Clinicians' Online Neurology Network Empowering Communities through Telemedicine – Multiple Sclerosis (CONNECT-MS)

Background: MS is the most common cause of neurological disability among young adults in the USA. California’s desert communities and Central Coast are medically underserved areas for people living with MS.

Objectives: Develop and deliver a comprehensive telemedicine program for neurologists, primary care clinicians and patients that increase both providers’ and patients’ awareness of state-of-the-art care while creating quantifiable improvements in quality and coordination of care.

Methods: A site coordinator at each end-user site was responsible for communicating with the project team and arranging for: training sessions; telemedicine consultations; and a list of clinicians working directly with the telemedicine program.  Clinicians completed a brief pre-test assessment to identify specific learning needs for MS care;  working with the telemedicine program; the demographics of their clinic populations number served and number currently receiving MS disease-modifying therapy.

Participating clinicians chose CME in different formats, at their convenience. On-Site: Program faculty offered in-person training session at each end-user site to deliver content tailored to their specific needs. Online: Enduring materials include a video of the presentation. Curriculum: presentation and work-up, neurologic exam, early identification, disease-modifying therapies, critical time-window, progressive MS, MS in adolescents, symptom management, exacerbations, mobility, bladder and bowel, depression, and mistreatment. Telemedicine Outreach A HIPAA-compliant telemedicine application accessed using any device with video conferencing capability - smart phone, tablet, laptop or desktop computer.  Consultant participated in key components of  patient evaluation and gave immediate feedback to the clinician.  Consultations were provided for those patients whom the clinicians deem to be the most complex, including new consultations and follow-ups.

Results:

- 12 educational presentations to clinicians, patients and family members.

- 39 telemedicine consultations.

- 17 physicians completed a 24-item multiple-choice test of MS medical knowledge pre/post participating in the curriculum, mean pretest score 7.8 ± 0.6 vs. mean post-test score 13.6 ± 1.1. 

- Analysis of variance found within-subjects change score (mean increase 5.8 statistically significant (p<.0001) with a large effect size (posttest mean - pretest mean/standard error) of 1.3.

- Participating clinicians, patients and families provided positive feedback.

Conclusions: We established a comprehensive telemedicine and health information exchange network throughout the Central California Coast in collaboration with VCMC and UCRSOM.  Urban and rural providers in these territories were connected to regional MS specialists and resources.  Tools allowed rural clinics to connect one another, hubs in Ventura and Riverside, and all available telemedicine/exchange partners.