Yardi Ruta, McLouth Christopher J, Roman Guzman Ana M, Vasireddy Rani Priyanka, Mathias Sally V, Jehi Lara
Kentucky Neurological Institute, University of Kentucky, Lexington.
Geisinger Neuroscience Institute, PA.
Neurol Clin Pract. 2025 Apr;15(2):e200459. doi: 10.1212/CPJ.0000000000200459. Epub 2025 Mar 24.
This study was undertaken to compare the effectiveness of telemedicine visits with traditional in-person visits for epilepsy care and simultaneously attempts to identify patient demographics favoring telehealth.
We retrospectively collected demographic and clinical data from all adult epilepsy clinic visits at the University of Kentucky between July 2021 and September 2022. A propensity model using inverse probability of treatment weighting was constructed to examine the association between these variables and the choice of telemedicine vs in-person visits. The study investigated the effect of visit type on 5 specific clinical outcomes, using stabilized weights derived from the propensity model to adjust for confounding. Noninferiority analyses were conducted to compare telemedicine and in-person visits, with a predefined noninferiority margin set at a difference in proportions of 0.10.
Among 442 encounters included in the final analysis, 155 (35.1%) were in-person, while 287 (64.9%) were virtual. Telemedicine was noninferior to in-person visits for making antiseizure medication (ASM) regimen changes, discussing epilepsy surgery, and in postvisit emergency department visits for breakthrough seizures. The incidence of postvisit seizures and abnormalities on neurologic examination between visit modalities differed but did not meet the criteria for noninferiority. A propensity model identified 3 key variables influencing the decision to choose telehealth-age, distance to the clinic, and presence of a significant other. The likelihood of preferring telehealth increased by 42% for every 10-year decrease in age. Similarly, with every 50 miles an individual had to drive, their preference for a telemedicine visit increased by 33%. Finally, individuals in a relationship were more likely to prefer telehealth visits.
Telemedicine proves to be an effective and noninferior alternative to in-person appointments, proving particularly beneficial in overcoming geographic barriers to access. A hybrid model of mixed visit types can help overcome the limitations of conducting a thorough neurologic examination. Younger individuals, those facing long travel distances, and patients with significant others prefer current telemedicine technology. This emphasizes the need for future advancements in more user-friendly and affordable technology tailored toward diverse demographic needs.
本研究旨在比较远程医疗就诊与传统面对面就诊在癫痫护理方面的有效性，并同时尝试确定有利于远程医疗的患者人口统计学特征。
我们回顾性收集了2021年7月至2022年9月期间肯塔基大学所有成人癫痫门诊就诊的人口统计学和临床数据。构建了一个使用治疗权重逆概率的倾向模型，以检验这些变量与远程医疗就诊与面对面就诊选择之间的关联。该研究使用从倾向模型得出的稳定权重来调整混杂因素，调查就诊类型对5种特定临床结局的影响。进行非劣效性分析以比较远程医疗和面对面就诊，预定义的非劣效性界值设定为比例差异0.10。
在最终分析纳入的442次就诊中，155次（35.1%）为面对面就诊，而287次（64.9%）为虚拟就诊。在调整抗癫痫药物（ASM）治疗方案、讨论癫痫手术以及就诊后因突破性癫痫发作前往急诊科就诊方面，远程医疗不劣于面对面就诊。就诊方式之间就诊后癫痫发作的发生率和神经学检查异常情况有所不同，但未达到非劣效性标准。一个倾向模型确定了影响选择远程医疗决策的3个关键变量——年龄、到诊所的距离以及是否有重要他人陪伴。年龄每降低10岁，选择远程医疗的可能性增加42%。同样，个人每多驾车行驶50英里，他们选择远程医疗就诊的偏好就增加33%。最后，处于恋爱关系中的个人更有可能选择远程医疗就诊。
远程医疗被证明是面对面预约的一种有效且非劣效的替代方式，在克服就医的地理障碍方面尤其有益。混合就诊类型的混合模式有助于克服进行全面神经学检查的局限性。较年轻的个体、面临长途旅行的人以及有重要他人陪伴的患者更喜欢当前的远程医疗技术。这强调了未来需要开发更便于用户使用且价格合理的技术，以满足不同人口统计学需求。
