Teleneurology clinics for polyneuropathy: a pilot study

Abstract

Introduction: Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System.

Methods: For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics.

Results: The average tele-PN encounter and exam times were 28.5 and 9.1 min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic's success, saving an average of 231 min per patient in round-trip travel. The medical team's caring and collaborative spirit received high praise. While the clinic's efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement.

Conclusion: In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter.

Keywords: Evidence-based; Guidelines; Neuropathy; Polyneuropathy; Telemedicine; Teleneurology.

Fig. 1

The VA Neuropathy Scale

Fig. 2

Key driver diagram. This diagram illustrates our proposed drivers of high-satisfaction scores, and ultimately, being the preferred clinical choice of patients who may either not receive specialty care, receive in-person specialty care at a more distant VA center, or receive specialty care outside of the VA system in their local area. This driver diagram includes structural factors (convenience of clinic), process factors (efficient visit, good communication), and outcome factors (symptom improvement) that we felt were important to measure to evaluate the clinic’s performance

Fig. 3

Patient satisfaction ratings by encounter component. For each encounter (n = 44), patients were asked to rate the check-in process, exam, and history on a 5-item scale from excellent to very poor. For the check-in process, there were 34 excellent, 7 good, and 3 fair ratings. For the exam, there were 33 excellent, 10 good, and 1 fair ratings. For the history, there were 34 excellent, 9 good, and 1 fair ratings. No respondents answered poor or very poor