Abstracts

Rationale: The Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, VA is the sole VA provider of subspecialized epilepsy care for veterans who reside in Virginia. Veterans face a particular challenge to obtain subspecialized care due to the unique nature in which medical coverage is distributed. In 2017, we profiled our experience of our small population of veterans we serve via telehealth in West Virginia, and discovered numerous disparities. Most are attributed to poor access to subspecialty care or misconceptions on the delivery of epilepsy care and its management. We now profile our larger Virginia population by compiling cumulative experience in delivering and expanding outpatient epilepsy telehealth visits since 2014. Methods: We conducted a retrospective review of our epilepsy telehealth visits since its inception in 2014. Patient visits were individually collected from the VA's health information exchange system. Given that many veterans move around the country, data was collected not only from Virginia records, but anywhere a veteran may have obtained VA or DoD healthcare in the United States and its territories. Patient demographics, geographic distribution, type and duration of military service, duration of clinical symptoms until subspecialty evaluation (clinic, EEG, EMU), duration of symptoms to formal diagnosis, number and types of medications tried, presence or absence of traumatic brain injury (military or non-military) are profiled. Results: Similar to our prior experience with West Virginia, veterans in Virginia have experienced prolonged duration of symptoms until subspecialty epilepsy evaluation. Within our telehealth population, no show rates in particular have markedly declined since transitioning from traditional face-to-face to telehealth visits. Travel time from a patient's home has also decreased from 1-3 hours to 30 minutes or less in most cases. Duration from initial consultation to epilepsy monitoring unit evaluation has also decreased, leading to earlier and improved characterization of epileptic seizures as well as psychogenic non-epileptic events. Comorbid traumatic brain injury and/or mental illness is high. Conclusions: The VA has a unique advantage in its telehealth delivery of epilepsy subspecialty care due to the numerous networked medical centers and outpatient clinics throughout the state of Virginia. In combination with a national health information exchange, effective use of telehealth may provide vital care to patients in underserved areas or regions with insufficient resources. This model may serve useful for large medical centers with multiple satellite clinics in need of broader subspecialty service in distant parts of the country. Funding: None