Australian clinicians’ experience with telehealth in a multiple sclerosis outpatient clinic during the COVID-19 pandemic has shown that a hybrid model is likely the best way forward.

An investigation into the impact of  telehealth on services at a Melbourne hospital during the COVID-19 pandemic found that telehealth was well liked but had significant drawbacks in some areas.

Clinicians were more likely to record worsening disability scores for people experiencing multiple sclerosis at face-to-face appointments, compared to telehealth consultations, the study revealed.

The findings based on experiences of patients and clinicians at the the MS Centre, Royal Melbourne Hospital clinic from March to December 2020,  showed that Expanded Disability Status Scale (EDSS) increases were recorded in 31% of face-to-face visits and 20% of telehealth consults.

This was particularly marked for patients with lower baseline disability (36% face-to-face compared to 16% at telehealth).

Despite the EDSS results, however, the study found no significant delays in the identification of increased disability status for patients, and rates of commencement for disease-modifying therapy were similar across the two consultation methods.

“Telemedicine-based physical assessments are feasible, but clinicians should be aware of limitations and how they compare with in-person examination,” the paper published in Multiple Sclerosis and Related Disorders, concluded.

“Clinicians should consider whether treatment inertia influence management decisions during telehealth consultations,” the authors said.

Hybrid model

One of the co-authors, Dr Vivien Li, told the limbic the best way forward for telehealth should be determined in an individualised way for each patient.

“In stable patients with a defined diagnosis, a hybrid model of alternating face-to-face and telehealth visits can be feasible and acceptable,” she said.

“However, for new patients or when acute issues arise, face-to-face consultations should be prioritised.”

Likewise, she said video was preferable to telephone consultations to allow “some degree” of physical assessment.

But she said with the removal of Covid-19 restrictions, face-to-face visits should be encouraged, particularly after a long period of only remote appointments. “With prolonged telehealth-based management, relevant clinical outcomes should be continually monitored,” Dr Li said. “In MS, this includes relapses, disability worsening, medication adherence and safety monitoring.”

Overall, the study revealed almost three out of four consultations (73%) during the study period were through telehealth. It used medical records to compare management decisions from two appointments before the study period, throughout the study period, and subsequent in-person appointments.

The authors noted, however, that there may be more “treatment inertia” – a lack of treatment change – in telehealth assessments.

“Whilst clinicians were equally likely to commence or change disease-modifying therapy during telehealth and face-to-face appointments, symptomatic therapies were initiated more frequently in the latter,” the paper said.

“One explanation is that additional clinical clues gained from in-person evaluation may generate more differential diagnoses prompting further investigation.”

Overall, the study found patient satisfaction with telehealth was high but both patients and clinicians preferred face-to-face interactions. It noted that the digital approach would like remain for the long term.