Virtual neurology survey: Factors influencing virtual care use among Ontario neurologists.

Background and objectives: Current virtual care guidance lacks specialty-specific considerations. Neurological care is unique due to its reliance on physical examination and complex patient population. Our aim was to determine which factors impact virtual care suitability in neurology, virtual care adoption patterns, and satisfaction with virtual care among neurologists. Methods: Surveys were sent to Ontario neurologists through a shared email from September to November 2021. The survey consisted of four parts: demographics, virtual care adoption patterns, factors influencing virtual care use, and physician satisfaction with virtual care. Results: Sixty-six of 380 (17.4%) neurologists completed the survey. The pandemic resulted in a substantial increase in virtual care use, from 1.6% of all ambulatory visits in 2019 to 70.6% in 2020. Video teleconferencing was considered more appropriate across a broader range of presentations than phone visits, with both methods more suited to follow-ups. Neurologists were largely satisfied with virtual care except for the virtual neurological examination. The neurological presentations identified as least amenable to virtual consultation were movement disorders, limb weakness, gait/balance changes, and vision changes. Four presentations were felt to be most amenable to virtual care: sleep disorders, seizure, headache, and dizziness/syncope. Factors that were felt to reduce virtual care suitability included discussion of sensitive topics and acute presentations. Conclusion: Neurologists were satisfied with virtual care as a means of providing outpatient care, though the specific reason for referral influenced perceived appropriateness. These results can inform the basis of the development of consensus guidelines for virtual care provision in neurology.