TeleSCOPE 2.0: A Follow-up Real-world Study of Telehealth for the Detection and Treatment of Drug-induced Movement Disorders (DIMD)
Rimal Bera1, Ezra Blaustein2, Shilpi Singh2, Morgan Bron3, Heintje Calara4, Samantha Cicero3, Kendra Martello4, Rif S. El-Mallakh5
1University of California, Irvine School of Medicine, 2IQVIA Inc., 3Neurocrine Biosciences, Inc., 4Neurocrine Biosciences, 5University of Louisville
Objective:
To understand telehealth’s impact on assessment of DMIDs post-COVID restrictions.
Background:
Since COVID-19, mental healthcare telehealth has increased. A 2021 online survey (TeleSCOPE 1.0 [T1]) identified challenges assessing DIMDs with telehealth. TeleSCOPE 2.0 [T2] was a follow-up study.
Design/Methods:
T2 was fielded (5/18-6/9/2023) to clinicians affiliated with neurology/psychiatry practices who prescribed VMAT2 inhibitors or benztropine for DIMDs in the past 6 months and saw ≥15% of patients via telehealth at peak and post-COVID.
Results:
100 neurologists, 100 psychiatrists, and 105 NP/PAs responded. More patients were seen in-person post-COVID (12-27% vs 31-53%), but video percentage remained consistent (54-62% vs 37-53%). T2 appointment setting was influenced by access to care, technology, and digital literacy; less patients had video connection issues. Common T2 DIMD telehealth evaluation methods included personal phone videos (48-66%), telemedicine applications (36-45%), and health/fitness trackers (6-13%). Common T2 diagnostic telehealth issues included determining signs of difficulty with gait/falls/walking/standing; difficulty writing/using phone/computer; and painful movements. More patients evaluated for DIMDs received an eventual diagnosis in T2 vs T1 in-person (34-53% vs 26-46%) and video (32-51% vs 29-44%) but, on average, neurologists/psychiatrists required 1 more telehealth visit to confirm DIMD diagnosis vs in-person. On average, >50% clinicians recommended patients come in-person to confirm DIMD diagnosis. Most clinicians reported ongoing difficultly diagnosing patients via phone. In T2, less clinicians found it difficult to manage DIMDs by video (T1 52-54%; T2 28-36%). Half of clinicians reported the non-presence of a caregiver as a significant barrier to diagnosis and treatment via telehealth. Clear guidelines and provider education were the most feasible strategies to implement to improve telehealth quality of care.
Conclusions:
Clinicians see value in telehealth, but it’s still not as effective as in-person – requiring 1 additional telehealth visit for DIMD diagnosis; >50% of clinicians recommend patients come in-person to confirm DIMD diagnosis. Significant barriers to telehealth remain.