Falconer Drew, Gow Sonia, Whitney David, Walters Hannah, Rogers Sean
Inova Parkinson's and Movement Disorders Center, Falls Church, VA, United States.
Front Neurol. 2022 Apr 7;13:830196. doi: 10.3389/fneur.2022.830196. eCollection 2022.
The onset of the COVID-19 pandemic in March of 2020 forced a rapid pivot to telehealth and compelled a use-case experiment in specialty telehealth neurology movement disorders care. The aims of this study were to quantify the potential benefit of telehealth as an option to the Parkinson's disease community as shown by the first 9 months of the COVID-19 pandemic, and to quantify the potential impact of the absence of a deep brain stimulation (DBS) telehealth option on DBS patient follow-up.
New patient visits to the Inova Parkinson's and Movement Disorder's Center from April to December 2020 (9 months) were retrospectively reviewed for telehealth vs. in-person, demographics (age, gender, race, primary insurance), chief complaint, prior movement disorders specialist (MDS) consultation, imaging tests ordered, and distance/travel time from primary zip code to clinic. Additionally, DBS programming visit volume from April to December 2020 was compared to DBS programming visit volume from April to December 2019.
Of the 1,097 new patients seen, 85% were via telehealth ( = 932) and 15% in person ( = 165). In the telehealth cohort, 97.75% had not consulted with an MDS before ( = 911), vs. 87.9% of in-person ( = 145). Age range was 61.8 +/- 17.9 years (telehealth), 68.8 +/- 16.0 years (in-person). Racial breakdown for telehealth was 60.7% White ( = 566), 10.4% Black ( = 97), 7.4% Asian ( = 69) and 4.5% Hispanic ( = 42); in-person was 70.9% White ( = 117), 5.5% Black ( = 9), 7.9% Asian ( = 13) and 5.5% Hispanic ( = 9). Top 5 consultation reasons, top 10 primary insurance providers and imaging studies ordered between the two cohorts were similar. Distance/travel time between primary zip code and clinic were 33.8 +/- 104.8 miles and 42.2 +/- 93.4 min (telehealth) vs. 38.1 +/- 114.7 miles and 44.1 +/- 97.6 min (in-person). DBS programming visits dropped 24.8% compared to the same period the year before (254 visits to 191 visits).
Telehealth-based new patient visits to a Movement Disorders Center appeared successful at increasing access to specialty care. The minimal difference in supporting data highlights the potential parity to in-person visits. With no telehealth option for DBS visits, a significant drop-off was seen in routine DBS management.
2020年3月新冠疫情的爆发迫使迅速转向远程医疗，并促使在专科远程医疗神经学运动障碍护理方面进行了一个用例实验。本研究的目的是量化在新冠疫情的前9个月中远程医疗作为帕金森病群体的一种选择的潜在益处，并量化缺乏深部脑刺激（DBS）远程医疗选项对DBS患者随访的潜在影响。
回顾性分析2020年4月至12月（9个月）因诺瓦帕金森病与运动障碍中心的新患者就诊情况，比较远程医疗与面对面就诊的情况，包括人口统计学特征（年龄、性别、种族、主要保险）、主要诉求、之前的运动障碍专科医生（MDS）会诊情况、所开具的影像检查，以及从主要邮政编码所在地到诊所的距离/出行时间。此外，将2020年4月至12月的DBS程控就诊量与2019年4月至12月的DBS程控就诊量进行比较。
在1097名新就诊患者中，85%（n = 932）通过远程医疗就诊，15%（n = 165）为面对面就诊。在远程医疗队列中，97.75%（n = 911）此前未咨询过MDS，而面对面就诊的这一比例为87.9%（n = 145）。年龄范围为61.8±17.9岁（远程医疗），68.8±16.0岁（面对面）。远程医疗患者的种族构成是：60.7%为白人（n = 566），10. / 4%为黑人（n = 97），7.4%为亚洲人（n = 69），4.5%为西班牙裔（n = 42）；面对面就诊患者中，70.9%为白人（n = 117），5.5%为黑人（n = 9），7.9%为亚洲人（n = 13），5.5%为西班牙裔（n = 9）。两个队列中前5位的会诊原因、前10位的主要保险提供商以及所开具的影像检查相似。主要邮政编码所在地与诊所之间的距离/出行时间分别为33.8±104.8英里和42.2±93.4分钟（远程医疗），以及38.1±114.7英里和44.1±97.6分钟（面对面）。与前一年同期相比，DBS程控就诊量下降了24.8%（从254次就诊降至191次就诊）。
基于远程医疗的运动障碍中心新患者就诊在增加专科护理可及性方面似乎是成功的。支持数据的微小差异凸显了与面对面就诊的潜在等同性。由于DBS就诊没有远程医疗选项，常规DBS管理出现了显著下降。
