A home telemedicine model implemented at Children’s Mercy’s Comprehensive Epilepsy Center in Kansas City showed high levels of satisfaction among Registered Nurses (APRNs) and other clinicians -PC, according to preliminary data from Erin Fecske, DNP, APRN, CNRN, CPNP, FAES, at AES2020.1
The telemedicine model was initiated in March 2020 in response to the coronavirus-19 disease (COVID-19) pandemic. 3 months after performing the intervention, Dr. Fecske and colleagues surveyed 36 clinicians at the epilepsy center to assess satisfaction with the model. A total of 24 providers responded, including 12 treating physicians, 11 registered nurses (Advanced Practice Registered Nurses, APRNs) and 1 general practitioner.
Almost all respondents (96%) said that telehealth at home enabled them to adequately assess patients with epilepsy. Of the 2901 patients with epilepsy seen via home telemedicine visits within 3 months, 66 patients (2%) required a face-to-face visit within 2 weeks of the virtual visit.
Not facilitated and facilitated visits to telemedicine for epilepsy
Clinicians at the Comprehensive Epilepsy Center use telemedicine in different ways and in different settings for epilepsy visits. The first method is in-home telemedicine for re-examinations or follow-up exams, said Dr. Fecske in an interview. These visits are not relieved, which means a clinician will not be on site to assist with the visit. Although ancillary equipment (e.g., stethoscope, handheld camera) is typically not used during home follow-up exams, new home visits are somewhat limited as families require the use of a camera to provide a visual exam.
The second modality is to facilitate telehealth at an off-site location through telehealth trained nurses and aids to assist the patient, said Dr. Fecske. “These visits are used by new patients and follow-up patients as we would use a traditional clinic visit as the exam is not limited,” she noted.
“Alternatively, facilitated visits can be made to one of our regional offices for primary care partners,” explained Dr. Fecske. “The visit to telemedicine [using Microsoft Teams] occurs in the primary care of the patient. This facilitated visit includes a member of the Primary Services Bureau who we hope will improve the primary care provider’s commitment to care for patients with epilepsy. ”
Remote epilepsy counseling services
“With all of these modalities, we can work with our counseling services such as dietitians and social workers to provide the same support that we would provide for a traditional face-to-face visit,” said Dr. Fecske. “In situations in which I would have to visit an epileptologist together [such as presurgical planning]the epileptologist can attend the telemedicine appointment with the epilepsy APRN. ”
“We have an APRN that runs a multidisciplinary ketogenic diet screening clinic where preCOVID required more than 2 hours of personal clinic visits from families,” said Dr. Fecske. “With the use of telemedicine, we have created videos that families can watch in advance. The actual time in the clinic is reduced to around an hour during a home telemedicine visit. During this time we can meet an occupational therapist, nutritionist, social worker, cooking educator, pharmacist, and epilepsy APRN with the family and conduct appropriate assessments for ketogenic nutritional readiness. ”
Other members of the care team can also be added at the patient’s request, said Dr. Fecske. “I’ve had children in group homes and we can include members of the care team who have been identified by the family, which has been very beneficial.”
The decision to use telemedicine during a personal visit is at the discretion of the provider, who selects the modality when ordering for follow-up. For infants or patients with epileptic convulsions, face-to-face visits may be preferred, explained Dr. Fecske. Additionally, most of the new patients seen on their first visit via telemedicine at home will be seen in person on their next visit for a full neurological exam, she said.
Before the COVID-19 pandemic, telehealth in the epilepsy center was limited to facilitated visits, during which patients were presented at external locations and with additional devices. At that time, according to Dr. Fecske only approved a small number of providers for telemedicine.
“With the initial home-stay orders in our states, we had to quickly move to a more comprehensive telemedicine model,” said Dr. Fecske. “Now all of our neurology providers are qualified to deliver telemedicine. As we work to offer more face-to-face visits, we also monitor the intervals in the clinic to make sure we can follow the recommendations of the Centers for Disease Control and Prevention. For this reason, we have continued to use our telemedical services to ensure that patients continue to be seen regularly and adequately monitored. ”
Limitations and benefits of telemedicine visits for epilepsy
Technology limitations were one of the most frequently cited issues among respondents. According to Dr. Fecske families may not have a high-resolution camera, poor internet connection or internet access, or difficulty using video applications. While some caregivers may be able to get parts of the exam, other components – such as B. Reflexes – difficult to obtain.
“While we see telemedicine as a great way to improve access, we also need to consider how it can add another barrier to access for our patients and families,” said Dr. Fecske.
“One of the greatest benefits of moving to this telemedicine model is that we can continue to safely care for patients in an unusual situation,” said Dr. Fecske. “I have patients who continue to request home visits because they feel this is the safest option for them right now. In addition, there is so much history associated with epilepsy that much of our visits are spent talking to families and patients and getting accurate descriptions that we can all reach during a telemedicine model at home. ”
In addition, telemedicine can reduce the number of missed work hours for adult patients and parents and the missed school time for children with epilepsy for epilepsy, said Dr. Fecks. She advised clinicians who practice telemedicine for epilepsy visits to see what aspects of care they are committed to and what technology they are unfamiliar with.
“If you need a face-to-face visit to get a better assessment, stand up for what you think is safest for your patient,” said Dr. Fecks.
1. Fecske E., Le Pichon JB, Wellman C., Waller M., Abdelmoity A. Transition to telemedicine: being nimble during COVID-19. Poster presented at: AES2020; December 4 to 8, 2020.
This article originally appeared on Clinical Advisor