How Has the COVID-19 Pandemic Impacted Neurologic Care?

Treatment for chronic neurological disorders such as Parkinson disease (PD) has exhibited extensive innovations in recent years, especially through the use of telemedicine. While promising and effective, the widespread implementation of these services have lagged due to issues relating to reimbursement issues and technology costs.

In many ways, this has caused care for neurologic disorders to not just remain stagnant, but grow worse when considering the financial burden of these conditions. As indicated in a study last year by Michael J. Fox Foundation for Parkinson Research, the annual economic burden of PD in the United States was $52 billion, more than double previous estimates.

However, the current coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented changes to how care is provided, with CMS broadening access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their physicians without risking infection.

As authors of an opinion article published in JAMA Neurology note, “the silver lining of this crisis is that it accelerates delivery of remote care for those with chronic neurological conditions.” When it comes to chronic neurologic care, researchers highlight 4 considerations, referred to as the 4 C’s: better access to care, greater convenience, enhanced patient comfort, and better confidentiality.

Awareness among clinicians has pointed to the conclusion that chronic neurologic care may be best delivered as close to the patient’s home as possible. Notably, the significance of relevant disease complications play a chief role as the documentation of occurrences such as falls or seizures can be unreliable especially among those with neurologic disorders. Moreover, quality of care is an additional consideration as outpatient visits were described by authors as “inefficient and often unsafe,” with many patients having to commute to appointments only to see clinicians for 10 to 15 minutes.

“Consider also that driving a car is unsafe for many patients with neurological conditions, while entering and exiting the car can cause falls and fractures,” said the authors.

Ultimately, authors indicate that the proposed fifth C, contagion, may serve as the catalyst for transforming neurologic care with telehealth. Researchers note that a common truism in healthcare is that it is resilient to change, but as the current conditions brought by the COVID-19 pandemic require the nationwide use of telehealth, physician response was noted by researchers as being “overwhelmingly positive.”

The attractiveness of telemedicine is not unwarranted as a 2017 study published in The American Journal of Accountable Care, highlights how it can significantly improve the quality of healthcare by increasing accessibility and efficiency through reducing the need to travel, providing clinical support, overcoming geographic barriers, offering various types of communication devices, and improving patient outcomes.

There still remain several obstacles, particularly for patients who are either uninsured or are covered by private insurance. To optimize telemedicine among these insurance providers who may not have been prepared for the technological transition, the American Academy of Neurology provided guidelines for telemedicine visits in which they addressed legal issues and standards of care.

As these innovations grow, the major question that will eventually be addressed is when the pandemic subsides, what will this mean for neurologic care?

For researchers, they hope that the time in which healthcare systems have experimented with telemedicine will promote the continued use of these services, especially in neurologic care whose patients would benefit from enhanced monitoring and timely intervention. “Telemedicine for chronic neurological disorders should become part of the new normal rather than the exception. Governments, health care systems, and payers should be encouraged to continue to embrace the new age of access from home, even after the pandemic passes,” said the authors.

Reference

Bloem BR, Dorsey ER, Okun MS. The coronavirus disease 2019 crisis as catalyst for telemedicine for chronic neurological disorders [published online April 24, 2020]. JAMA Neurol. doi: 10.1001/jamaneurol.2020.1452.