AUTHOR=Solomon Daniel L. , Dirlikov Benjamin , Shem Kazuko L. , Elliott Christopher S. 

TITLE=The Time Burden of Specialty Clinic Visits in Persons With Neurologic Disease: A Case for Universal Telemedicine Coverage

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.559024

DOI=10.3389/fneur.2021.559024

ISSN=1664-2295

ABSTRACT=Objective
Those with neurologic disorders are often burdened not only by the condition itself but also an increased need for subspecialty medical care. This may require long distance travel, while even small distances can be a hardship secondary to impaired mobility and transportation. We sought to examine the burden of time associated with clinical visits for those with neurologic disorders and their family/caregivers. These topics are discussed as an argument to support the universal coverage for telemedicine in this population. 
Design
Cohort Study. 
Setting
Specialty clinic at community hospital.
Participants 
208 unique patients with neurologic disability at physical medicine and rehabilitation or neurourology clinic over a 3-month period.
Main Outcome Measures
Patient survey on commute distance, time, difficulties, and need for caregiver assistance to attend visits.
Results
Approximately 40% of patients were covered by Medicare.  Many patients (42%) perceived it difficult to attend their clinic visit with transportation difficulties, commute time, and changes to their daily schedule being the most commonly cited reasons. Most patients (75%) lived within 25 miles of our clinics and experienced an average commute time of 79.4 minutes, though 10% required 3 hours or more. Additional family/caregiver assistance was required for 76% of patients, which resulted in an inclusive average commute time of 138.2 minutes per patient. 
Conclusion
Neurologically-disabled patients and their caregivers are burdened in commuting to outpatient appointments. Increased emphasis on telemedicine coverage for those with neurologic disability should be considered by all payors, especially considering the burden that is placed not only on patients but also their family members and caregivers who often assist them.