Healthcare Delivery and Huntington's Disease During the Time of COVID-19.

Pfalzer, Anna C; Hale, Lisa M; Huitz, Elizabeth; Buchanan, Danielle A; Brown, Brittany K; Moroz, Sarah; Rouleau, Renee M; Hay, Kaitlyn R; Hoadley, Jennifer; Laird, Amy; Ciriegio, Abagail E; Watson, Kelly H; Jones, Maile T; Lin, Ya-Chen; Kang, Hakmook; Riordan, Heather; Isaacs, David A; McDonell, Katherine; Compas, Bruce E; Claassen, Daniel O

BACKGROUND Safer-at-home orders during the COVID-19 pandemic altered the structure of clinical care for Huntington's disease (HD) patients. This shift provided an opportunity to identify limitations in the current healthcare infrastructure and how these may impact the health and well-being of persons with HD. OBJECTIVE The study objectives were to assess the feasibility of remote healthcare delivery in HD patients, to identify socioeconomic factors which may explain differences in feasibility and to evaluate the impact of safer-at-home orders on HD patient stress levels. METHODS This observational study of a clinical HD population during the 'safer-at-home' orders asked patients or caregivers about their current access to healthcare resources and patient stress levels. A chart review allowed for an assessment of socioeconomic status and characterization of HD severity. RESULTS Two-hundred and twelve HD patients were contacted with 156 completing the survey. During safer-at-home orders, the majority of HD patients were able to obtain medications and see a physician; however, 25% of patients would not commit to regular telehealth visits, and less than 50% utilized an online healthcare platform. We found that 37% of participants were divorced/single, 39% had less than a high school diploma, and nearly 20% were uninsured or on low-income health insurance. Patient stress levels correlated with disease burden. CONCLUSION A significant portion of HD participants were not willing to participate in telehealth services. Potential explanations for these limitations may include socioeconomic barriers and caregiving structure. These observations illustrate areas for clinical care improvement to address healthcare disparities in the HD community.