TeleSCOPE 2.0: A Follow-Up Real-World Study of Telehealth for the Detection and Treatment of Drug-Induced Movement Disorders (DIMD)
Authors: Bera Rimal , Blaustein Ezra , Singh Shilpi , Bron Morgan , Calara Heintje , Cicero Samantha A. , Martello Kendra , El-Mallakh Rif S. 
Published: January 2025

Introduction

Since COVID-19, mental healthcare telehealth services have increased. A 2021 online survey (TeleSCOPE 1.0 [T1]) identified challenges evaluating, diagnosing, and monitoring DIMDs with telehealth (via video or phone). TeleSCOPE 2.0 (T2) was conducted to understand the telehealth impact post-COVID restrictions.

Methods

T2 was fielded (5/18-6/9/2023) to neurologists (neuro), psychiatrists (psych), and nurse practitioners (NP)/physician assistants (PA) affiliated with neuro/psych practices who prescribed vesicular monoamine transporter 2 inhibitors or benztropine for DIMD in the past 6 months and saw ≥15% of patients via telehealth at peak and post-COVID.

Results

100 neuros, 100 psychs, and 105 NP/PAs responded. More patients were seen in-person post-COVID (12-27% vs 31-53%), but percentage seen by video remained largely unchanged (54-62% vs 37-53%). Issues influencing appointment setting in T2 remained access to care, technology, and digital literacy although T2 clinicians reported less patients had issues connecting for a video visit. In T2, clinicians used multiple telehealth methods to evaluate DIMDs including personal phone videos (48-66%), telemedicine apps (36-45%), health/fitness trackers (6-13%), and other (2-5%). Common T2 diagnostic telehealth issues included determining signs of difficulty with gait, falls, walking, and standing; difficulty writing, using phone, computer; and painful movements. In patients evaluated for DIMD, more received an eventual diagnosis in T2 vs T1 both in-person (34-53% vs 26-46%) and video (32-51% vs 29-44%) but, on average, neuros and psychs required 1 more telehealth visit to confirm a DIMD diagnosis vs in-person. Over half of clinicians on average recommended patients come in-person to confirm a DIMD diagnosis. Most clinicians reported ongoing difficultly diagnosing patients via phone. Neuros were less comfortable than psychs/NP/PAs with telehealth visits due to risk of misdiagnosis and liability. While all clinicians saw telehealth advantages, neuros expect to see more of their patients in person post-COVID. However, in T2, the number of clinicians who found it difficult to manage DIMDs cases by video had significantly decreased (T1 52-54%; T2 28-36%). Half of clinicians reported the non-presence of a caregiver as a significant barrier to diagnosis and treatment via telehealth. Clear guidelines and provider education were the most feasible strategies to implement to improve telehealth quality of care.

Conclusions

T2 clinicians are more comfortable managing DIMDs via telehealth but require ˜1 more visit to confirm a diagnosis vs in-person. Significant barriers to telehealth remain including digital literacy, inconsistent caregiver presence, and lack of clear diagnosis guidelines. Clinicians see value in telehealth but it is still not as effective as in-person. Significantly more clinicians are in-office post-COVID and >50% recommend patients come in-person to confirm a DIMD diagnosis.

Funding

Neurocrine Biosciences, Inc.