Telemedicine in Neurological Disorders: Opportunities and Challenges

Chirra, Martina; Marsili, Luca; Wattley, Linsdey; Sokol, Leonard L.; Keeling, Elizabeth; Maule, Simona; Sobrero, Gabriele; Artusi, Carlo Alberto; Romagnolo, Alberto; Zibetti, Maurizio; Lopiano, Leonardo; Espay, Alberto J.; Obeidat, Ahmed Z.; Merola, Aristide

doi:10.1089/tmj.2018.0101

Cited by 118 publications

(117 citation statements)

References 101 publications

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“…26 Providers also expressed that there is huge potential for video visits, given the increased ability to monitor health data remotely, such as gait sensors and applications for commercially available smart devices to track movement. 5,12,23,27 These positive responses to the value and potential of video visits indicate potential to maintain provider engagement as we transition out of the initial responses to the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 97%

Accelerated launch of video visits in ambulatory neurology during COVID-19

et al. 2020

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The COVID-19 pandemic has rapidly moved telemedicine from discretionary to necessary. Here we describe how the Stanford Neurology Department: 1) rapidly adapted to the COVID-19 pandemic, resulting in over 1000 video visits within four weeks and 2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to: equipment/software, provider engagement, workflow/triage, and training. Upon reflection, the key drivers of our success were provider engagement and a supportive physician champion. The physician champion played a critical role understanding stakeholder needs, including staff and physicians’ needs, and creating workflows to coordinate both stakeholder groups. Prior to COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated post-pandemic era.

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Section: Discussionmentioning

confidence: 97%

Accelerated launch of video visits in ambulatory neurology during COVID-19

et al. 2020

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“…During the lockdown period many visits have been cancelled or postponed without an alternative certain date. Telemedicine is actually feasible for PD considering that most of the physical examination, except rigidity and postural instability, can be visualized [30]. In addition telemedicine could reduce travel time, distance and waiting time in patients with PD living in unserved areas [30].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and impact of COVID-19 in Parkinson’s disease: evidence from a multi-center survey in Tuscany region

et al. 2020

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Background If Parkinson's Disease (PD) may represent a risk factor for Coronavirus disease 2019 (COVID-19) is debated and there are few data on the direct and indirect effects of this pandemic in PD patients. Objective In the current study we evaluated the prevalence, mortality and case-fatality of COVID-19 in a PD cohort, also exploring possible risk factors. We also aimed to investigate the effect of lockdown on motor/non-motor symptoms in PD patients as well as their acceptability/accessibility to telemedicine. Method A case-controlled survey about COVID-19 and other clinical features in PD patients living in Tuscany was conducted. In non-COVID-19 PD patients motor/non-motor symptoms subjective worsening during the lockdown as well as feasibility of telemedicine were explored. Results Out of 740 PD patients interviewed, 7 (0.9%) were affected by COVID-19, with 0.13% mortality and 14% casefatality. COVID-19 PD patients presented a higher presence of hypertension (p < 0.001) and diabetes (p = 0.049) compared to non-COVID-19. In non-COVID-19 PD population (n = 733) about 70% did not experience a subjective worsening of motor symptoms or mood, anxiety or insomnia. In our population 75.2% of patients was favorable to use technology to perform scheduled visits, however facilities for telemedicine were available only for 51.2% of cases. Conclusion A higher prevalence of COVID-19 respect to prevalence in Tuscany and Italy was found in the PD population. Hypertension and diabetes, as for general population, were identified as risk factors for COVID-19 in PD. PD patients did not experience a subjective worsening of symptoms during lockdown period and they were also favorable to telemedicine, albeit we reported a reduced availability to perform it.

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“…The validity of telemedicine to assess patients with PD has been well documented in many studies (for a review, see ref. 45). Telemedicine is the use of electronic information and communication technology to provide and support health care when distance separates participants.…”

Section: Telemedicinementioning

confidence: 99%

Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID‐19 Experience

Fasano

Antonini

Katzenschlager

et al. 2020

Movement Disord Clin Pract

129

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Background Although the COVID‐19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID‐19. Objective To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future. Conclusion Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.

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Telemedicine in Neurological Disorders: Opportunities and Challenges

Cited by 118 publications

References 101 publications

Accelerated launch of video visits in ambulatory neurology during COVID-19

Accelerated launch of video visits in ambulatory neurology during COVID-19

Prevalence and impact of COVID-19 in Parkinson’s disease: evidence from a multi-center survey in Tuscany region

Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID‐19 Experience

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