How Has Neurological Telemedicine Fared Amid COVID-19?

Amid the coronavirus disease 2019 (COVID-19) pandemic, telemedicine usage has grown significantly to meet the demand of patients seeking care without the threat of infection. For neurological conditions, such as Parkinson disease, researcher Victor Patterson, South Eastern Health and Social Care Trust, Belfast, Northern Ireland, UK, writes in a review published in Nature Reviews Neurology that relatively few neurologists used telemedicine in their everyday practice prior to the pandemic. 

“Two main reasons probably accounted for this lack of uptake: first, there was no incentive to change practice; and second, a fear prevailed that practising telemedicine might not quite be legal,” explained Patterson.

Now in 2020, Patterson writes that neurologists worldwide have started using various types of telemedicine to manage patients during the pandemic. “Two reasons exist to use telemedicine: first, if no other way of practicing is possible; and second, if using telemedicine has clear advantages over traditional face-to-face medicine.”

Past research on telemedicine in neurology (teleneurology) has shown it could replicate everything that would be achieved via face-to-face consultation for conditions from coma to headache, with additional cost savings and positive reviews from patients.

Seeking to examine the comparable efficacy of both health care delivery approaches, Patterson reviewed “short clinical pieces” assessing teleneurology in the past year. One study, conducted in the emergency department (ED) at the Mayo Clinic, examined how videolinks provided in the ED can provide patient care for neurological and other presentations while reducing potential COVID-19 exposure to health care workers and reducing use of personal protective equipment (PPE).

Examined over a 11-week period, patients’ rooms were provided access to videolinks that allowed a majority of “checking” visits to be completed remotely. In the investigators’ findings, this approach was shown to save PPE costs from the 3508 virtual visits made, which Patterson says is an example of the second primary reason to use telemedicine, cost-saving advantages over face-to-face medicine.

Another paper, indicated as a how-to-do-it paper from someone with experience doing videolink teleneurology in Scotland, examined how to optimize high-end equipment in a hospital setting and commercially available software for home use. Researchers recorded a 3000% increase in home video calls in all specialities in Scotland during the first weeks of the pandemic. They say that the real-time technical support utilized for high-end video conferencing can be leveraged at a national level, rather than by individual hospitals.

In concluding, Patterson notes a lack of research this year on asynchronous teleneurology using email, web servers, or smartphone applications, which he says can provide a big advantage over real-time methods and can save neurologists time.

“Perhaps their potential will be realized in coming years as well as further applications of synchronous teleneurology now that many more neurologists all over the world are using these approaches.”

Reference

Patterson V. Neurological telemedicine in the COVID-19 era. Nature Reviews Neurology. Published November 30, 2020. doi:10.1038/s41582-020-00438-9