Abstracts

Rationale: Epilepsy care through the Department of Veterans Affairs (VA) has faced numerous barriers to access of care. The overall number of neurologists that care for veterans is low, and those that specialize in epilepsy care make up a very small fraction. The Hunter Holmes McGuire VA Medical Center (VAMC) in Richmond, VA is one of larger referral centers in the Mid-Atlantic region. With a small team of just three epileptologists, one epilepsy nurse practitioner and one epilepsy telehealth nurse, we are tasked with providing specialized epilepsy care to all veterans in Virginia and West Virginia. Due to this wide area of coverage, patients may sometimes need to travel more than 6 hours, with some requiring overnight lodging to facilitate just a routine follow up visit. This results in a massive logistical and capital burden. Many patients are restricted from driving due to seizures, and thus are reliant on family or friends for transportation, and this cost is compensated by the VA.The Veterans Affairs Central Office (VACO) has thus tasked select sites such as the McGuire VAMC as Epilepsy Centers of Excellence (ECoE), to fill the gaps in epilepsy care for veterans. One method is the implementation of outpatient epilepsy telehealth visits since 2014. These are facilitated by high-definition video conferencing, with some sites equipped with additional medical equipment for cardiorespiratory auscultation and technicians on-site who can perform simple elements of the neurological exam as needed. Similar to other telehealth service models, we have employed a “hub-and-spoke” configuration to provide accessible outpatient evaluation with centralized coordination of ancillary tests and referrals. Outpatient sites of telehealth delivery are strategically selected based on a patient’s home address and the choice of a telehealth visit or standard face-to-face visit is offered at the time of scheduling. Methods: We conducted a retrospective review of epilepsy visits since 2014 to 2016 via our center’s analytics software (BI Office – Pyramid Analytics. Bellevue, WA). Data was subsequently segmented to outpatient and inpatient encounters. Outpatient telehealth encounters were then segmented separately. Totals of unique patient encounters, as well as breakdown of cost of care were then analyzed. Results: We have maintained a steady number of approximately 120 unique telehealth visits per year since 2014. The availability of epilepsy consultation has also facilitated increased use of epilepsy monitoring unit evaluations. This has additionally facilitated better distinction between epileptic seizures and non-epileptic spells, which in certain cases may go undiagnosed for many years. We have observed increased use of our hospital’s inpatient resources, but an overall decrease in outpatient and grand total capital utilization for epilepsy care for veterans across Virginia and West Virginia. This cost savings does not take into account the recovery of lost work productivity, travel expenses and stress of logistics that patients experience to attend follow up visits. Our epilepsy telehealth service has decreased the necessary travel time, in some cases from several hours, to less than half an hour. This has also resulted in up to 90% satisfaction in care. Conclusions: Telehealth usage can thus facilitate increased access to subspecialty care, despite limitations in staff numbers. This can serve as a model to further expand telehealth usage within and outside the VA, especially academic medical centers with wide geographic coverage. This may also facilitate the future justification for home telehealth technologies to those that cannot make their appointments due to their medical comorbidities or psychosocial barriers. Funding: No external or internal funding sources were used to support this abstract.