Clinic to in-home telemedicine reduces barriers to care for patients with MS or other neuroimmunologic conditions
Clinic to in-home telemedicine reduces barriers to care for patients with MS or other neuroimmunologic conditions
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DOI：
10.1212/nxi.0000000000000505
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发表时间：
2018-11-01
影响因子：
8.8
通讯作者：
Gelfand, Jeffrey M.
中科院分区：
文献类型：
--
作者：
Bove, Riley;Garcha, Priya;Gelfand, Jeffrey M.
目的描述远程医疗支持的神经系统护理在学术门诊MS和neuroimmunology诊所的常规使用，并量化其在减少患者负担的作用。MethodsBetween 2017年1月和2017年12月，我们调查了患者和MS神经科医生后，50个连续的常规安排的电视访问和100个方便的样本在诊所访问。计算汇总统计和比较performed.ResultsOverall，98%的电视参与者发现该技术易于使用，只有17%的人认为，一个人的考试会更有效地解决他们的需求的访问。MS神经学家报告在47/48（98%）的电视访视中实现了临床目标，并进行了充分的体格检查，但有2例例外（可能的马尾综合征和视野丧失）。由于电视可用，避免了三次急诊转诊。远程医疗减少了旅行负担，包括平均（+/- SD）旅行距离为160（+/- 196）英里，并避免了过夜住宿和航空旅行。远程医疗还减少了间接成本，包括休假时间（65%的在职患者）和照顾者负担（30%的人避免照顾者休假/履行义务）。在提供者人际沟通技能的8个领域中，远程医疗参与者和诊所参与者仅对1个领域进行了评分（目光接触），总体而言，96%的诊所和100%的远程医疗参与者同意/强烈同意他们的临床目标已经达到。诊所到家庭远程医疗减少了旅行和护理人员的负担，并实现了高效、方便和有效的随访。
ObjectiveTo describe the routine use of telemedicine-enabled neurologic care in an academic outpatient MS and neuroimmunology clinic and quantify its role in reducing patient burden.MethodsBetween January 2017 and December 2017, we surveyed patients and MS neurologists after 50 consecutive routinely scheduled televideo visits and a convenience sample of 100 in-clinic visits. Summary statistics were calculated and comparisons performed.ResultsOverall, 98% televideo participants found the technology easy to use, and only 17% believed that an in-person examination would have more effectively addressed their needs for the visit. MS neurologists reported achieving their clinical goals in 47/48 (98%) of televideo visits and an adequate physical examination with 2 exceptions (possible cauda equina syndrome and visual field loss). Three emergency department referrals were avoided due to televideo availability. Telemedicine reduced travel burden, including a mean (+/- SD) travel distance of 160 (+/- 196) miles and avoiding overnight lodging and air travel. Telemedicine also reduced indirect costs, including time off work (65% of employed patients) and caregiver burden (30% avoided caregiver time off from work/obligations). Across 8 domains of provider interpersonal communication skills, telemedicine and in-clinic participants rated only 1 domain to be different (eye contact), and overall, 96% of in-clinic and 100% of telemedicine participants agreed/strongly agreed that their clinical goals had been met.ConclusionsWhen incorporated as part of the continuum of MS/neuroimmunology care, clinic to in-home telemedicine reduces travel and caregiver burden and enables efficient, convenient, and effective follow-up.