Impact of telehealth on health care in a multiple sclerosis outpatient clinic during the COVID-19 pandemic.

Ambulatory Care Facilities COVID-19 Humans Multiple Sclerosis / diagnosis Pandemics Recurrence Telemedicine
COVID-19 Multiple sclerosis Outcome assessment Outpatient care Telemedicine

Journal

Multiple sclerosis and related disorders
ISSN: 2211-0356
Titre abrégé: Mult Scler Relat Disord
Pays: Netherlands
ID NLM: 101580247

Informations de publication

Date de publication:
Jul 2022
Historique:
received: 10 02 2022
revised: 31 03 2022
accepted: 24 05 2022
pubmed: 7 6 2022
medline: 29 6 2022
entrez: 6 6 2022
Statut: ppublish

Résumé

The coronavirus disease 2019 (COVID-19) pandemic has precipitated expansion of telemedicine in outpatient management of chronic diseases including multiple sclerosis (MS). Studies conducted pre-pandemic, when telehealth was an alternative to in-person consultations, represent a different setting to current practice. The aim of this study was to assess the impact of telehealth on MS outpatient care in a tertiary metropolitan hospital in Melbourne, Australia during the COVID-19 pandemic. From March-December 2020, patients and clinicians in the MS outpatient clinic were surveyed regarding their attitudes towards telehealth. Scores on the Expanded Disability Status Scale (EDSS) from telehealth and face-to-face appointments during the study period were compared to scores from face-to-face consultations before and after this period. Medical records were reviewed to compare management decisions made during telehealth versus face-to-face consultations. Diagnoses and treatment of MS relapses were compared to 2019. Telehealth was used in 73% of outpatient appointments. Patient satisfaction was generally high. Patients and clinicians preferred face-to-face consultations but were willing to use telehealth longer term. Overall, there were no significant delays in identifying patients experiencing disability worsening via telehealth, but EDSS increase was recorded in more face-to-face than telehealth appointments particularly for those with lower baseline disability. Disease-modifying therapy commencement rates were similar, but symptomatic therapy initiation and investigation requests occurred more frequently in face-to-face visits. Comparable numbers of MS relapses were diagnosed and treated with corticosteroids in 2019 and 2020. Patient satisfaction with telehealth was high, but both clinicians and patients preferred in-person appointments. Telehealth implementation did not lead to high rates of undetected disability worsening or undiagnosed acute relapses, but telehealth-based EDSS assessment may underestimate lower scores. Treatment inertia may affect some management decisions during telehealth consultations. Telehealth will likely play a role in outpatient settings beyond the COVID-19 pandemic with further studies on its long-term impact on clinical outcomes required.

Sections du résumé

BACKGROUND BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic has precipitated expansion of telemedicine in outpatient management of chronic diseases including multiple sclerosis (MS). Studies conducted pre-pandemic, when telehealth was an alternative to in-person consultations, represent a different setting to current practice. The aim of this study was to assess the impact of telehealth on MS outpatient care in a tertiary metropolitan hospital in Melbourne, Australia during the COVID-19 pandemic.
METHOD METHODS
From March-December 2020, patients and clinicians in the MS outpatient clinic were surveyed regarding their attitudes towards telehealth. Scores on the Expanded Disability Status Scale (EDSS) from telehealth and face-to-face appointments during the study period were compared to scores from face-to-face consultations before and after this period. Medical records were reviewed to compare management decisions made during telehealth versus face-to-face consultations. Diagnoses and treatment of MS relapses were compared to 2019.
RESULTS RESULTS
Telehealth was used in 73% of outpatient appointments. Patient satisfaction was generally high. Patients and clinicians preferred face-to-face consultations but were willing to use telehealth longer term. Overall, there were no significant delays in identifying patients experiencing disability worsening via telehealth, but EDSS increase was recorded in more face-to-face than telehealth appointments particularly for those with lower baseline disability. Disease-modifying therapy commencement rates were similar, but symptomatic therapy initiation and investigation requests occurred more frequently in face-to-face visits. Comparable numbers of MS relapses were diagnosed and treated with corticosteroids in 2019 and 2020.
CONCLUSIONS CONCLUSIONS
Patient satisfaction with telehealth was high, but both clinicians and patients preferred in-person appointments. Telehealth implementation did not lead to high rates of undetected disability worsening or undiagnosed acute relapses, but telehealth-based EDSS assessment may underestimate lower scores. Treatment inertia may affect some management decisions during telehealth consultations. Telehealth will likely play a role in outpatient settings beyond the COVID-19 pandemic with further studies on its long-term impact on clinical outcomes required.

Identifiants

DOI: 10.1016/j.msard.2022.103913 PMID: 35661564 PMC: PMC9137249
pubmed: 35661564
pii: S2211-0348(22)00424-2
doi: 10.1016/j.msard.2022.103913
pmc: PMC9137249
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103913

Informations de copyright

Copyright © 2022 Elsevier B.V. All rights reserved.

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Auteurs

Vivien Li (V)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia. Electronic address: vivien.li@unimelb.edu.au.

Izanne Roos (I)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.

Mastura Monif (M)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Department of Neuroscience, Monash University, Melbourne, Australia.

Charles Malpas (C)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.

Stefanie Roberts (S)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.

Mark Marriott (M)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia.

Katherine Buzzard (K)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, Australia.

Ai-Lan Nguyen (AL)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.

Nabil Seery (N)

Department of Neuroscience, Monash University, Melbourne, Australia.

Lisa Taylor (L)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia.

Tomas Kalincik (T)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.

Trevor Kilpatrick (T)

Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.

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Classifications MeSH

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