Community neurologists reported their most significant challenges brought on by the COVID-19 pandemic include isolation, trust, and quality care delivery, according to a study published in Neurology.

Along with other healthcare providers, neurologists rapidly adopted World Health Organization and Institute of Medicine strategies to care for patients during the pandemic while limiting the spread of the virus. Researchers in the current study (ClinicalTrials.gov Identifier: NCT03076671) sought to learn directly from community-based neurologists what they experienced on the frontlines.

From July to November 2020, researchers individually interviewed 20 community-based neurologists who provided outpatient palliative care for patients with Parkinson disease and were willing to refer at least 6 patients per year over 3.5 years of study enrollment and receive 8 hours of additional training in palliative care clinical training. Neurologists who primarily worked at academic medical institutions were excluded from the study.


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Researchers conducted the interviews via phone or teleconference and completed matrix analysis of responses to their questions regarding how the pandemic affected them, their practice, and the lives of their patients.

Four themes emerged: political and pandemic-specific stressors, stressors involved in increased telehealth, hopelessness, and limited means to cope with stress.

During the pandemic, clinical hours decreased, and patients experienced more stress, isolation, and confusion. That confusion included the limited knowledge care partners reported they had about the welfare of their loved ones who were in nursing homes.

As health care systems transitioned to remote care, neurologists adapted to using the technology involved, separated from colleagues and patients, without training or institutional support, they said. There often were adjustments in procedures and patients who needed help navigating virtual care.

The impact of social isolation on patients’ health was “unsettling and troubling” for neurologists. Neurologists experienced increased burnout during the pandemic because their responsibilities increased, their options for self-care decreased, and they felt isolated from their colleagues.

“Neurology providers are finding it difficult to maintain a therapeutic relationship with patients during a period of politicized medicine and misinformation and feel there is a lack of support for new models of care,” the researchers said.

Study limitations included generalization to areas outside of Colorado, changes in the pandemic and institutional response, and the method of conducting interviews.

“Our study suggests that strategies to promote engagement and to decrease systematic contributors to burnout are essential to maintaining quality of care and supporting the neurology workforce during and after the pandemic,” the researchers concluded.

Reference

Ayele R, Macchi ZA, Dini M, et al. Experience of community neurologists providing care for patients with neurodegenerative illness during the COVID-19 pandemic. Neurology. Published June 14, 2021. doi: 10.1212/WNL.0000000000012363