Parul Dayal

Limited access to outpatient pediatric neurology care can lead to inconsistent management of patients’ medical conditions and may result in unplanned hospital encounters, including visits to the emergency department (ED) and hospital admissions.^1-8 For children, appropriate access to outpatient care is hindered by the shortage of pediatric neurologists across the country.⁹ Confounding these shortages is the fact that pediatric subspecialists are concentrated at tertiary care centers located primarily in urban areas,^10-12 forcing children with neurologic disorders living in rural communities to travel long distances to see the nearest pediatric neurologist.

Background To determine whether telemedicine improves access to outpatient neurology care for underserved patients, we compared appointment completion between urban, in-person clinics and telemedicine clinics held in rural and underserved communities where neurology consultations are provided remotely. Methods In this retrospective study, we identified patients scheduled for outpatient care from UCDH pediatric neurologists between January 1, 2009, and July 31, 2017, in person and by telemedicine. Demographic and clinical variables were abstracted from electronic medical records. We evaluated the association between consultation modality and visit completion in overall and matched samples using hierarchical multivariable logistic regression. Results We analyzed 13,311 in-person appointments by 3,831 patients and 1,158 telemedicine appointments by 381 patients. The average travel time to the site of care was 45.8 ± 52.1 minutes for the in-person cohort and 22.3 ± 22.7 minutes for the telemedicine cohort. Telemedicine sites were located at an average travel time of 217.1 ± 114.8 minutes from UCDH. Telemedicine patients were more likely to have nonprivate insurance, lower education, and lower household income. They had different diagnoses and fewer complex chronic conditions. Telemedicine visits were more likely to be completed than either “cancelled” or missed (“no show”) compared with in-person visits (OR 1.57, 95% CI: 1.34–1.83; OR 1.66, 95% CI: 1.31–2.10 matched on travel time to the site of care; OR 2.22, 95% CI: 1.66–2.98 matched on travel time to UCDH). Conclusions The use of telemedicine for outpatient pediatric neurology visits has high odds of completion and can serve as an equal adjunct to in-person clinic visits.