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.