Evaluating The Role Of Telemedicine In Increasing Access To Neurological Care: A Re-Aim Analysis Of A Neurological Consult Program For Drug-Induced Movement Disorders

Shortages in access to specialty care exist worldwide, especially for neurological disorders, which are a leading cause of disability. Barriers to care include an unequal distribution of neurologists in certain regions, a shortage of physicians, the distance that patients need to travel, and physical or cognitive impairment. Telemedicine has been promoted as a promising way to address these barriers and to improve access to neurological care. It has been widely used for indications such as stroke, headache, epilepsy, and movement disorders. We focus primarily on the use of telemedicine in movements disorders, where a large proportion of people are limited by mobility changes, caused by their disease progression. To date, several studies have investigated the usability of telemedicine for movement disorders, especially in Parkinson disease (PD). The first paper is a scoping review of studies that assessed the application of telemedicine for providing care to individuals with movement disorders. The aims and outcome measures of the included papers were reviewed and summarized to describe the main focuses of the literature related to this topic thus far. We confirmed that most of the prior studies had focused on PD, and about 70% enrolled 50 or less participants. There were five main outcomes reported in every study included in the review: feasibility, acceptability, efficacy, validity/reliability, and clinical outcomes. Our conclusion was that telemedicine in movement disorders has been demonstrated as a feasible, acceptable, and effective way to provide care, and healthcare professionals adapted quickly to these visits following the COVID-19 pandemic. We aimed to investigate if telemedicine could improve access to care in our rural state of Vermont, for patients experiencing drug-induced movement disorders (DIMDs). DIMDs reduce quality of life and can be persistent and irreversible if not recognized and addressed early on. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we designed a study with mixed methods to evaluate the implementation of a neurological consult service for patients with DIMDs. Our findings were that patients and their mental health clinicians who were engaged in the project were satisfied with the service, and that finding ways to support both groups of respondents is critical for it to succeed and be maintained. We further examined the feasibility, effectiveness, and acceptability of the consult service, with a focus on the telemedicine application. Completing visits remotely was feasible, with only one instance of technical issues impacting an exam, and there were high rates of adherence for the initial consult visit. The neurologists were able to effectively assess participants through telemedicine and make care recommendations, which did not adversely impact health outcomes. Lastly, participant and mental health clinician (MHC) reports of satisfaction demonstrate that telemedicine is an acceptable way to provide neurological care to people with DIMDs.