AUSTIN, Texas — A pediatric epilepsy telemedicine pilot program at University of Iowa Children's Hospital in Iowa City is getting rave reviews from families involved, a new survey shows.
The program uses telemedicine as an adjunct to yearly clinic visits, and the feedback has been "very positive," Charuta N. Joshi, MBBS, FRCPC, director of pediatric epilepsy at the hospital, told Medscape Medical News.
In a survey of parents in the program, most said they are able to talk about the same information during their telemedicine visit as an in-person visit and are not worried about their privacy.
"Importantly," Dr. Joshi said, "our families find telemedicine is convenient and makes their life much easier. Overall, they are very satisfied."
Dr. Joshi reported results of the survey here at the Child Neurology Society (CNS) 2013 Annual Meeting.
Telemedicine Practical for Pediatric Epilepsy
Management of the epileptic patient has always been tough, in part because of driving restrictions the adult patient faces once diagnosed with epilepsy, Dr. Joshi and her colleague Tyler Fick, MS, note in a conference poster.
For the pediatric patient with epilepsy, the burden falls on the caregiver, often in terms of expensive travel and missed time from work, and, for the child, missed time from school.
The current standard of care for the pediatric epileptic patient is a clinic visit once per year, with additional visits to the clinic as needed, Dr. Joshi noted. In her experience, oftentimes these additional visits are for parent/caretaker questions about medication side effects, dosage management, or continued questions about long-term prognosis — questions that could be answered via a telemedicine "visit."
Telemedicine has been shown to be "very effective" in adults with epilepsy. "However, little research has been done to assess the use of telemedicine for the pediatric epileptic patient," the authors say.
In their survey, 9 of 12 (75%) caregivers of epileptic children using telemedicine at their institution "completely agreed" that they were able to talk about the same information during their telemedicine visit as they would have in the clinic. The remaining 3 "agreed" that they were able to talk about the same information.
All 12 "completely agreed" that there was enough time during the telemedicine visit to deal with everything that needed to be covered. None were worried about their privacy during the telemedicine visit.
Seven (58.3%) "completely agreed" that telemedicine made it easier for them to access healthcare services, and 4 (33.3%) "agreed" that telemedicine made it easier. The remaining respondent "neither agreed nor disagreed" with the statement.
Most of those surveyed said they spend between $100 and $300, or more, to travel to a clinic visit, and most said they would prefer, without considering any other factors, for their next visit to be arranged by telemedicine.
"When asked to provide additional comments, most felt that telemedicine was a great addition to the clinical practice and were appreciative of the money and time saved using telemedicine," the authors report. They note that insurance remunerated all the telemedicine visits as they would have a hospital visit for a similar level of billing.
"Our study is somewhat of a pilot study for telemedicine in the pediatric neurology clinic," they note. They say it's important to "keep in mind that telemedicine visits should serve as an adjunct rather than a complete replacement of in-clinic visits. When considering using telemedicine, the physician must look at each instance and make sure he or she is not over-reaching with telemedicine and thus possibly compromising care," they conclude.
No Surprises
Jonathan D. Linkous, CEO of the American Telemedicine Association, said he's not surprised by the survey results. "I've seen probably hundreds of surveys of patient acceptance of telemedicine; they all like it."
"For any movement disorder like epilepsy or Parkinson's, telemedicine has been recognized by the patient groups as important, because the patients often can't get out to see their doctor, even if they are in an urban area," Linkous noted.
He also said that telemedicine is "very well established in several areas of medicine, particularly teleradiology and telepathology, also teledermatology and in mental health. There is also remote monitoring of patients in intensive care units and in emergency rooms, for example, having a neurologist (off site) take a look at a stroke patient as soon as they come in. This is really starting to be done throughout the country."
The authors and Mr. Linkous have disclosed no relevant financial relationships.
Child Neurology Society (CNS) 2013 Annual Meeting. Abstract #75. Presented October 31, 2013.
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