Dr. Linda S. Williams and her team’s study highlights telemedicine’s potential to alleviate two pressing issues in neurology: a shortage of neurologists and geographic disparities in care access. They evaluated a VA telehealth program, which significantly improved access to neurologists for veterans in underserved areas. The program reduced community referrals, maintained high patient and provider satisfaction, and directly addressed health equity concerns. The future of telemedicine in neurology looks promising, with home-based devices and subspecialty input offering innovative solutions to enhance patient care.
Dr. Linda S. Williams, a neurologist at the Richard L. Roudebush VA Medical Center in Indianapolis and a researcher at the Regenstrief Institute, recently conducted a study that demonstrates the benefits of telemedicine in enhancing access to and care for veterans with neurologic illnesses. In managing their chronic diseases, neurologic patients frequently encounter difficulties like physical restrictions, geographic hurdles, and financial limitations. One potential remedy to deal with these problems is telehealth.
In one of the largest studies focusing on outpatient general teleneurology care, Dr. Williams and her team evaluated an innovative VA telehealth program. This program caters to patients with various common neurologic conditions, including headaches, seizures, multiple sclerosis, recent stroke, and back pain. Their research investigates the effectiveness of telemedicine in enhancing outpatient care access and rectifying healthcare inequities.
We had the opportunity to sit down with Dr. Williams to delve into the fusion of neurology and telehealth, the comprehensive VA teleneurology program, the study’s findings, and more.
Q. What challenges in the field of neurology can telemedicine help address?
A. Telemedicine can effectively tackle two major challenges in neurology. Firstly, the shortage of neurologists is a pressing issue, with only about 1.5% of practicing physicians in the U.S. specializing in neurology, as per a 2021 report by the American Association of Medical Colleges. Secondly, there’s often a mismatch between the location of neurologists’ practices and where patients with neurologic conditions reside, as highlighted by a 2021 study analyzing the distribution of neurologists and patients with neurologic diseases.
Telemedicine offers a solution by enabling neurologists to work remotely, reducing early retirements, and efficiently distributing their expertise. It also eliminates the need for patients to travel to remote clinic locations. This is especially vital for rural-dwelling patients with limited access to specialty neurology care. Additionally, since neurologic conditions can impair mobility and driving abilities, telemedicine becomes a game-changer by increasing access and reducing travel-related burdens for patients and their families.*
Q. Your research team recently assessed a VA telehealth program for outpatient general teleneurology care. Could you describe this program and its objectives?
A. The VA National TeleNeurology Program (NTNP) was established in 2019 with funding from the VA Office for Rural Health. Its primary goal is to bridge the gap in neurology care access across VA facilities. Leveraging the VA’s history of telehealth technology, the NTNP started with eight facilities and has since expanded to 14 nationwide.
The NTNP operates from the Philadelphia VA, directed by Dr. Jayne Wilkinson, while its neurologists are spread across the country, some working at VA facilities and others remotely. This program provides general neurology outpatient video visits, either at the veteran’s home or a nearby VA facility. Patients receive an email with a link for their telehealth visit, simplifying the connection process.
Although physical examinations aren’t conducted in person, much of the neurologic examination can be performed virtually through patient interaction, tasks performed on camera, and observing patients’ movements. Some VA facilities offer devices like telehealth stethoscopes to aid in physical examinations.
Beyond neurologist visits, the NTNP includes nurse and pharmacist visits, enhancing patient education, and addressing medication-related issues.*
Q. What outcomes has this outpatient teleneurology program achieved, and what contributed to these results?
A. The NTNP program’s primary achievement is expanding access to highly trained neurologists for veterans in facilities lacking neurology resources. In fiscal year 2022, over 1,700 veterans received new consultations through NTNP, with nearly 4,000 neurology visits completed. Collaborative efforts with clinic and telehealth managers at participating sites significantly improved the scheduling and completion times for neurology consultations compared to referrals to the community.
NTNP visits were completed within an average of 73 days from the initial consult date, while community consults took an average of 99 days. High satisfaction ratings from both veterans and referring providers underscore the program’s success. Interestingly, satisfaction levels remained consistent regardless of the neurologic condition, with patients having higher medical complexity reporting greater satisfaction, suggesting telehealth’s effectiveness in increasing access for those facing greater care barriers.
One notable achievement was the reduction in community neurology referrals following NTNP implementation, even after accounting for facility size, rural location, and program duration. This indicates a sustained positive impact on facilities that adopted NTNP.*
Q. How does this program address health equity, and what has been its impact in this regard?
A. The NTNP specifically targets veterans residing in rural areas, focusing on sites with limited local neurology care resources and a significant rural veteran population. By doing so, the program directly addresses access challenges faced by these patients. It also mitigates disability-related and socioeconomic disparities resulting from difficulties in traveling to appointments, both for patients and their caregivers.
To ensure access to telehealth care for those lacking appropriate electronic devices, the VA offers consultations for device assistance, sending devices, and providing setup assistance when needed.*
Q. What does the future hold for telemedicine in the field of neurology?
A. The future of telemedicine in neurology is promising, driven by the persistent mismatch between neurologist distribution and patient location, unmet neurologic care needs, and growing demand for patient-centric care options. One exciting avenue is the use of home-based devices that collect neurologic data for remote review and integration into care plans. These devices, such as in-home electroencephalograms (EEG) and personal kinetographs (PKG), extend neurologists’ reach and provide valuable clinical data for patient management.
Subspecialty input through telemedicine is also on the rise, where subspecialist neurologists conduct outpatient teleneurology visits or provide e-consultations to assist general neurologists in complex cases. Acute telestroke care, for example, has been in use for years, enabling stroke specialists to evaluate patients remotely and make treatment recommendations.
The NTNP has recently introduced a subspecialist e-consult program, with multiple sclerosis and movement disorders being the most requested consults. In summary, the future of telemedicine in neurology offers numerous possibilities for scaling and delivering specialized care efficiently and conveniently to patients.*
