Exploring the influence of telehealth on patient engagement with a multidisciplinary Non-Epileptic Seizure (NES) Clinic..., 2022, Watson et al

Full title: Exploring the influence of telehealth on patient engagement with a multidisciplinary Non-Epileptic Seizure (NES) Clinic during the COVID-19 pandemic

Abstract

The ILAE task force has identified a gap in treatment access for patients with nonepileptic seizures (NES) [[1] ].
Access to multidisciplinary treatment clinics for adults with NES is limited with only 18 institutions delivering care across the United States [[2]]. Patient engagement has been low in the University of Colorado, NES Clinic treatment program despite our clinic’s status as the only clinic of its kind in the mountain west. We analyzed patient factors of those who engaged in treatment before and after COVID-19 regulations were imposed and found a 23.6% increase in treatment engagement using telehealth. Those who engaged using telehealth were more likely to be of white race, of non-Hispanic ethnicity, publicly insured, employed, have a Charlson Comorbidity Index (CCI) of zero, a daily seizure rate of 0–1, did not have suicidal ideation or attempts, and live greater than 25 miles from the NES clinic. Delivering NES treatment via telehealth reduced the logistical and psychological barriers to initiating recovery and with a severe lack of accessible treatments for patients with NES, barrier reduction is necessary. This study describes patient factors that result in higher engagement with NES treatment using telehealth and emphasizes the importance of telehealth utilization to improve access to available treatment.

Open access, https://www.epilepsybehavior.com/article/S1525-5050(22)00156-1/fulltext

 

They just can't help themselves putting their own interpretation as the only valid reasons: "initiating recovery".

Upper floor clinics with elevator access are considered more accessible by patients with limited mobility than those who ask patients to simply crawl up on their ass to show they really want to get better. I mean there's a way to put this psychologically, there is an element of humiliation to it, but all it takes is common sense and listening to the patients to understand that practical barriers are just that, practical barriers. Even restaurants understand that if there's huge construction in front of their business, they will have fewer customers. Call that psychological if you want, it's just a practical barrier.

Obviously people with seizures have limited options for transport, often won't risk driving themselves even if they could possibly do it. And that's if they even have a car, after long enough without income most people have to sell everything they own. And clinics are just not nice places to be for that, loud, uncomfortable, annoying.