Harrison Madaline B, Morrissey Dana
Department of Neurology, University of Virginia, Charlottesville, Virginia, USA.
Telemed J E Health. 2021 May;27(5):583-586. doi: 10.1089/tmj.2020.0316. Epub 2020 Oct 6.
Huntington's disease (HD) is a complex neurodegenerative disorder that causes impairment in cognitive, motor, and psychological function and requires subspecialty neurological and interdisciplinary care. Access to subspecialty care for HD is restricted by disability from the disease, lack of trained providers, and barriers to care for disadvantaged and rural populations. Since 1999, the University of Virginia HD clinic has used telemedicine to provide clinical services, consultation, and staff training. Initially, encounters were scheduled with the neurologist on a case-by-case basis at outlying rural clinics and community hospitals. Since 2015, telemedicine visits have been conducted by the entire interdisciplinary HD team and access has been extended to homes and long-term care facilities. This infrastructure was used to conduct a virtual clinic 2 days after initiation of coronavirus disease (COVID) mitigation. The clinic has continued to provide subspecialty and interdisciplinary care through telemedicine while clinic access has been restricted. A total of 69 individuals have been seen in 127 telemedicine visits, 56 of which were conducted by the interdisciplinary team. Telemedicine can provide high-quality subspecialty neurological and interdisciplinary care for HD that offers continuity across a wide range of care settings, and can overcome both anticipated and unanticipated barriers to access.
亨廷顿舞蹈症（HD）是一种复杂的神经退行性疾病，会导致认知、运动和心理功能受损，需要神经专科及跨学科护理。HD患者获得专科护理受到疾病导致的残疾、缺乏专业医护人员以及弱势群体和农村人口就医障碍的限制。自1999年以来，弗吉尼亚大学HD诊所一直使用远程医疗提供临床服务、会诊和员工培训。最初，在偏远的农村诊所和社区医院根据具体病例安排与神经科医生的会诊。自2015年以来，整个HD跨学科团队开展了远程医疗问诊，并将服务范围扩大到患者家中和长期护理机构。在实施冠状病毒病（COVID）缓解措施两天后，利用这一基础设施开展了虚拟诊所服务。在诊所就诊受限的情况下，该诊所继续通过远程医疗提供专科及跨学科护理。通过127次远程医疗问诊共诊治了69名患者，其中56次是由跨学科团队进行的。远程医疗可为HD患者提供高质量的专科神经及跨学科护理，在广泛的护理环境中提供连续性服务，并可克服预期和意外的就医障碍。
