Some Pediatric Neurology Patients Require In-Person Visits

Despite the widespread benefits of telehealth, researchers from the Children’s Hospital of Philadelphia (CHOP) found that some pediatric neurology patients, including those who are younger and have neuromuscular disorders, need to have in-person visits.  

CHOP, founded in 1855, is the first pediatric hospital in the nation. During the rapid implementation of telehealth as a result of the COVID-19 pandemic, researchers from the hospital sought to decipher whether the pediatric patient population undergoing neurological treatment benefitted more from in-person or virtual care.  

To do this, the team reviewed 7,130 telemedicine visits between March and November 2020. Researchers' main focus when reviewing visits was what they termed 'visits of concern (VOC).' They defined VOCs as telehealth visits that required an in-person follow-up sooner than if the initial visit had been conducted in person. Neurology providers indicated a VOC through a questionnaire that was built into the general telemedicine documentation template. 

“In our latest study, we wanted to focus on the so-called ‘visits of concern,’ or telemedicine visits that necessitated in-person visits to address concerns that simply could not be properly addressed by a telemedicine visit,” said the first author of the study Marisa S. Prelack, MD, a pediatric neurologist in the Division of Neuroscience at CHOP, in the press release.  

Of the 7,130 visits evaluated, 5 percent, or 292 visits, were categorized as a VOC. The median age of patients in VOCs was 9 years 3 months, younger than patients in non-VOCs whose median age was 11 years 3 months.   

VOCs were often triggered by various factors related to socioeconomic and racial disparities. For example, VOCs were more common among those patients with a lower median household income and those who are among a racial minority. Researchers also noted that conditions such as epilepsy and headache were the most common illnesses found in VOCs.  

But kids with neuromuscular disorders and developmental delays had a higher proportion of VOCs than kids with other neurological conditions. 

“This study reaffirmed our previous findings that telemedicine is effective for a large majority of child neurology visits, while identifying which patients are more likely to require in-person visits,” said Ingo Helbig, MD, a pediatric neurologist at CHOP, director of the genomic and data science core of the Epilepsy NeuroGenetics Initiative (ENGIN), and senior author of this study, in a press release. “Telemedicine must be applied equitably, and our study also showed that families of color and socially vulnerable patient groups may have lower access to telemedicine visits.” 

Several recent studies have indicated that health conditions are linked to patient preference for a certain modality of care.  

For example, a UC Davis Health study from January published in the Journal of Asthma revealed that young adult asthma patients parents of pediatric asthma patients prefer a hybrid care method. Participants in the study indicated that though telehealth for asthma care was convenient, in-person care was more effective in certain circumstances.   

Another study from February published in AIDS and behavior reported that HIV patients preferred telehealth rather than in-person care. Researchers found that the attendance rate was higher for telehealth than in-person care, at 78.9 percent and 61.9 percent, respectively, during the study period.