Bove Riley, Garcha Priya, Bevan Carolyn J, Crabtree-Hartman Elizabeth, Green Ari J, Gelfand Jeffrey M
Division of Neuroinflammation and Glial Biology (R.B., P.G., C.J.B., E.C-H., A.J.G., J.M.G.), Department of Neurology, Weill Institute for the Neurosciences, UCSF MS and Neuroinflammation Center, University of California; and Neuro-ophthalmology Division (A.J.G.), Department of Ophthalmology, University of California, San Francisco.
Neurol Neuroimmunol Neuroinflamm. 2018 Oct 2;5(6):e505. doi: 10.1212/NXI.0000000000000505. eCollection 2018 Nov.
To 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.
Between 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.
Overall, 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.
When 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.
描述在学术性门诊多发性硬化症和神经免疫学诊所中远程医疗支持的神经科护理的常规使用情况，并量化其在减轻患者负担方面的作用。
在2017年1月至2017年12月期间，我们在连续50次常规安排的远程视频就诊后对患者和多发性硬化症神经科医生进行了调查，并对100次门诊就诊的便利样本进行了调查。计算了汇总统计数据并进行了比较。
总体而言，98%的远程视频参与者认为该技术易于使用，只有17%的人认为面对面检查能更有效地满足他们此次就诊的需求。多发性硬化症神经科医生报告称，在48次远程视频就诊中有47次（98%）实现了临床目标，除了2例（可能的马尾综合征和视野缺损）外，体格检查也足够。由于有远程视频服务，避免了3次急诊转诊。远程医疗减轻了出行负担，平均（±标准差）出行距离为160（±196）英里，避免了过夜住宿和航空旅行。远程医疗还降低了间接成本，包括误工时间（65%的在职患者）和照顾者负担（30%避免了照顾者误工/请假）。在提供者人际沟通技巧的8个领域中，远程医疗和门诊参与者仅对1个领域（眼神交流）的评价不同，总体而言，96%的门诊参与者和100%的远程医疗参与者同意/强烈同意他们的临床目标已达成。
当作为多发性硬化症/神经免疫学护理连续过程的一部分时，从诊所到家中的远程医疗可减轻出行和照顾者负担，并实现高效、便捷和有效的随访。
