Asynchronous Telemedicine Platform Associated with Decreased Migraine-Related Emergency Room and Urgent Care Use
Sara Crystal1, Alexander Mauskop2, Alan Rapoport3, Robert Cowan4, Philip Bain5, Jessica Kiarashi6, Elizabeth Murdoch7, Adam Cohen8, Neil Parikh9
1NY Headache Center, KMG, Thirty Madison, 2NY Headache Center, 3David Geffen School of Medicine, UCLA, 4Stanford Neurosciences Health Center, 5Bozeman Health, 6UT Southwestern Medical Center, 7Thirty Madison, 8Yale New Haven Health System, The Johns Hopkins University Applied Physics Lab, 9Thirty Madison, UCLA
Objective:
To describe the change in patient-reported emergency room (ER) and urgent care centers (UCC) use before and after patients joined a migraine telemedicine platform.
Background:
ERs are suboptimal for migraine care given long wait times, high costs, and the administration of non-evidence based treatment including opioids. While UCCs may be preferred to ERs due to lower costs, there are similar quality issues. Access to ongoing care models, including telemedicine-based approaches, may result in decreased migraine-related ER and UCC use, collectively called emergent healthcare resource use (EHRU).
Design/Methods:
Patients receiving care from the novel migraine telemedicine platform, Cove, have access to on-demand asynchronous evidence-based consultation, ongoing messaging, and e-pharmacy. Data from patients completing the headache-focused intake questionnaire and an outcomes-based follow-up questionnaire at 3-months were analyzed. Data collected included demographics, EHRU, treatment type, and patient satisfaction. Statistical differences in patient-reported EHRU in the 3-months before and after joining the telemedicine platform were assessed using McNemar’s test.
Results:
Data from 4,789 patients who completed the intake and follow-up questionnaire were analyzed. The median age was 38 years (range: 18-85 years), 90% were female, and 15% were Black, indigenous, and/or people of color.
Patients experienced reduced migraine-related EHRU between intake and follow-up. At intake, 4.8% of patients reported an ER visit and 7.0% reported an UCC visit in the prior 3 months. At follow-up, only 2.1% of patients reported an ER visit (55.3% reduction, p<.01) and 3.8% an UCC visit (45.7% reduction, p<.01) in the prior 3 months.
After joining the telemedicine platform, 91.8% received acute and 52.6% received preventive medications. No patients were prescribed opioids through the platform.
At follow-up, 90.6% of patients were satisfied with the care received.
Conclusions:
Telemedicine platforms may contribute to reduced EHRU in patients with migraine, and provide access to evidence-based migraine care including the avoidance of opioid-based treatments.