Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities

ABSTRACT Objective: To describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States. Methods: A retrospective cohort of consecutive patients seen in the first four weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video and when unable phone-only visits were scheduled. Patients were divided into two groups based on the telehealth visit type: video or phone-only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured post-visit telephone call. Results: Of 1011 telehealth patient-visits, 44% were video and 56% phone-only. Patients who completed a video visit were younger (39.7 vs 48.4 years, p Conclusion: Rapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, black patients with Medicare or Medicaid insurance were less likely to adopt video visits.