Objective: To assess international patients’ access to medical care from their movement disorder specialist before and during the COVID-19 pandemic and the impact of the implementation of telemedicine.

Background: The scarcity of neurologists, particularly in developed countries, results in some patients traveling internationally to access medical care. The COVID-19 pandemic led to a rapid expansion of telemedicine due to social distancing practices and travel restrictions. Our interest is whether international patients in a movement disorders clinic were able to maintain access to medical care after wide implementation of telemedicine despite travel restrictions.

Method: A retrospective chart review of international patients at the University of Miami Movement Disorders clinic within a date range between 3/1/2019 – 3/1/2021 was performed. Visits were distributed into two-time frames; time frame 1 between 3/1/2019 and 2/29/2020 before the widespread implementation of telemedicine, and 3/1/2020 and 3/1/2021 after implementation. Outcome measures were type of visit (telemedicine or in-person), visit frequency, and changes in medical management. Fisher’s exact test, student’s t-test, and paired sample t-test were used for statistical analyses

Results: Thirty-nine international patients’ charts were reviewed with a total of 121 visits, 52 in the first-time frame and 69 in the second. No visits in time frame 1 were tele-medicine visits, while 52 (75.4%) of time frame 2 visits were conducted via telemedicine (p-value <0.01). We did not find a statistical difference in the frequency of medication changes or changes in DBS programming between telemedicine and in person visits (82.7% versus 78.3% respectively, p-value 0.65) or in the frequency of visits in time frame 1 compared to time frame 2 among patients seen in both time frames (1.73 versus 1.77 visits, p-value 0.64).

Conclusion: This study demonstrated a significant increase in the utilization of telemedicine services in international patients in a movement disorders clinic during the COVID-19 pandemic. Telemedicine allowed patients to maintain the same high level specialist care as evidenced by visit frequency and medical management despite travel disruptions. We believe utilization of telemedicine reduces socio-economic burden associated with international travel and is a useful method for expanding access to health care across national and regional boundaries.

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3. Dorsey ER, Deuel LM, Voss TS, et al. Increasing access to specialty care: A pilot, randomized controlled trial of telemedicine for Parkinson’s disease. Movement Disorders 2010;25:1652-1659.
4. Kristoffersen ES, Sandset EC, Winsvold BS, Faiz KW, Storstein AM. Experiences of telemedicine in neurological out‐patient clinics during the COVID‐19 pandemic. Annals of Clinical and Translational Neurology 2021;8:440-447.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/international-telemedicine-during-covid-19-pandemic-in-an-academic-movement-disorder-clinic/