Telemedicine Care Quality, Social Vulnerability Index Barriers Measured for Patients With Epilepsy

The start of the COVID-19 pandemic necessitated a swift shift to virtual care and the rapid adoption of telemedicine; however, there remains limited knowledge on how this uptake of technology has met patients’ medical needs and the impact social factors might impact access to the technology. Researchers presenting at the American Epilepsy Society (AES) annual meeting that took place from December 2-6 in Nashville, Tennessee, investigated equity and quality care of telemedicine, and how social vulnerability impacts telemedicine accessibility.

In one abstract, researchers from Banner University Medical Center found that slightly more patients indicated a preference for telemedicine visits and that the strongest indicator for preferring in-person visits was being a female patient within 10 miles of the clinic location (83%).¹

Even though survey respondents indicated that differences in care quality of telemedicine vs in-person visits didn’t exist, patients said that telemedicine reimbursement should be less.

The purpose of this study was to examine the preference, advantages, and restrictions of telemedicine for patients with epilepsy, as well as a desire for comprehension in patient viewpoints of clinician compensation for telemedicine interactions.

From May to July 2022, patients with epilepsy who were expected to participate in telemedicine or in-person clinical visits at an academic epilepsy center in Phoenix, Arizona, were offered a 10-question survey that 120 patients filled out.

The survey asked questions about patient demographics, preference of telemedicine, views on quality of care, and effects on finances.

The majority of patients surveyed preferred telemedicine instead of in-person visits (64%).

If the travel distance consisted of 10 miles or less, 77% of patients started that they’d rather participate in in-person visits, while there was no difference found between 11 to 50 miles or over 50 miles in telemedicine preferences.

Other findings from the survey included:

• Women indicated a higher desire for in-person clinic visits (62%) over men (35%)
• The attitudes of most patients reflected the same quality and ease of appointment in telemedicine visits as compared to in-person visits
• 18% of patients reported less reimbursement for doctors and 43% said they should be able to receive a discount for telemedicine
• Most patients in this survey preferred telemedicine and indicated that there was no reduction in quality of care

A second abstract from the AES annual meeting analyzing responses of 24 patients with epilepsy with high social vulnerability index (SVI) at the Children’s Hospital of Philadelphia (CHOP) found that activating a virtual patient portal did not meaningfully restrict participation in telemedicine.²

Patients with high SVI conveyed the experience of numerous obstacles in the patient portal regardless of previous telemedicine visit attendance. So, the portal alone might be a main contributor to the generally reduced use of telemedicine.

CHOP saw trends in data that indicated that patients with higher SVI might be less likely to finish a neurology telemedicine visit as compared with patients with a lower SVI, without knowing why. Researchers investigated the role of access or use of telemedicine technology played a role in decreased use of telemedicine.

The measured population included 24 patients with epilepsy who also had high levels of SVI. These patients were divided into 2 groups: one group had a history of participating in telemedicine at the start of the COVID-19 pandemic and the other did not.

Surveys to evaluate accessibility and activation of the patient portal, among other factors such as utilization, were then provided to each cohort.

Experience in activating the patient portal were similar in both cohorts, but the cohort that did not participate in telemedicine at the start of COVID-19 recounted that they weren’t as familiar with the patient portal after activation.

Continued research into hurdles that patients encounter preventing more patient portal involvement is needed.

“To ensure equitable care access for patients with high SVI, we continue to investigate the barriers preventing higher engagement with the patient portal but are also ensuring ongoing access to in-person visits,” the researchers concluded.

References

1. Chung R, Chung S, Haas E. Patient’s preference and care quality of telemedicine in epilepsy care. Presented at: American Epilepsy Society Annual Meeting; December 2-6, 2022; Nashville, Tennessee. Abstract 3.464.

2. DiGiovine M, Caffeé L, Chuo J, et al. Understanding disparities in telemedicine: evaluating barriers to telemedicine and patient portal access and use in epilepsy patients with high social vulnerability index. Presented at: American Epilepsy Society Annual Meeting; December 2-6, 2022; Nashville, Tennessee. Abstract 2.353.