Barriers to telemedicine among physicians in epilepsy care during the COVID-19 pandemic: A national-level cross-sectional survey in Japan

Takafumi Kubota; Naoto Kuroda; Toru Horinouchi; Naoki Ikegaya; Yu Kitazawa; Satoshi Kodama; Izumi Kuramochi; Teppei Matsubara; Naoto Nagino; Shuichiro Neshige; Temma Soga; Yutaro Takayama; Daichi Sone

doi:10.1016/j.yebeh.2021.108487

Barriers to telemedicine among physicians in epilepsy care during the COVID-19 pandemic: A national-level cross-sectional survey in Japan

Epilepsy Behav. 2022 Jan:126:108487. doi: 10.1016/j.yebeh.2021.108487. Epub 2021 Dec 3.

Authors

Affiliations

¹ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurology, University Hospitals of Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. Electronic address: takafumi.kubota.c7@tohoku.ac.jp.
² Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA.
³ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Psychiatry and Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
⁴ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan. Electronic address: nikegaya@yokohama-cu.ac.jp.
⁵ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
⁶ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁷ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
⁸ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
⁹ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Epilepsy Center, TMG Asaka Medical Center, Asaka, Saitama, Japan.
¹⁰ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan.
¹¹ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
¹² Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
¹³ Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.

Abstract

Objective: This study aimed to investigate the factors affecting the unwillingness of physicians involved in epilepsy care to continue telemedicine during the coronavirus disease 2019 (COVID-19) pandemic in Japan.

Method: This was a national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan) which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES). We asked physicians who conducted telemedicine in patients with epilepsy (PWE) during the COVID-19 pandemic at four clinics and 21 hospitals specializing in epilepsy care in Japan from March 1 to April 30, 2021. The following data were collected: (1) participant profile, (2) characteristics of PWE treated by telemedicine, and (3) contents and environmental factors of telemedicine. Statistically significant variables (p < 0.05) in the univariate analysis were analyzed in a multivariate binary logistic regression model to detect the independently associated factors with the unwillingness to continue telemedicine.

Result: Among the 115 respondents (response rate: 64%), 89 were included in the final analysis. Of them, 60 (67.4%) were willing to continue telemedicine, and 29 (32.6%) were unwilling. In the univariate binary logistic regression analysis, age (Odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.10-3.09, p = 0.02), psychiatrist (OR = 5.88, 95% CI 2.15-16.08, p = 0.001), hospital (OR = 0.10, 95% CI 0.01-0.94, p = 0.04), the number of COVID-19 risk factors in the participant (OR = 2.88, 95% CI 1.46-5.69, p = 0.002), the number of COVID-19 risk factors in the cohabitants (OR = 2.52, 95% CI 1.05-6.01, p = 0.04), COVID-19 epidemic area (OR = 4.37, 95% CI 1.18-16.20, p = 0.03), consultation time during telemedicine (OR = 2.51, 95% CI 1.32-4.76, p = 0.005), workload due to telemedicine (OR = 4.17, 95% CI 2.11-8.24, p < 0.001) were statistically significant. In the multivariate binary logistic regression analysis, workload due to telemedicine (OR = 4.93, 95% CI 1.96-12.35) was independently associated with the unwillingness to continue telemedicine.

Conclusion: This national-level cross-sectional survey found that workload due to telemedicine among physicians involved in epilepsy care was independently associated with the unwillingness to continue telemedicine.

Keywords: Barrier; COVID-19; Epilepsy; Seizure; Telehealth; Telemedicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cross-Sectional Studies
Epilepsy*
Humans
Japan
Pandemics
Physicians*
SARS-CoV-2
Surveys and Questionnaires
Telemedicine*