Original article
Impact of telehealth on health care in a multiple sclerosis outpatient clinic during the COVID-19 pandemic

https://doi.org/10.1016/j.msard.2022.103913Get rights and content

Highlights

  • Patient satisfaction with telehealth was high with video consultations preferred.

  • Clinicians strongly preferred in-person visits which allow physical examination.

  • Telehealth-based EDSS was feasible but may under-estimate lower EDSS.

  • Treatment inertia may affect management decisions during telehealth consultations.

Abstract

Background

The coronavirus disease 2019 (COVID-19) pandemic has precipitated expansion of telemedicine in outpatient management of chronic diseases including multiple sclerosis (MS). Studies conducted pre-pandemic, when telehealth was an alternative to in-person consultations, represent a different setting to current practice. The aim of this study was to assess the impact of telehealth on MS outpatient care in a tertiary metropolitan hospital in Melbourne, Australia during the COVID-19 pandemic.

Method

From March-December 2020, patients and clinicians in the MS outpatient clinic were surveyed regarding their attitudes towards telehealth. Scores on the Expanded Disability Status Scale (EDSS) from telehealth and face-to-face appointments during the study period were compared to scores from face-to-face consultations before and after this period. Medical records were reviewed to compare management decisions made during telehealth versus face-to-face consultations. Diagnoses and treatment of MS relapses were compared to 2019.

Results

Telehealth was used in 73% of outpatient appointments. Patient satisfaction was generally high. Patients and clinicians preferred face-to-face consultations but were willing to use telehealth longer term. Overall, there were no significant delays in identifying patients experiencing disability worsening via telehealth, but EDSS increase was recorded in more face-to-face than telehealth appointments particularly for those with lower baseline disability. Disease-modifying therapy commencement rates were similar, but symptomatic therapy initiation and investigation requests occurred more frequently in face-to-face visits. Comparable numbers of MS relapses were diagnosed and treated with corticosteroids in 2019 and 2020.

Conclusions

Patient satisfaction with telehealth was high, but both clinicians and patients preferred in-person appointments. Telehealth implementation did not lead to high rates of undetected disability worsening or undiagnosed acute relapses, but telehealth-based EDSS assessment may underestimate lower scores. Treatment inertia may affect some management decisions during telehealth consultations. Telehealth will likely play a role in outpatient settings beyond the COVID-19 pandemic with further studies on its long-term impact on clinical outcomes required.

Keywords

Multiple sclerosis
Telemedicine
Outpatient care
Outcome assessment
COVID-19

Abbreviations

MS
multiple sclerosis
COVID-19
Coronavirus disease 2019
EDSS
expanded disability severity scale
IQR
interquartile range
CI
confidence interval
F2F
face-to-face

Cited by (0)

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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