SARS-CoV-2-related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: A German single-center experience

Abstract

Introduction: When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services.

Methods: Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives.

Results: Telephone contacts for 272 patients (mean age: 38.7 years, range: 17-79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25).

Conclusion: Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.

Keywords: Anticonvulsant; COVID; Corona; Pandemic; Seizure.

Fig. 1

Time course of SARS-CoV-2 pandemic in Hessen, from March 2 to June 2, 2020, showing the cumulative (A) and daily number (B) of confirmed cases, as well as the daily (C) and cumulative (D) number of COVID-19 associated deaths (status as of June 4, 2020, based on the official Robert Koch-Institut [RKI, Berlin, Germany] dataset, www.rki.de).

Fig. 2

Geographical overview of Europe (A) and Germany (B) to help locating the Federal State of Hessen (darker area). (C) The inset numbers represent enrolled patients from the different administrative regions of Hessen. Using color grading (lower right), the total number of COVID-19 cases of the different administrative regions of Hesse are shown (status as of June 4, 2020, based on the official Robert Koch-Institut [RKI, Berlin, Germany] dataset (www.rki.de). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Likert scales for patient subjective urgency for canceled personal appointments, reactions to appointment cancelations, and subjective threat assessment of SARS-CoV-2 according to initial phone call notes (A, n = 272). In addition, patient and physician satisfaction with individual telemedical consultations (B, n = 109), and disadvantages of telemedicine compared with face-to-face appointments are shown for patients who accepted telemedicine consultations (C, n = 109). Discrepancies between patients' and physicians' rating of urgency for the appointment are displayed as Sankey diagram (D, n = 109).