Headache patients indicated overall satisfaction with a telemedicine model during the COVID-19 pandemic but prefer a hybrid model — incorporating both in-person and telemedicine visits — in the postpandemic era, according to research results published in the European Journal of Neurology.
To determine patient satisfaction with headache teleconsultation during the COVID-19 pandemic and their preferred appointment type, researchers conducted an observational, transversal study through an online questionnaire in a consecutive sample of patients.
All adult patients in the headache clinic at a hospital in Porto, Portugal, who participated in at least 1 headache teleconsultation between March 18 and May 18, 2020, were included in the study. Participants had a previous diagnosis of primary headache or neuropathies and facial pain disorder.
All patients had a previous in-person appointment for diagnosis.
Following their telemedicine visit, participants filled out an online questionnaire using Google™ Forms. Questions collected included sociodemographic data and patient opinions on 6 domains: visit adequacy, satisfaction with information provided by the physician, satisfaction with follow-up, satisfaction with any changes in medication, consideration of telemedicine visits in a nonpandemic context, and preferred appointment method (face to face, teleconsultation, or a combination of both).
During the study period, 254 headache consultations were conducted via telephone. A total of 129 surveys were completed with 83 valid inquiries, yielding a valid response rate of 64.3%.
Respondents were primarily women (88%) with an average age of 40.9±11.8 years. Most were married and had at least 1 dependent family member. In terms of education, 44.6% of participants finished high school; 9.6% of patients were unemployed.
Most patients lived within 10 to 30 minutes of the hospital, with only 6% living less than 10 minutes away. Just over 10% of patients took more than 1 hour to get to the hospital, and 77.1% had access to a car.
The most frequent diagnosis was migraine (83.1%). Tension-type headaches had been diagnosed in 32.5% of patients, and 5% of patients had another type of primary headache disorder. Three patients had a previous diagnosis of trigeminal neuralgia, and 5 had concomitant medication-overuse headaches, while 17% had resistant headaches.
Overall, most participants felt that the telemedicine headache visits were adequate (81.9%), 88% were satisfied with information provided by their physician, 86.7% were satisfied with their teleconsultation follow-up, and 74% were satisfied with medication changes prescribed during the visit. Overall, 90.4% of patients indicated that they would agree with a new tele-evaluation if they remained stable.
The preferred visit model for the postpandemic era was the mixed model that incorporates both telemedicine and in-person visits, followed by face-to-face appointments. Within the group of patients who had unscheduled evaluations during the pandemic, 21% preferred face-to-face evaluations vs 12.5% who preferred teleconsultation.
Men were slightly more satisfied with telemedicine compared with women (90% vs 82.2%), and dissatisfied patients were more frequently married, had fewer dependents, and were more likely to have a college-level education (14.3%, 64.3%, and 50%, respectively). These dissatisfied patients were also more frequently unemployed (21.4% vs 7.2%).
Study limitations include a slightly lower response rate compared with other studies, likely due to telephone numbers being unavailable in patient records and the use of text message to send a link to the questionnaire, and the potential lack of internet access among potential respondents.
“The COVID-19 pandemic led to profound [restructuring] of outpatient clinics,” the researchers wrote. “Given the high satisfaction with teleconsultation in the present study, a model combining a first-time face-to-face visit…followed by teleconsultation once the patient has reached symptom stability may probably be appropriate, even outside a pandemic setting.”
Dias L, Martins B, Pinto MJ, Rocha AL, Pinto M, Costa A. Headache teleconsultation in the era of COVID-19: patients’ evaluation and future directions. Eur J Neurol. Published online May 15, 2021. doi:10.1111/ene.14915