Outpatient tele-epilepsy care is feasible on a large scale with positive patient experiences, according to research presented at the 2019 American Epilepsy Society Annual Meeting, held December 6 to 10, in Baltimore, Maryland.
Tele-neurology is increasingly utilized for inpatient healthcare, specifically in cases of acute stroke. However, few studies have assessed the use of outpatient neurology telemedicine, especially the use of telemedicine in epilepsy. Unique morbidities, such as loss of driving privileges, unpredictable seizure occurrence, and hardship due to unemployment make virtual care for patients with epilepsy of particular importance.
This study described data collected from patients who self-selected to participate in the Cleveland Clinic Epilepsy Center’s virtual follow-up program between January 2017 to September 2018. This program, among the largest single-center implementations of outpatient telemedicine visits for epilepsy to date, allowed patients to use personal devices for video-conference follow-up visits. Clinicians conducted tele-epilepsy visits through the American Well platform. After each visit, patients were given an optional survey to rate their overall experience with the platform as well as their experience with the clinician.
During the study period, 789 participants (average age 39.1±14.9; 55.3% women) completed 1090 tele-epilepsy visits from 38 different states, with 24.2% of patients completing more than one visit. Tele-epilepsy visits were a mean of 16.9±10.7 minutes in duration, and were conducted by epilepsy physicians (63%, n=688), psychologists (2%, n=20), advanced practice providers (34%, n=371), and neurosurgeons (1%, n=11).
Of patients participating in this program, 26% were local (<50 miles from the Cleveland Clinic Epilepsy Center), 29.4% were near-regional (51-150 miles from center), 22.5% were far-regaional (151-270 miles away from center), and 22.1% were remote (>270 miles from center). Over the 1090 visits studied, tele-epilepsy care prevented an estimated 265,136 miles of travel, with a median distance of 125.5 miles saved (interquartile range, 45.2-253.8).
On a 5-point scale with 5 being the best, the average patient-rated overall experience was 4.72; patient-rated provider experience was 4.88. There was a steep growth in demand for tele-epilepsy services that was sustained throughout the study period.
Study investigators found that high patient ratings, significant repeat utilization, and sustained demand indicated an overall positive patient experience with tele-epilepsy outpatient services. They concluded, “We should seek to understand in what context tele-epilepsy is most effective and beneficial to patients to better leverage technology to serve out patients and enable access to epilepsy care.”
Fesler JR, Stanton S, Merner K, et al. Bridging the gap in epilepsy care: A single center experience of more than 1000 tele-epilepsy outpatient visits. Presented at: the American Epilepsy Society’s Annual Meeting; December 6-10, 2019; Baltimore, MD. Abstract 2.36.