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December 2021; 11 (6) Research

Patient and Clinician Perspectives of New and Return Ambulatory Teleneurology Visits

Samantha M.R. Kling, Jessica J. Falco-Walter, View ORCID ProfileErika A. Saliba-Gustafsson, Donn W. Garvert, Cati G. Brown-Johnson, Rebecca Miller-Kuhlmann, Jonathan G. Shaw, Steven M. Asch, Laurice Yang, Carl A. Gold, Marcy Winget
First published March 9, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001065
Samantha M.R. Kling
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Jessica J. Falco-Walter
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Erika A. Saliba-Gustafsson
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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  • ORCID record for Erika A. Saliba-Gustafsson
Donn W. Garvert
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Cati G. Brown-Johnson
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Rebecca Miller-Kuhlmann
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Jonathan G. Shaw
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Steven M. Asch
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Laurice Yang
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Carl A. Gold
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Marcy Winget
Evaluation Sciences Unit (SMRK, EAS-G, DWG, CGB-J, JGS, SMA, MW), Division of Primary Care Population Health, Department of Medicine, and Department of Neurology & Neurological Sciences (JJF-W, RM-K, LY, CAG), Stanford University School of Medicine, CA.
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Citation
Patient and Clinician Perspectives of New and Return Ambulatory Teleneurology Visits
Samantha M.R. Kling, Jessica J. Falco-Walter, Erika A. Saliba-Gustafsson, Donn W. Garvert, Cati G. Brown-Johnson, Rebecca Miller-Kuhlmann, Jonathan G. Shaw, Steven M. Asch, Laurice Yang, Carl A. Gold, Marcy Winget
Neurol Clin Pract Dec 2021, 11 (6) 472-483; DOI: 10.1212/CPJ.0000000000001065

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Abstract

Background and Objectives To evaluate the adoption and perceived utility of video visits for new and return patient encounters in ambulatory neurology subspecialties.

Methods Video visits were launched in an academic, multi-subspecialty, ambulatory neurology clinic in March 2020. Adoption of video visits for new and return patient visits was assessed using clinician-level scheduling data from March 22 to May 16, 2020. Perceived utility of video visits was explored via a clinician survey and semistructured interviews with clinicians and patients/caregivers. Findings were compared across 5 subspecialties and 2 visit types (new vs return).

Results Video visits were adopted rapidly; all clinicians (n = 65) integrated video visits into their workflow within the first 6 weeks, and 92% of visits were conducted via video, although this varied by subspecialty. Utility of video visits was higher for return than new patient visits, as indicated by surveyed (n = 48) and interviewed clinicians (n = 30), aligning with adoption patterns. Compared with in-person visits, clinicians believed that it was easier to achieve a similar physical examination, patient-clinician rapport, and perceived quality of care over video for return rather than new patient visits. Of the 25 patients/caregivers interviewed, most were satisfied with the care provided via video, regardless of visit type, with the main limitation being the physical examination.

Discussion Teleneurology was robustly adopted for both new and return ambulatory neurology patients during the COVID-19 pandemic. Return patient visits were preferred over new patient visits, but both were feasible. These results provide a foundation for developing targeted guidelines for sustaining teleneurology in ambulatory care.

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.

  • ↵* These authors contributed equally to the manuscript and are sharing first authorship.

  • Received November 23, 2020.
  • Accepted February 10, 2021.
  • © 2021 American Academy of Neurology
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