Abstracts

Rationale: Children and youth with epilepsy (CYE) exhibit an elevated rate of psychiatric co-morbidities like depression, anxiety, and attention‐deficit‐hyperactivity disorder (ADHD)1. School attendance is severely impacted in CYE due to seizures2. This is compounded by days lost due to attending their epilepsy clinics. This may lead to an unintended neglect of their psychological wellbeing that may impact overall health care of CYE. Improving access to psychiatric care with minimal additional burden to routine life may ameliorate such problems. Telemedicine allows health care professionals to evaluate, diagnose and treat patients using telecommunications technology without travel. We started IMPACTT (Integrating Mobile Provider Access for Telemedicine and Transition) to address the needs of CYE and their families through various means, including tele-psychiatry (telemedicine in psychiatry) care. The aim of our study is to describe our initial experience and to analyze the patient satisfaction with tele-psychiatry for CYE.  Methods: CYE with psychiatric comorbidities enrolled under IMPACTT were scheduled for a follow-up psychiatry care visit to be performed using telemedicine from the location of their choice (usually home) on a personal smartphone, computer, tablet, etc. Parents of above patients were sent an online survey containing 38 questions after their tele-psychiatry visit. Patients seen during 05/01/18 to 09/01/18 were included in the current study. Qualitative statistical tools were used to analyze the data. Results: A total of 27 CYE with psychiatric comorbidities completed the online survey with help of their parents. Their average age was 14.4 +- 7.8 years with 16(59.3%) being female. The epilepsy duration was <1 year in 3 (11.1%) CYE and >5 years in 18 (66.7%) CYE. All were on anti-epileptic drugs (AEDs), including 20 (74.1%) on multiple AEDs. Psychiatric co-morbidities included 4 (14.8%) with ADHD, 11 (40.7%) with depression/anxiety and rest had developmental delay/intellectual disability. A total of 21 (77.8%) patients used to travel >50 miles to attend psychiatry clinic. Prior in-person visits used to lead to >5 hours of missed school hours in 13 (48.1%) CYE and >5 hours of missed work by 19 (70.3%) parents. In comparison, tele-psychiatry visit affected none to <1 hour of school in >80% (22/27; 81.4%) CYE and all, but 1, parents had to miss none to <1 hour of work. A total of 25 (92.5%) responders found care provided to CYE during telemedicine to be comparable or better to in-person visits. As noted in Table 1, an overwhelming majority of CYE and parents liked, and even preferred Telemedicine compared to in-person visit on various metrics.  Conclusions: Although generalization of our results is limited by a small study sample, this first of its kind study reveals that telemedicine provides a novel and easy to access avenue of psychiatry care to CYE. We found that the experience and care received through telemedicine was highly satisfactory to CYE and led to significant reduction in hours and resources spent on continued psychiatric care compared to current standard of care. While it is clearly preferred by CYE and parents, the impact on healthcare costs, clinical outcomes and coverage by insurance are issues that need to be explored in future studies along with identification of CYE who would benefit most from tele-psychiatry.  Funding: Health Resources and Services Administration (HRSA)