MC09
Clinic to in-Home Telemedicine Reduces Barriers to Care for Patients with Multiple Sclerosis and Neuroinflammation
For people living with chronic diseases, medical appointments represent one of many “hassles of daily life.” In-person medical appointments also have hidden financial and opportunity costs. The UCSF Center for Multiple Sclerosis and Neuroinflammatory Diseases routinely provides clinic to in-home televideo appointments for established patients using a secure platform. We previously reported a very high correlation between in-clinic and telemedicine-based disability examinations.
Objectives:
To describe the real-world use of telemedicine-enabled clinical care in a large MS / Neuroimmunology academic practice and quantify its role in alleviating patient burden.
Methods:
Adults with MS and other neuroinflammatory diseases presenting for routine evaluations at our Center (100 in-person visits, 50 via telemedicine), were consecutively enrolled between 1- and 10/2017. After clinical visits, both patients and their respective clinicians completed questionnaires. Summary statistics were calculated.
Results:
Of 50 televideo visits, mean (SD) patient age was 51.3 years (16.8), EDSS 4 (SD 2, range 0-8) and visit duration 37 minutes (14). Physicians reported achieving their clinical goals in 96% of visits and adequate physical examination in 92% of visits (exceptions: concern for cauda equina syndrome, shingles, visual field loss, and possible subtle clinical worsening). Physicians also reported that the televideo visit allowed them to avoid sending 2 patients to the emergency room.
Patients conducted televideo visits in their home (80%) or at work (20%); 98% agreed that the platform was easy to use; only 16% felt that an in-person visit would have been more effective in addressing their goals. Travel burden was substantially reduced, avoiding an average travel distance of 246 kilometers; 11% of patients avoided air travel, and 23% overnight lodging. Caregiver burden was also reduced: 39% avoided caregiver time off from work, and 21% avoided arranging childcare. Of 49% of employed patients, 67% avoided taking time from work. In comparison with in-clinic evaluations, there was no difference in patients’ ratings of 6/7 standard quality of care metrics (p>0.15 for each); they differed only in their rating of the provider’s eye contact.
Conclusions:
When incorporated as part of the continuum of MS / neuroimmunology clinical care, telemedicine substantially reduces travel and caregiver burden and enables efficient, convenient and effective follow-up.