38. doi:https://doi.org/10.1002/mus.27557
73.
KonankiRGulatiSPrasadKSainiLPandeyRMPaulVK. Comparison of telephone with face to face consultation for follow up of neurocysticercosis. Epilepsy Res. 2018;145:110-115. doi:https://doi.org/10.1016/j.eplepsyres.2018.06.005
74.
NussbaumNLYoungSRDeLeonRCEngelmannMLSchraegleWA. The future is now: pediatric neuropsychological presurgical epilepsy evaluation in the age of COVID-19. Epileptic Disord.2021;23(2):274-280. doi:https://doi.org/10.1684/epd.2021.1274
75.
MengGMcAineyCPerlmanCMMcKillopITisseverasingheTChenHH. Service process factors affecting patients’ and clinicians’ experiences on rapid teleconsultation implementation in out-patient neurology services during COVID-19 pandemic: a scoping review. BMC Health Serv Res. 2022;22(1):534. doi:https://doi.org/10.1186/s12913-022-07908-4
76.
MacaronMMSegun-OmosehinOAMatarRH, et al.A systematic review and meta analysis on burnout in physicians during the COVID-19 pandemic: a hidden healthcare crisis. Front Psychiatry. 2023;13:1071397. doi:https://doi.org/10.3389/fpsyt.2022.1071397
77.
PanagiotiMGeraghtyKJohnsonJ, et al.Association between physician burnout and patient safety, professionalism, and patient satisfaction. JAMA Intern Med. 2018;178(10):1317. doi:https://doi.org/10.1001/jamainternmed.2018.3713
78.
ZöllnerJPRosenowFSchubert-BastS, et al.Consultation requests and satisfaction with a telehealth network for epilepsy: longitudinal analysis of the Epilepsy Network Hessen Evaluation. Telemed e-Health. 2024:30(7):e2013-e2023. doi:https://doi.org/10.1089/tmj.2023.0659
79.
OlszewskiCThomsonSPringK, et al.A comparison of telemedicine and in-person neurology visits: What are the factors that patients consider when selecting future visit type?J Neurol. 2022;269(9):5022-5037. doi:https://doi.org/10.1007/s00415-022-11149-0
