Abstracts

Rationale:
Telemedicine clinic visits have traditionally originated from spoke clinic sites but recent trends have favored home-based telemedicine, particularly in the time of Covid-19. Our study focused on the clinical and technical experience of patients in rural Hawaii seen in seizure clinic via home-based telemedicine. We additionally compared characteristics of patients using telemedicine versus in-person clinic visits prior to the Covid-19 pandemic.
Method:
For the retrospective portion of our study, we queried charts of adult outpatients treated by the two full-time epileptologists at a Level 4 epilepsy center accredited by the National Association of Epilepsy Centers between November 2018 and December 2019. We included patients who live on the neighbor islands of Hawaii but not on Oahu, i.e., patients who would require air travel to see an epileptologist. There had been no set protocol at the epilepsy center for telemedicine referral; our practice had been to offer telemedicine visits to all neighbor island patients when felt to be appropriate. We collected demographic and clinic visit data.  For the prospective portion we surveyed neighbor island patients or their caregivers, seen via home-based telemedicine between March 2020 and June 2020. Survey collection is ongoing. We obtained verbal consent for study participation. Survey questions addressed satisfaction with clinical care, visit preferences, and potential barriers to care.
Results:
In a 14-month period prior to the Covid-19 pandemic, 139 (74%) neighbor island patients were seen exclusively in-person in seizure clinic while 50 (26%) had at least one telemedicine visit. Table 1 displays characteristics of in-person versus telemedicine clinic visits.  During the Covid-19 pandemic, we surveyed 21 consecutive (based on staff availability) patients seen by telemedicine, 43% female, with median age of 28 years. Telemedicine connection was set up by the patient in 71% of cases, or by the patient’s mother (24%) or wife (5%). Median patient satisfaction score was 5 (“highly satisfied”) on a 5-point Likert scale with mean of 4.3. 90% of patients used a home WiFi connection. 62% used a smartphone while 33% used a computer. See Table 2 for responses to additional questions.
Conclusion:
Home-based telemedicine visits provide a high-satisfaction method for seizure care delivery despite some obstacles. Demographic biases may be an obstacle to telemedicine care. In a quarter of cases, surveyed patients identified that their mother set up the telemedicine connection suggesting technological competence in an older female demographic. However, patients seen by telemedicine were more likely to be male and younger compared to patients seen in-person. Additionally, despite overall satisfaction, most patients felt the physical exam and visit quality were superior at in-person clinic visits. During the Covid-19 pandemic when there may be barriers to in-person clinic visits, home-based telemedicine is a feasible alternative.
Funding:
:Queen’s Health System – Armstrong Institute Collaboration Research & Innovation Mentorship Program.