Durner Gregor, Durner Joachim, Dunsche Henrike, Walle Etzel, Kurzreuther Robert, Handschu René
Neurosurgery Department Bezirkskrankenhaus Günzburg Günzburg Germany.
Neurology Department m&I Fachklinik Ichenhausen Ichenhausen Germany.
Mov Disord Clin Pract. 2016 Oct 24;4(3):368-373. doi: 10.1002/mdc3.12436. eCollection 2017 May-Jun.
Treatment of advanced-stage idiopathic Parkinson's disease (PD) is a demanding challenge, and in Germany, medication regimen adjustments are often made during inpatient stays. Admissions often follow an acute worsening of symptoms and functioning. In order to reduce long and expensive inpatient stays, and to provide more frequent consultations, a 24/7 live stream telemedicine home treatment service was established.
A pilot study was conducted in which laptops were distributed to 50 patients for 1 year to see whether such a service was feasible (in terms of patient participation and compliance) and whether this intervention affected the patient's condition, measured in UPDRS, Mini-Mental Status Examination (MMSE), 39-item Parkinson's Disease Questionnaire (PDQ39), and H & Y Scale.
Seventy-two percent (36) of the patients were compliant and did not experience technical issues. Patients lived, on average, 198 ± 183 km away from the specialist clinic. In total, 264 video conversations took place with 6.9 ± 7.2 (0-29) calls per patient. We found a significant improvement in PDQ39 scores, but not in UPDRS, MMSE, or H & Y scores, at 1 year.
Our data shows that 24/7 live stream telemedicine is feasible and can help to improve quality of life. However, a detailed preliminary review of the patient's willingness to use such a service should be made to obtain the best results. Improvement of the technical setup and network coverage would facilitate an improved service and increase efficiency.
晚期特发性帕金森病（PD）的治疗是一项艰巨的挑战，在德国，药物治疗方案的调整通常在住院期间进行。入院往往是在症状和功能急性恶化之后。为了减少长期且昂贵的住院时间，并提供更频繁的会诊，建立了一项全天候实时远程医疗居家治疗服务。
开展了一项试点研究，向50名患者分发笔记本电脑，为期1年，以观察这样一项服务是否可行（就患者参与度和依从性而言），以及这种干预是否会影响患者的病情，通过统一帕金森病评定量表（UPDRS）、简易精神状态检查表（MMSE）、39项帕金森病问卷（PDQ39）和 Hoehn & Yahr 分级量表进行衡量。
72%（36名）患者依从且未遇到技术问题。患者平均居住在距离专科诊所198±183公里处。总共进行了264次视频对话，每位患者平均通话6.9±7.2次（0 - 29次）。我们发现，在1年时，PDQ39评分有显著改善，但UPDRS、MMSE或Hoehn & Yahr评分没有改善。
我们的数据表明，全天候实时远程医疗是可行的，并且有助于提高生活质量。然而，应该对患者使用这种服务的意愿进行详细的初步评估，以获得最佳效果。改进技术设置和网络覆盖将有助于改善服务并提高效率。
