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June 2021; 11 (3) Research

Rapid Implementation of Outpatient Teleneurology in Rural Appalachia

Barriers and Disparities

Roy E. Strowd, Lauren Strauss, Rachel Graham, Kristen Dodenhoff, Allysen Schreiber, Sharon Thomson, Alexander Ambrosini, Annie Madeline Thurman, Carly Olszewski, L. Daniela Smith, Michael S. Cartwright, Amy Guzik, Rebecca Erwin Wells, Heidi Munger Clary, John Malone, Mustapha Ezzeddine, Pamela W. Duncan, Charles H. Tegeler
First published July 13, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000000906
Roy E. Strowd
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD, MEd, MS
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Lauren Strauss
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD
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Rachel Graham
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
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Kristen Dodenhoff
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
BA
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Allysen Schreiber
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
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Sharon Thomson
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
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Alexander Ambrosini
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
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Annie Madeline Thurman
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
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Carly Olszewski
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
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L. Daniela Smith
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
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Michael S. Cartwright
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD, MS
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Amy Guzik
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD
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Rebecca Erwin Wells
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD, MPH
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Heidi Munger Clary
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD, MPH
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John Malone
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD
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Mustapha Ezzeddine
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD
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Pamela W. Duncan
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
PhD
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Charles H. Tegeler
Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC.
MD
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Full PDF
Citation
Rapid Implementation of Outpatient Teleneurology in Rural Appalachia
Barriers and Disparities
Roy E. Strowd, Lauren Strauss, Rachel Graham, Kristen Dodenhoff, Allysen Schreiber, Sharon Thomson, Alexander Ambrosini, Annie Madeline Thurman, Carly Olszewski, L. Daniela Smith, Michael S. Cartwright, Amy Guzik, Rebecca Erwin Wells, Heidi Munger Clary, John Malone, Mustapha Ezzeddine, Pamela W. Duncan, Charles H. Tegeler
Neurol Clin Pract Jun 2021, 11 (3) 232-241; DOI: 10.1212/CPJ.0000000000000906

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Abstract

Objective To describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States.

Methods A retrospective cohort of consecutive patients seen in the first 4 weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video, and when unable, phone-only visits were scheduled. Patients were divided into 2 groups based on the telehealth visit type: video or phone only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured postvisit telephone call.

Results Of 1,011 telehealth patient visits, 44% were video and 56% phone only. Patients who completed a video visit were younger (39.7 vs 48.4 years, p < 0.001), more likely to be female (63% vs 55%, p < 0.007), be White or Caucasian (p = 0.024), and not have Medicare or Medicaid insurance (p < 0.001). The most common barrier to scheduling video visits was technology limitations (46%). Although patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%, p = 0.05).

Conclusion Rapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, Black patients with Medicare or Medicaid insurance were less likely to complete video visits.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received May 19, 2020.
  • Accepted June 25, 2020.
  • © 2020 American Academy of Neurology
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The Nerve!: Rapid online correspondence

  • Author response: Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities
    • Roy E. Strowd, Associate Professor of Neurology, Vice Chair for Health System Integration and Outreach, Department of Neurology, Wake Forest School of Medicine
    • Lauren Strauss, Assistant Professor of Neurology, Telehealth Committee Chair, Department of Neurology, Wake Forest School of Medicine
    • Amy Guzik, Associate Professor of Neurology, Director of Telestroke Services, Department of Neurology, Wake Forest School of Medicine
    Submitted August 11, 2020
  • Reader response: Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities
    • Khichar Shubhakaran, Senior Professor and Head of Department of Neurology, Dr. S.N. Medical College (Jodhpur, India)
    Submitted July 16, 2020
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