Abstracts

Rationale: Children and youth with epilepsy (CYE), are often challenged by limited access to high-quality coordinated care. Telemedicine can serve as a tool to bridge the gap by increasing access and facilitating the coordination of care between the CYE, families and caregivers, pediatric neurologist, and primary care provider. The Access Improvement and Management of Epilepsy through Telehealth (AIM-ET) project was developed to determine the feasibility of using telemedicine as a tool to improve access by providing quality epilepsy care in the patient’s local community. Methods: The need for improving access to epilepsy care was identified by the National Coordinating Center for Epilepsy at the American Academy of Pediatrics (AAP). Three Pediatric Neurology groups (one each in Utah, California and Alabama) were recruited to implement telemedicine visits for CYE, in partnership with a local primary care practice or health department. Return visits for established CYE patients were conducted using HIPAA compliant 2-way secure video technology. Outcome measures identified included patient and provider satisfaction, out of pocket costs, missed work and school time as well as miles traveled for visits to determine access improvement. Scores were analyzed by a paired sample t-test with 0.05 as the level of significance. IRB approval was obtained from each site and from the AAP. Results: Between November 2017 and May 2018, 18 CYE have been seen using telemedicine visits across the 3 sites. Ages ranged from 2-18 years. Epilepsy type distribution was identified as absence epilepsy in 15% of CYE, generalized epilepsy in 40%, focal epilepsy in 27% and the remaining 18% were unsure. Sixty seven percent were on one medication, 27% were on >1 medication and 6% identified as receiving other therapies. 95% of participants reported out of pocket costs: total cost for in-person visits was $3,995, vs. $945 for Telemedicine visits. The average number of missed school hours were reduced and statistically significant; 3.1 school hours for in-person visits vs. 1.85 hours missed for telemedicine visits (p= 0.008). The average number of missed work hours were reduced as well; in person visit averaged 3.8 hours missed vs 1.8 hours missed for telemedicine visits (p= 0.0003). Based on the reported minimum distances for visits, it was estimated that telemedicine visits resulted in approximately 50% less driving distance. Patients/parents were more satisfied or equally satisfied with telemedicine visits as compared to in-person visits in 94.4%. Conclusions: The AIM-ET project demonstrates feasibility of implementing telemedicine for the medical care for CYE. Telemedicine for management and coordination of care of CYE was associated with high rates of patient satisfaction. These visits saved money and cut down on driving distance for families while keeping care in their local communities. Telemedicine can be a time-effective strategy for patient care as it significantly decreases the amount of time children are out of school or caregivers miss work for medical appointments. Funding: Funded by HRSA grant U23MC26252-05-04