To assess the socioeconomic benefit, usage patterns, impact on time to surgery, and spatial distribution of telehealth use for Essential Tremor (ET) patients being evaluated for deep brain stimulation (DBS) or high-intensity frequency ultrasound (HIFU) at our institution from 2017-2023.

Tremor disorders present with overlapping features, frequently requiring in-person diagnostic visits. During the COVID-19 pandemic, clinicians, including movement disorder specialists, adopted telehealth. More than half of all Appalachians must travel more than 60 miles to see a specialist, potentially allowing for telehealth to ease this inequity.

We retrospectively reviewed 290 ET patients and 3,377 appointments (ICD-10: G25.0). Data on appointment type, geographic location, and time to surgery were collected. Travel costs were calculated using the IRS reimbursement rates. A subset of charts was reviewed for patient/provider surgical hesitancy. Heat maps visualized spatial patterns of care. Correlation analysis examined associations between social determinants of health and time to surgery.

Of 3,377 appointments, 194 (5.74%) were via telehealth and 3,183 (94.26%) were in-person. Most new neurology (99.18%) and neurosurgery (98.30%) visits were in-person, with only 9 using telehealth. In-person visits incurred $440,061.26 and 12,308.60 hours in travel costs and time. Telehealth saved $47,694.37 and 1,354.01 hours. Telehealth was used for post-conference follow-up, medication/disease management, and surgical discussions (χ²(2, N=73)=2.50, p=0.29). 81 patients lived less than 60 miles, 154 between 60-180 miles, and 55 more than 180 miles from the clinic. Those with pre-surgical DBS telehealth visits had longer times to surgery (t=2.64, p=0.016). This difference was not significant after removing patients with surgical hesitancy (t=1.81, p=0.078). Heat maps showed broader reach among telehealth users. Higher education was associated with in-person visits, higher unemployment with telehealth use.

Telehealth offers major travel/cost savings while expanding access. Delayed surgery appears related to patient hesitancy, not telehealth. Future telehealth use should prioritize equitable access.