2019年冠状病毒病大流行后多发性硬化远程神经病学护理的可及性扩大。
Expanded access to multiple sclerosis teleneurology care following the COVID-19 pandemic.
作者信息
McGinley Marisa P, Gales Shauna, Rowles William, Wang Zhini, Hsu Wan-Yu, Amezcua Lilyana, Bove Riley
机构信息
Mellen Center, Cleveland Clinic, Cleveland, USA.
Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, USA.
出版信息
Mult Scler J Exp Transl Clin. 2021 Feb 25;7(1):2055217321997467. doi: 10.1177/2055217321997467. eCollection 2021 Jan-Mar.
BACKGROUND
Teleneurology for multiple sclerosis (MS) care was considered feasible, but utilization was limited.
OBJECTIVE
To describe how the existing teleneurology populations at two academic MS Centers changed during the COVID-19 pandemic.
METHODS
In this cross-sectional study, we captured all in-person and teleneurology visits at two academic MS Centers between January 2019 and April 2020. We compared group differences between the Centers, and COVID-related changes using T-, chi-squared Kruskal-Wallis and Fisher exact tests.
RESULTS
2268 patients completed 2579 teleneurology visits (mean age 48.3 ± 13.3 years, 72.9% female). Pre-COVID, the Centers' teleneurology populations were similar for age, sex, MS type, and disability level (all p > 0.1), but differed for race (96.5% vs 80.7% white, p ≤ 0.001), MS treatment (49.1% vs 32.1% infusible, p ≤ 0.001), and median distance from Center (72 vs 186 miles, p ≤ 0.001). Post-COVID, both Centers' teleneurology populations had more black (12.7% vs 4.37%, p ≤ 0.001) and local (median 34.5 vs 102 miles, p ≤ 0.001) patients.
CONCLUSION
Teleneurology visits in 2019 reflected the organizational and local teleneurology reimbursement patterns of our Centers. Our post-COVID-19 changes illustrate the potential for payors and policy to change disparities in access to, or utilization of, remote care. Patients' perception of care quality and value following this shift warrants study.
背景
远程神经学用于多发性硬化症（MS）护理被认为是可行的，但利用率有限。
目的
描述两个学术性MS中心现有的远程神经学患者群体在新冠疫情期间的变化情况。
方法
在这项横断面研究中，我们记录了2019年1月至2020年4月期间两个学术性MS中心的所有面对面就诊和远程神经学就诊情况。我们使用T检验、卡方检验、Kruskal-Wallis检验和Fisher精确检验比较了两个中心之间的组间差异以及与新冠疫情相关的变化。
结果
2268名患者完成了2579次远程神经学就诊（平均年龄48.3±13.3岁，72.9%为女性）。在新冠疫情之前，两个中心的远程神经学患者群体在年龄、性别、MS类型和残疾水平方面相似（所有p>0.1），但在种族方面存在差异（白人分别为96.5%和80.7%，p≤0.001），在MS治疗方面存在差异（可输注治疗分别为49.1%和32.1%，p≤0.001），以及与中心的中位距离存在差异（分别为72英里和186英里，p≤0.001）。在新冠疫情之后，两个中心的远程神经学患者群体中黑人患者更多（分别为12.7%和4.37%，p≤0.001），本地患者更多（中位距离分别为34.5英里和102英里，p≤0.001）。
结论
2019年的远程神经学就诊情况反映了我们中心的组织和当地远程神经学报销模式。我们在新冠疫情后的变化说明了支付方和政策在改变远程护理的可及性或利用率方面的差异方面的潜力。这种转变后患者对护理质量和价值的看法值得研究。
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