Expanded access to multiple sclerosis teleneurology care following the COVID-19 pandemic

Abstract

Background: Teleneurology for multiple sclerosis (MS) care was considered feasible, but utilization was limited.

Objective: To describe how the existing teleneurology populations at two academic MS Centers changed during the COVID-19 pandemic.

Methods: In this cross-sectional study, we captured all in-person and teleneurology visits at two academic MS Centers between January 2019 and April 2020. We compared group differences between the Centers, and COVID-related changes using T-, chi-squared Kruskal-Wallis and Fisher exact tests.

Results: 2268 patients completed 2579 teleneurology visits (mean age 48.3 ± 13.3 years, 72.9% female). Pre-COVID, the Centers' teleneurology populations were similar for age, sex, MS type, and disability level (all p > 0.1), but differed for race (96.5% vs 80.7% white, p ≤ 0.001), MS treatment (49.1% vs 32.1% infusible, p ≤ 0.001), and median distance from Center (72 vs 186 miles, p ≤ 0.001). Post-COVID, both Centers' teleneurology populations had more black (12.7% vs 4.37%, p ≤ 0.001) and local (median 34.5 vs 102 miles, p ≤ 0.001) patients.

Conclusion: Teleneurology visits in 2019 reflected the organizational and local teleneurology reimbursement patterns of our Centers. Our post-COVID-19 changes illustrate the potential for payors and policy to change disparities in access to, or utilization of, remote care. Patients' perception of care quality and value following this shift warrants study.

Keywords: COVID-19; Multiple sclerosis; health disparities; models of care.

Figure 1.

Main comparisons performed in the MS populations across two academic Centers. *Patients who completed both in-clinic and teleneurology visits during the study period were only included in the teleneurology population. Only first visit was included for patients had multiple visits.

Figure 2.

Comparison of distances from Centers by race in the combined CC and UCSF teleneurology populations.