Abstracts

Rationale: The lifetime prevalence of epilepsy is estimated at 1%. Surveys by the Child Neurology Society suggest that the number of pediatric neurologists is not expected to grow to meet needs of children with neurological disorders, requiring improved co-ordination of care between the specialist and primary care physician (PCP). Furthermore, seeing a pediatric neurologist often requires children and youth with epilepsy (CYE) to travel long distances, resulting in missed school time, loss of work days and extra expenses for travel and lodging. The Michigan Pediatric Epilepsy Telemedicine Project aims to improve care of CYE by improving care co-ordination between patients, PCPs and neurologists within the framework of a medical home (a team based healthcare delivery model usually lead by a PCP that provides comprehensive and continuous medical care to patients with the goal of maximizing health outcomes), and reducing the impact on travel, school and work attendance. Methods: The clinic visits were conducted using a Polycom HDX7000 w/1080 option HD video conferencing system, with a PCP at the local site and neurologist at the specialist site. The pediatric neurologists were located at one of 2 children's hospitals in Michigan. Clinic data from epilepsy telemedicine visits were reviewed, along with post-visit satisfaction surveys given to the PCPs and parents of CYE as part of routine clinical care. Expected mileage reimbursement and lodging expenses were calculated, based on the travel distance to see the pediatric neurologist reported by families and Michigan Medicaid mileage reimbursement rates. The impact of telemedicine on school and work absences was also estimated. Results: Since October 2011, 11 primary care clinic sites have become operational in the telemedicine project: all are pediatric primary care practices or Federally Qualified Health Centers, at least 50 miles away from a pediatric neurology practice. Between October 2011 and May 2014, 81 CYE were seen, 8 as new consultations. Mean age was 11 years (range 3 months to 16 years), 60% male, 80% were enrolled in Medicaid and/or Children's Special Health Care Services. Epilepsy Action Plans were updated for 97% of patients. In satisfaction surveys 100% families and 97% physicians indicated satisfaction with telemedicine services. Missed days of school avoided were 243, missed days of parental work avoided 243, mileage reimbursement costs saved were $12,051, lodging costs saved $9,210. Conclusions: The Michigan Pediatric Epilepsy Telemedicine Project demonstrates that subspecialty medical care can be successfully co-ordinated between a pediatric neurologist and PCP within a medical home, with high levels of patient and physician satisfaction. A telemedicine clinic allows patients and families to access their subspecialty care without travelling long distances and missing days of work and school. This Project also suggests that telemedicine can potentially reduce some medical care expenses.