Does telemedicine impact stroke clinic follow-up during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has led to rapid implementation of telemedicine (TM) care in outpatient neurology clinics Early follow-up after acute stroke hospitalization has been associated with decreased readmission and improved care transitions Stroke survivors may face multiple barriers to in-person follow-up, including inability to drive, limited mobility, and reliance on working caregivers;therefore TM may be preferred We sought to evaluate the impact of TM care provision during the COVID-19 pandemic on patient follow-up Methods: Using our clinic EMR, we included patients scheduled for stroke hospitalization follow-up in the Stroke Transitions, Education, and Prevention (STEP) clinic from 10/1/2019 till 7/31/2019 We calculated arrival rates, no-show rates, and cancellation rates for the pre-COVID time period (10/1/19 - 3/13/20) and the period following the implementation of TM services (3/17/20 - 7/31/20) Results: We identified 593 eligible patients with 282 patients scheduled in the pre-COVID period and 311 patients in the COVID period Arrival, cancellation, and same day no-show rates were 63 1%, 23 0%, and 12 4% in the pre-COVID period and 54 0%, 37 9%, and 7 07% in the COVID period, respectively The arrival rate decreased significantly (p=0 03) and the cancellation rate increased significantly (p<0 001);the same day no-show rate also decreased significantly (p=0 04) Conclusion: Despite the availability of TM services, the arrival rate for stroke patients scheduled for follow-up during the pandemic decreased significantly, largely because of cancellations Low noshow rates do not explain the full picture of follow-up Increased cancellations might be explained by several factors including barriers to technology, apprehension regarding TM, reliance on caregivers to participate in TM visits while practicing social distancing Identification of barriers to TM follow-up should be further investigated to prevent the deleterious impact of poor care transitions on strokepatients