Abstracts

Rationale: Telehealth has emerged as a feasible method of ambulatory care delivery. We aimed to evaluate the quality and experience of new patient epilepsy visits (NPV) conducted via telehealth (TH) compared to in-person (IP) from the perspective of patient, epileptologist and ancillary clinic staff at a level 4 NAEC academic epilepsy center. Our secondary aim was to measure quality metric fulfillment for TH and IP NPVs. This project is a quality improvement initiative.

Methods: An interview tool was developed to obtain patient feedback about NPVs completed via TH or IP (n=15 each; >60% response rate). Interviews were conducted with individual epileptologists (n=11) and TH based medical assistants (MAs) (n=4). 49 NPV charts (n=35 TH & n=24 IP; 11 epileptologists; 7/2020-12/2020) were abstracted to measure the following disease specific and cross-cutting quality process metrics: seizure frequency documentation, depression screening, medication reconciliation, after visit summary (AVS). Our sample was not powered to assess statistical differences; trends were assessed for quality improvement.

Results: Over 90% of TH patients would use it again or recommend it, and 2/3 reported perceived appropriateness for NPVs. Two-thirds of IP patients lived < 10 miles (vs 40% TH). The majority (93%) of TH were employed (vs 27% IP). The main driver for selection of visit type was clinic schedule offer; technology availability/comfort did not impact decision. 60% of TH patients DID have COVID safety concerns (vs 14% IP). MAs reported an inefficient check-in system. >90% of epileptologists felt comfortable using TH. Quality metrics findings from chart abstractions revealed (TH vs. IP): seizure frequency documentation ≥ 1 type (94% vs. 88) and all types (51% vs. 33%); depression screening (83% vs. 70%), medication reconciliation (46 % vs. 58%) and AVS completion (69% vs. 83%).

Conclusions: Patients would recommend TH NPVs for epilepsy while epileptologists were comfortable using the technology. There was a trend for higher rates of seizure frequency documentation and depression screening in TH visits, while medication reconciliation and AVS completion rates were higher in IP visits. While TH for NPV epilepsy visits is feasible and satisfactory to patients and providers larger studies are needed to conclude if quality processes are comparable.

Funding: Please list any funding that was received in support of this abstract.: University of Colorado Clinical Effectiveness and Patient Safety Grant 2020-2021.