Describe patient characteristics of the National TeleNeurology Program (NTNP) and compare access with care in the community (CITC)

Approximately 25% of all Veterans in the United States reside in rural communities with limited access to healthcare. The NTNP provides virtual neurological care to Veterans residing in rural/underserved areas. Here we report characteristics of Veterans completing an NTNP consult and compare access with those receiving neurological CITC, which is often the only option for rural Veterans. 

Outpatient NTNP and CITC consults completed between October 2020 through June 2021 were included. NTNP consults occurred at either a local VA clinic or in-home. Demographics, diagnoses, rurality and Charlson Comorbidity Index (CCI), a measure of overall medical comorbidity, were examined. Comparisons between VA and community care were analyzed using Wilcoxon-Mann-Whitney tests. 

Across 11 participating sites, 549 unique consults were completed. Most patients were male (463, 84.3%), white (479, 87.2%) and had an average age of 59.2 +/- 16.7 years. Among all consults, 314 (57.2%) were for rural/highly rural and 235 (42.8%) were for urban Veterans. The most prevalent consult requests were for headache (26.1%), movement disorders (16.6%), post-stroke/TIA (8.4%), neuropathy/radiculopathy (6.8%), seizures (6.6%) and dementia (5.5%). A subgroup analysis showed no significant difference in CCI for NTNP and CITC consults (p=0.734). Consult scheduling was done within a mean of 7.5 days for NTNP vs. 24.0 days for CITC (p<.001). The mean time for consult completion was 27.5 vs. 63.0 days for NTNP and CITC, respectively (p<.001). There was almost a two-fold difference in discontinued consults for CITC (21.9%) compared to NTNP (13.3%, p<.001).

NTNP is a national telehealth program that has increased access to neurological care for rurally-residing Veterans with a variety of diagnoses. Among participating facilities, NTNP consults are scheduled and completed significantly faster than community referrals.