Research Article
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Published Online: 6 May 2014

Teleneurology: Successful Delivery of Chronic Neurologic Care to 354 Patients Living Remotely in a Rural State

Publication: Telemedicine and e-Health
Volume 20, Issue Number 5

Abstract

Background: Delivery of specialty healthcare to rural citizens in the United States remains largely unmet. The Veterans Health Administration is in a unique position to deliver specialty care to rural Veterans because it is mandated to deliver medical care to all eligible Veterans regardless of residence. To accomplish this, the VHA developed large national telehealth networks that provided over 1 million episodes of care in 2012. We investigated whether clinical video telehealth technologies can provide quality efficient neurologic follow-up care to Veterans living in the rural southwest United States. Patients and Methods: Veterans with chronic neurologic conditions living remotely in New Mexico, southern Colorado, eastern Arizona, and western Texas were offered follow-up teleneurology care at 11 rural community-based outpatient clinics following initial evaluation at the Albuquerque, NM, neurology outpatient clinic. Results: Over a 2-year period, 87% of 354 consecutive patients returned a performance improvement satisfaction questionnaire. Ninety percent of the patients were fully satisfied with their visit, and 92% felt teleneurology saved them time and money. We calculated an average time savings of 5 h and 325 miles driven, plus at least $48,000 total cost savings. Ninety-five percent reported they wanted to continue their neurologic care by teleneurology. Conclusions: Our study confirms earlier pilot studies of successful follow-up care through telemedicine. Our patients were highly satisfied with the convenience and quality of their teleneurology visit, and the neurology providers were convinced that neurologic care to both teleneurology and clinic follow-up patients was equivalent. Teleneurology to rural Veterans can provide quality neurologic care and overwhelming patient satisfaction and save considerable time and money.

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References

1.
Projection of physician supply in the United States. Office of Data analysis and Management report. Rockville, MD: U.S. Department of Health and Human Services, 1985:3–85.
2.
Fordyce MA, Chen FM, Doescher MP, Hart LG. 2005 physician supply and distribution in rural areas of the United States. Final report #116. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, 2007.
3.
Clifford WB, Heaton TB, Voss PR, Fuguitt GV. The rural elderly in demographic perspective. In: Coward RT, Lee GR, eds. The elderly in rural society: Every fourth elder. New York: Marcel Dekker, 1992:35–57.
4.
Patterson VH, Esmonde TFG. Comparison of the handling of neurologic outpatient referrals by general physicians and a neurologist. J Neurol Neurosurg Psychiatry 1993;56:830.
5.
Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, Lancaster AE. Care coordination/home telehealth: The systematic implementation of heath informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health 2008;14:1118–1126.
6.
Bloch C. Federal agencies: Activities in telemedicine, telehealth, and health technology. Potomac, MD: Bloch Consulting Group, 2010:165–185.
7.
National Center for Veterans Analysis and Statistics. Characteristics of rural Veterans: 2010: data from the American Community Survey. U.S. Department of Veterans Affairs. July 2012. Available at www.teleheath.va.gov (last accessed January 16, 2013).
8.
Office of Rural Health. Fact sheet. November 2012;3(2). Available at www.ruralhealth.va.gov (last accessed May 2, 2013).
9.
Weeks W, Wallace A, West A, et al. Research on rural veterans. J Rural Health 2008;24:337–344.
10.
Craig JJ, McConville JP, Patterson VH, Wootton R. Neurological examination is possible using telemedicine. J Telemed Telecare 1999;5:177–181.
11.
Samii A, Ryan-Dykes R, Tsukuda RA, et al. Telemedicine for delivery of healthcare in Parkinson's disease. J Telemed Telecare 2006;12:16–18.
12.
Kane RL, Bever CT, Ehrmantraut M, et al. Teleneurology in patients with multiple sclerosis: EDDS ratings derived remotely and from hands-on-examination. J Telemed Telecare 2008;14:190–194.
13.
Ahmed SN, Mann C, Sinclair DB, Heino A, Iskiw B, Quigley D, Ohinmaa A. Feasibility of epilepsy follow-up care through telemedicine: A pilot study on the patient's perspective. Epilepsia 2008;49:573–585.
14.
Chua R, Craig J, Wootton R, Patterson V. Randomized controlled trial of telemedicine for new neurological outpatient referrals. J Neurol Neurosurg Psychiatry 2001;71:63–66.
15.
Rasmusson KA, Hartshorn JC. A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic. Epilepsia 2005;46:767–770.
16.
Craig J, Chua R, Wootton R, Patterson V. A pilot study of telemedicine for new neurological outpatient referrals. J Telemed Telecare 2000;6:225–228.
17.
Hubble JP, Pahwa R, Michalek DK, et al. Interactive video conferencing: A means of providing interim care to Parkinson's disease patients. Mov Disord 1993;8:380–382.
18.
Loh PK, Ramesh P, Maher S, Saligari J, Flicker L, Goldswain P. Can patients with dementia be assessed at a distance? The use of telehealth and standardized assessments. Intern Med J 2004;34:239–242.
19.
Ciemins EL, Holloway B, Coon PJ, McClosky-Armstrong T, Min S-J. Telemedicine and the Mini-Mental State Examination: Assessment from a distance. Telemed J E Health 2009;15:476–478.
20.
Darkins A, Foster L, Anderson C, Goldschmidt L, Selvin G. The design, implementation, and operational management of a comprehensive quality management program to support national telehealth networks. Telemed J E Health 2013;19:557–564.
21.
Godleski L, Darkins A, Peters J. Outcomes of 98,609 U.S. Department of Veterans Affairs patients enrolled in telemental health services, 2006–2010. Psychiatr Serv 2012;63:383–385.
22.
Department of Veterans Affairs. Store-and-forward telehealth. VHA Office of Telehealth Services. Available at www.teleheath.va.gov (last accessed January 16, 2013).
23.
Hsueh MT, Eastman K, McFarland LV, Raugi GJ, Reiber GE. Teledermatology patient satisfaction in the Pacific Northwest. Telemed J E Health 2012;18:377–381.
24.
Cavallerano AA, Conlin PR. Teleretinal imaging to screen for diabetic retinopathy in the Veterans Health Administration. J Diabetes Sci Technol 2008;2:33–39.

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Published In

cover image Telemedicine and e-Health
Telemedicine and e-Health
Volume 20Issue Number 5May 2014
Pages: 473 - 477
PubMed: 24617919

History

Published online: 6 May 2014
Published in print: May 2014
Published ahead of print: 11 March 2014
Accepted: 4 September 2013
Revision received: 30 August 2013
Received: 25 June 2013

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Authors

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Larry E. Davis
Neurology Service, New Mexico Veterans Affairs Healthcare System, Albuquerque, New Mexico.
Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Julia Coleman
Neurology Service, New Mexico Veterans Affairs Healthcare System, Albuquerque, New Mexico.
JoAnn Harnar
Neurology Service, New Mexico Veterans Affairs Healthcare System, Albuquerque, New Mexico.
Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Molly K. King
Neurology Service, New Mexico Veterans Affairs Healthcare System, Albuquerque, New Mexico.
Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico.

Notes

Address correspondence to:Larry E. Davis, MDNeurology ServiceNew Mexico Veterans Affairs Healthcare System1501 San Pedro Drive SEAlbuquerque, NM 87108E-mail: [email protected]
[email protected]

Disclosure Statement

No competing financial interests exist.

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