Telehealth a Barrier to Management of Drug-Induced Movement Disorders

Telehealth was found to impair the ability of clinicians to manage drug-induced movement disorders (DIMDs) in patients being treated with either a vesicular monoamine transporter 2 (VMAT2) inhibitor or benztropine, according to study results recently presented at Psych Congress 2021, held from October 29 to November 1, 2021, in San Antonio, Texas.

This observational study, the Real-World Tele-Health Evaluation of Tardive Dyskinesia (TD) Symptoms Communication/Observation Procedure Evaluation in Outpatient Clinical Settings (TeleSCOPE), included 277 clinician respondents (psychiatry, n=168; neurology, n=109). Study participants had at least 3 years of practice, at least 70% of which was spent seeing patients; had prescribed benztropine and/or VMAT2 for a DIMD within the past 6 months; and employed telehealth to conduct visits with at least 15% of patients within the period from December 2020 to January 2021. All participants completed a 20-minute online survey.

Although telehealth visits increased for both specialties during the COVID-19 pandemic, psychiatry experienced a greater increase than neurology for both phone (38% vs 21%) and video (49% vs 42%) visits. Further DIMD assessment was most commonly prompted by mentions of movements or tics by others (89% neurology vs 149% psychiatry), trouble walking/standing or with gait/falls (84% vs 143%), and reported difficulty eating or swallowing (75% vs 131%). However, managing these problems via telehealth proved challenging, and many individuals determined to be at risk (for example, those taking dopamine receptor­-blocking agents) did not undergo DIMD evaluation in visits conducted by phone only (91% vs 76%). The highest risk for a missed DIMD diagnosis was among patients without a caregiver and those with lower function.

The study authors concluded, “During the COVID-19 pandemic, telehealth significantly reduced clinicians’ ability or willingness to diagnose, assess, and monitor/treat DIMDs,” with multiple factors contributing to this situation.  “In-person evaluation continues to be the gold standard for assessing and treating DIMDs.” The study authors also noted that “the use of pre-visit materials … and specific questions and directions during virtual visits may improvement communication and lead to more accurate assessments.”

Disclosure: This clinical trial was supported by Neurocrine Biosciences, Inc. Please see the original reference for a full list of authors’ disclosures.

Reference

Bera R, Franey E, Martello K, Bron M, Yonan C. TeleSCOPE: a real-world study of telehealth for the detection and treatment of drug-induced movement disorders. Presented at: Psych Congress 2021; October 29-November 1, 2021; San Antonio, Texas.  Poster 122.