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Tan SYW, Gunawardana N, Roberts RC. The Lasting impact of the COVID-19 pandemic on outpatient neurology consultations. BMJ Neurol Open 2024; 6:e000608. [PMID: 38496231 PMCID: PMC10941104 DOI: 10.1136/bmjno-2023-000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Background The COVID-19 pandemic prompted rapid changes in outpatient neurology services and there remain unanswered questions regarding its long-term impact. First, what are the lasting changes of the pandemic on demographics and outcomes of new referrals and patients reviewed at outpatient neurology clinics? Safety concerns about virtual consultations during the initial stages of the pandemic were also raised. Has the continual adoption of virtual consultations led to negative outcomes for patients? Methods New referrals and first clinic appointments in 2019 (prepandemic baseline) and 2022 (postpandemic) in a tertiary referral centre were compared retrospectively. 7294 referrals (4946 clinic appointments) in 2019 and 6989 referrals (3976 clinic appointments) in 2022 were assessed. Outcomes investigated were rates of referrals accepted, time to clinic consultation, number of outpatient investigations per appointment, rates of discharge and the risk of reassessment. Results There was a change in triaging practice postpandemic, with more patients being offered virtual assessments. Virtual appointments were offered to a specific suitable cohort of patients. This resulted in a faster time to consultation, fewer investigations, higher rates of discharge, with a reduced risk of reassessment compared with prepandemic patients, and patients postpandemic who were seen face to face. Conclusion Outpatient neurology services have adapted postpandemic by effectively triaging referrals and allocating new patients appropriately to face-to-face or virtual clinics, improving patient outcomes and safety.
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Affiliation(s)
- Sean YW Tan
- Department of Neurology, Addenbrooke's Hospital, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Rhys C Roberts
- Department of Neurology, Addenbrooke's Hospital, Cambridge, UK
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Gandelman-Marton R. Potential feasibility of a remote first visit in the epilepsy clinic. Epilepsy Behav 2023; 146:109358. [PMID: 37499578 DOI: 10.1016/j.yebeh.2023.109358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Since the beginning of coronavirus disease (COVID-19) epidemic in Israel in early 2020, follow-up visits through phone consultations were available only for patients treated in our outpatient epilepsy clinic. OBJECTIVE To assess the potential feasibility of phone consultation instead of in-person first visit in the outpatient epilepsy clinic. METHODS The computerized database and medical records of all the patients who had an in-person first visit in our outpatient epilepsy clinic during a 4-year period (2018-2021) were retrospectively reviewed. Potential feasibility of a remote visit was assessed for all visits and was deemed possible when physical examination or vagal nerve stimulator (VNS) examination or parameter adjustment was not reported in the visit summary. RESULTS The study group included 462 patients who had an in-person first visit in the outpatient epilepsy clinic during the study period. A remote first visit was deemed potentially feasible in 404 (87%) patients. Those in whom a remote first visit was deemed potentially infeasible were older (p = 0.0001), with longer disease duration (p = 0.001) and higher rates of antiseizure medication polytherapy (p = 0.0001), VNS and additional symptoms (p = 0.0001). CONCLUSIONS A remote visit may be potentially feasible for most patients who are scheduled for a first visit in the epilepsy clinic. An in-person visit may remain the preferred option for patients with additional neurological symptoms or a VNS, and may also be considered in older patients and those with longer disease duration or antiseizure medication polytherapy.
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Affiliation(s)
- Revital Gandelman-Marton
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin 70300, Israel; Faculty of Medicine, Tel Aviv University, Israel.
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Ritsma BR, Gariscsak PJ, Vyas A, Chan-Nguyen S, Appireddy R. The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning. Clin Rehabil 2022:2692155221146448. [PMID: 36575852 DOI: 10.1177/02692155221146448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the virtual family conference as an educational, preparatory, and transition planning intervention in stroke rehabilitation. DESIGN Observational-cross-sectional study. SETTING Inpatient stroke rehabilitation. SUBJECTS Eighty-seven carers, participating in 48 conferences, were evaluated. INTERVENTIONS The virtual family conference, involving the patient, carer(s), and interdisciplinary rehabilitation team, completed prior to community transition. The conference protocol and framework, consisting of nine primary themes and additional sub-themes, are outlined. Teleconferencing was the utilized virtual modality. MAIN MEASURES Carers were assessed via questionnaires regarding pre- and post-conference rated: (1) stroke-related knowledge, (2) satisfaction with information provision, and (3) confidence, preparedness, and stress associated with community transition; by use of the Stroke Knowledge and Community Transition Preparedness Questionnaire, Mant et al. Information Satisfaction Questionnaire, and Kingston Caregiver Stress Scale. RESULTS Significant improvement in post-conference carer-rating was noted for knowledge, pertaining to stroke nature/impairments, stroke management/prevention, functional status, and community services. Significant gains were demonstrated in post-conference satisfaction with information provided regarding stroke and discharge planning, across all assessed topics. There was also a significant increase in carer-reported confidence and preparedness for the community transition as well as a significant reduction in self-perceived stress for elements of the caregiving role. Organization of community follow-up care was consistently enabled within the proposed framework. CONCLUSIONS The virtual family conference intervention demonstrated efficacy in facilitating carer education and preparation, along with discharge planning prior to community transition from stroke rehabilitation. Thus, illustrating potential benefits of family conferences and feasibility of their virtual application in stroke rehabilitative care.
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Affiliation(s)
- Benjamin R Ritsma
- Department of Physical Medicine & Rehabilitation, 4257Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | | | - Aarti Vyas
- Department of Medicine-Division of Neurology, 4257Queen's University, Kingston, ON, Canada
| | - Sophy Chan-Nguyen
- Department of Medicine-Division of Neurology, 4257Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Department of Medicine-Division of Neurology, 4257Queen's University, Kingston, ON, Canada
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Rabinovitch BS, Diaz PL, Langleben AC, Katz TM, Gordon T, Le K, Chen FY, Lewis EC. Wait times and patient throughput after the implementation of a novel model of virtual care in an outpatient neurology clinic: A retrospective analysis. J Telemed Telecare 2022:1357633X221139558. [PMID: 36529888 DOI: 10.1177/1357633x221139558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Neurology wait times - from referral to consultation - continue to grow, leading to various adverse effects on patient outcomes. Key elements of virtual care can be leveraged to improve efficiency. This study examines the implementation of a novel virtual care model - Virtual Rapid Access Clinics - at the Neurology Centre of Toronto. The model employs a patient-centred care workflow, involving multidisciplinary staff and online administrative tools that are synthesized to expedite care and maintain quality. METHODS Virtual Rapid Access Clinic efficacy was studied by determining average wait times and patient throughput, calculated from anonymous data that was extracted from the clinic patient database (n = 1542). Comparative analysis focused on new patient consultations during the 12-month periods prior to (pre-Virtual Rapid Access Clinic, n = 456) and following (post-Virtual Rapid Access Clinic, n = 1086) Virtual Rapid Access Clinic implementation. RESULTS After Virtual Rapid Access Clinic implementation, there was a mean 15-day wait time reduction, and a monthly average 52-patient increase in patient throughput. Wait time reductions and increased patient throughput were observed in all three Virtual Rapid Access Clinic sub-clinics - epilepsy, headache and concussion. Respectively, average wait times reduced significantly by 26.4 and 18.9 days and insignificantly by 1.1 days; monthly average patient throughputs increased by 235%, 95% and 161%. DISCUSSION These findings demonstrated that the Virtual Rapid Access Clinic model of care is effective at reducing patient wait times and increasing patient throughput. While the Virtual Rapid Access Clinic presents a feasible model both during and after pandemic restrictions, further research exploring its scalability in other care contexts, potential changes in care quality and efficiency outside of pandemic restrictions must be performed.
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Affiliation(s)
| | - Patrick L Diaz
- Department of Clinical Research, Neurology Centre of Toronto, Toronto, ON, Canada
| | - Amanda C Langleben
- Department of Clinical Research, Neurology Centre of Toronto, Toronto, ON, Canada
| | - Talia M Katz
- Department of Clinical Research, Neurology Centre of Toronto, Toronto, ON, Canada
| | - Tatyana Gordon
- Department of Clinical Research, Neurology Centre of Toronto, Toronto, ON, Canada
| | - Kevin Le
- Department of Clinical Research, Neurology Centre of Toronto, Toronto, ON, Canada
| | - Frank Yizhao Chen
- Department of Clinical Research, Neurology Centre of Toronto, Toronto, ON, Canada
- Jamaican Medical Cannabis Corporation, Toronto, ON, Canada
| | - Evan Cole Lewis
- Department of Clinical Research, Neurology Centre of Toronto, Toronto, ON, Canada
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Karakas C, Ward R, Hegazy M, Skrehot H, Haneef Z. Seizure control during the COVID-19 pandemic: Correlating Responsive Neurostimulation System data with patient reports. Clin Neurophysiol 2022; 139:106-113. [PMID: 35598434 PMCID: PMC9090858 DOI: 10.1016/j.clinph.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 01/08/2023]
Abstract
Objective To understand the impact of the Coronavirus Disease-2019 (COVID-19) pandemic on seizure frequency in persons with epilepsy with a Responsive Neurostimulation (RNS) system implanted. Methods Weekly long episode counts (LEC) were used as a proxy for seizures for six months pre-COVID-19 and during the COVID-19 period. Telephone surveys and chart reviews were conducted to assess patient mental health during the pandemic. The change in LEC between the two time periods was correlated to reported stressors. Results Twenty patients were included. Comparing the pre-COVID-19 period to the COVID-19 period, we found that only 5 (25%) patients had increased seizures, which was positively correlated with change in anti-seizure medications (ASM, p = 0.03) and bitemporal seizures (p = 0.03). Increased seizures were not correlated to anxiety (p = 1.00), depression (p = 0.58), and sleep disturbances (p = 1.00). The correlation between RNS-detected and patient-reported seizures was poor (p = 0.32). Conclusions Most of our patients did not have an increase in seizures following the COVID-19 pandemic. Changes in ASM and bitemporal seizures were positively correlated to increased LEC. There was no correlation between pandemic-related stress and seizures in those found to have increased seizures. Significance This is the first study correlating RNS-derived objective LECs with patient self-reports and potential seizure risk factors during the COVID-19 pandemic.
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Affiliation(s)
- Cemal Karakas
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, USA; Norton Children's Medical Group, Louisville, KY 40202, USA.
| | - Ryan Ward
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mohamed Hegazy
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Henry Skrehot
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA; Neurology Care Line, VA Medical Center, Houston, TX 77030, USA
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Yarbrough AJ, Johnson L, Vats A, Jaffee MS, Busl KM. The Neurology Access Clinic: A Model to Improve Access to Neurologic Care in an Academic Medical Center. Neurol Clin Pract 2022; 12:203-210. [DOI: 10.1212/cpj.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Delays in access to neurologic care is a major problem. In this pilot program, we aimed to evaluate the effectiveness of a novel staffing model for neurology outpatient clinic within an academic neurology center to increase access to neurological care, while incorporating such a model into a growing academic neurology department.Methods:We created a new model for provision of access to neurological care that could be introduced in an academic neurological department, the “access clinic”. One attending was assigned to staff the access clinic for one week at a time. This was introduced as rotation equal to conventional on-service inpatient rotations. Descriptive analyses were performed to characterize the access clinic’s performance characteristics. Comparisons were made to the previously established traditional faculty clinic model.Results:5,917 access clinic visits were compared to 6,000 traditional clinic visits. Lead time dropped from 142 to 18 days for new patients, and from 64 to 0 days for return visits. While total readmission rates were similar during both clinic periods, readmission through the emergency room was less for access clinic patients. Access clinic resulted in significant improvement in patient satisfaction ratings. The access clinic model was financially profitable.Conclusions:Our findings suggest that introducing an access clinic as service rotation for neurology faculty is both effective in offering enhanced access for patients to neurological care and for patient satisfaction. Future studies may test this model in other centers, and should address effect on provider satisfaction.
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Chan-Nguyen S, Ritsma B, Nguyen L, Srivastava S, Shukla G, Appireddy R. Virtual Care Access and Health Equity during the COVID-19 Pandemic, a qualitative study of patients with chronic diseases from Canada. Digit Health 2022; 8:20552076221074486. [PMID: 35116172 PMCID: PMC8808134 DOI: 10.1177/20552076221074486] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The COVID-19 pandemic has led to the widespread uptake of virtual care in Canada; however, virtual care may also create new barriers to health care. The purpose of this paper was to explore patient perceptions and concerns around virtual care access. Methods Between February and April 2020, we conducted semi-structured interviews with participants from four chronic disease clinics (stroke, epilepsy, amyotrophic lateral sclerosis, obstetrics medicine) in a mid-sized academic hospital in Southern Ontario, Canada. Consecutive sampling was done by including the patients receiving virtual care in those months. Caregivers were invited to participate in the event that patients were unable to participate in the interview. Thematic analysis was employed to identify overarching themes, and codes were reviewed and refined using a consensus process. Results We interviewed 31 participants (27 patients, four caregivers) that had taken part in virtual care. Our findings suggested that the COVID-19 pandemic served to isolate participants and had negatively impacted their access to health care. However, virtual care did provide a safe avenue for patients to receive care and served as a reassuring option during the pandemic. Low technological literacy and access were identified as barriers to virtual care. Greater awareness and patient engagement is needed in future research to improve access. Conclusion Certain populations can be disproportionately affected by differential access to virtual care. Future studies should examine how social determinants intersect to impact virtual health care access in different patient populations.
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Affiliation(s)
- Sophy Chan-Nguyen
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Benjamin Ritsma
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Lisa Nguyen
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Garima Shukla
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Department of Medicine, Queen's University, Kingston, ON, Canada
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