Authors :
Presenting Author: ANA ROMAN GUZMAN, MD – University of Kentucky, Neurology Institute, Lexington, Kentucky
Rani Vasireddy, MBBS, MHA – University of Kentucky, Neurology Institute, Lexington, Kentucky; Christopher McLouth, PhD – University of Kentucky, Behavioral Sciences, Lexington, Kentucky; Sally Mathias, MD – University of Kentucky, Neurology Institute, Lexington, Kentucky; Lara Jehi, MD, MHCDS – Cleveland clinic, Cleveland, Ohio; Ruta Yardi, MD – University of Kentucky, Neurology Institute, Lexington, Kentucky
Rationale:
Epilepsy is a chronic neurologic disorder affecting approximately 6.38 individuals per 1000. Patients with epilepsy often require lifelong care and frequent visits with a specialist, especially if they are medically refractory. The COVID-19 public health emergency led to the expansion of telemedicine as an alternative for ambulatory visits, benefiting patients with cognitive impairments and driving restrictions by easing access to care. However, our knowledge of the application and benefits of telemedicine is still lagging. Specifically, there is no literature to understand how a telemedicine visit compares with a traditional in-person visit and there is limited, conflicting data on patient demographics that are well suited for this technology. This study aims to conduct a comprehensive analysis of clinical and seizure-related outcomes between telemedicine and in-person visits and attempt to identify characteristics of patients who prefer telemedicine.
Methods:
With approval from the Institutional review board, we collected social, demographic, and clinical characteristics of all adult epilepsy patients seen either as an in-person or telehealth encounter at University of Kentucky between July 1, 2021 and September 30, 2022. Outcome measures to compare visit types were the following: changes made to anti-seizure medications, abnormalities found during examination, discussions regarding epilepsy surgery, post-visit seizure freedom, and post-visit emergency room/in-patient admissions.
Group comparison was done using Chi square test and stepwise regression model identified predictors of patients that preferred telemedicine visits.
Results:
Six hundred independent patient encounters were assessed for eligibility and five hundred ninety were included in the study. Two hundred forty four (38%) patients opted for in-person appointments while three hundred sixty six (62%) had virtual visits. A Pearson chi square test showed no difference in post-visit seizure freedom, post-visit ER admissions, anti-seizure medication changes, and ability to discuss epilepsy surgery between telemedicine and in-person visits. In-person visits were more likely to report abnormalities on neurologic exam (p< 0.0015) (Table1). To determine predictors of patient preference for telemedicine visits, a forward stepwise regression analysis was conducted. Initially, social, demographic, and visit variables known to be influential were included. Variables were added based on p-values, and the Akaike Information Criterion (AIC) was used to establish a limit on the total number of variables in the final model. The final model revealed six predictors that remained significant: younger age, under-represented races, individuals with significant others, residing at longer distances from the hospital (Figure 1), fewer seizures per month at baseline, and no history of seizure generalization.