Teleneurology acceptable among veterans with varying conditions

Veterans found their outpatient teleneurology experience acceptable independent of their neurologic condition, new research shows.

Published in the Journal of Neurology, the study examined whether patients with various neurological conditions found teleneurology acceptable and the factors influencing acceptability.

The Department of Veterans Health Administration’s (VA) Office of Rural Health developed the National Teleneurology Program (NTNP) in 2019 to combat neurology care access issues due to neurologist shortages and an aging population. The program provides timely and expanded access to specialty neurology care for veterans in rural and under-resourced areas.

The program includes 17 VA medical centers across the United States. Neurologists participating in the program are located nationwide, and patients can be referred for clinical evaluation of any neurologic symptoms or conditions.

Researchers assessed data from all sites that joined the program before 2023 for the study. Veterans who completed a teleneurology visit in the first six months of the program were eligible. Of the 637 patients contacted after their initial teleneurology consult, 299 agreed to an interview, and 277 completed the three patient acceptability questions on satisfaction, the similarity of the visit to an in-person visit, and the likelihood of recommending a teleneurology visit.

On assessing the data gathered from the 277 who completed the patient acceptability questions, researchers found that the mean total patient acceptability score was 18.3.

Of the 277 patients, 25.3 percent were seen for headaches, 16.6 percent for movement disorders, and 16.2 percent for neurological symptoms like dizziness, vision changes, and weakness. There was no significant difference in acceptability between diagnosis groups, either in total or individual scores on the acceptability questions.

In the acceptability model, researchers found that medical comorbidity was the only factor independently related to the acceptability score. Higher comorbidity was associated with higher acceptability scores, suggesting that patients with more chronic conditions were more likely to find teleneurology more acceptable.

Thus, researchers concluded that teleneurology care “is acceptable to patients with neurologic conditions and symptoms and may be especially acceptable to medically complex patients.”  

“There are always going to be certain clinical conditions or patient preferences where in-person visits are essential. But for most patients, a large portion of what we're trying to do —  understanding the patients’ symptoms, when they started, what helps them and what makes their symptoms worse — all those basics that we learn in medical school that we know are at least 75 percent of getting the right diagnosis can be done via video; we can then adapt most parts of our physical exam to be done via video too,” said study senior author Linda S. Williams, MD, a VA and Regenstrief Institute research scientist, in a press release. “This is true, no matter the healthcare system.

Healthcare stakeholders have largely been supportive of telehealth use in neurology care.

In 2021, the American Academy of Neurology issued a 22-page telehealth position statement calling for expanded telehealth coverage. It updated a 2014 document with evidence gathered during the COVID-19 pandemic, showing that telehealth benefits healthcare providers and their patients.

“The AAN predicts that telehealth will continue to play an essential role in the care of patients with neurologic conditions,” the 2021 document reads.

Teleneurology has proven popular not only in adult neurologic care, but pediatric care as well.

A study published in 2022 revealed that telehealth remained popular at Children's Hospital of Philadelphia (CHOP) following the elimination of in-person visit restrictions due to COVID-19.

The researchers assessed about 50,000 visits between October 2019 and April 2021, of which 34,837 were in-person, and 14,820 were telehealth outpatient visits. These visits represented a total of 26,399 pediatric neurology patients.

Researchers found that telehealth remained widely used following the elimination of in-person care barriers, with some patients, like those with epilepsy and attention-deficit hyperactivity disorder (ADHD), using telehealth more than in-person care.

However, certain patients engaged in telehealth less frequently, including those with neuromuscular and movement disorders and those who were younger. Ethnic minorities and patients with high social vulnerability were also less likely to use telehealth.