Global & Community Health: Implementation of and patient satisfaction with the first neurologic telemedicine program in Mexico during COVID-19

Since the coronavirus disease 2019 (COVID-19) pandemic outbreak, due to
the large number of patients requiring in-hospital care, hospitals
worldwide were converted into COVID-19 referral centers. In addition, as
part of the mitigation strategies besides social distancing and mandatory
use of facemasks, other measures to reduce the risk of infection among
healthcare workers such as increasing the time between work shifts and
sending high-risk personnel to in-home isolation were taken, leading to a
significantly reduced workforce, requiring relocation of medical personnel
from multiple specialties to the frontline.  By April 2020, due
to the reduction of medical and administrative staff in addition to the
steadily increasing number of patients, our center decided to stop all
face-to-face non-COVID-19 consultations. Therefore, we decided to adapt to
the challenges and started researching how to implement a teleneurology
program to re-open our neurology continuity clinic. Here, we describe our
experience developing and implementing a teleneurology program in Mexico
and patient satisfaction with our program. To assess patient satisfaction
and quality of the healthcare received, at the end of the consultations,
to those who had internet access, we sent via e-mail or text message an
anonymous 24-question online-based questionnaire (modified for the
COVID-19 pandemic) developed and validated for the Spanish-speaking
population. We included 304 patients. The most common neurologic disorders
we attended were neuromuscular disorders in 33.6% of patients, headache
disorders in 32.9%, epilepsy in 11.5%, cerebrovascular diseases in 5.9%,
and movement disorders in 5.6%. None of the patients required an in-person
visit. Of the 304 patients, only 125 (41%) answered the survey, 86.4%
preferred teleneurology instead of an in-person consultation, 83.3%
(90/108) of them because of concerns about getting COVID-19; 92%
completely agree that they felt comfortable when talking to the
neurologist through a camera and a microphone; 96% reported being
satisfied with their consultation; 87.2% completely agree in trusting that
their privacy would be protected. However, 4% were not satisfied, but
their reasons were not specified. Our findings suggest that telemedicine
is a feasible and acceptable option to continue with neurological patient
care during the COVID-19 pandemic.