Tarolli Christopher G, Biernot Julia M, Creigh Peter D, Moukheiber Emile, Salas Rachel Marie E, Dorsey E Ray, Cohen Adam B
Department of Neurology (CGT, PDC, ERD), University of Rochester; Center for Health + Technology (CGT, ERD), University of Rochester, NY; OSF HealthCare (JMB), Illinois Neurological Institute Memory and Dementia Care Clinic, Peoria, IL; Department of Neurology (JMB, EM, RMES, ABC), The Johns Hopkins Hospital, Baltimore, MD; and Health Technologies (ABC), Army Medical Response, National Health Mission Area, The Johns Hopkins University Applied Physics Lab (APL), Laurel, MD.
Neurol Clin Pract. 2021 Apr;11(2):e179-e188. doi: 10.1212/CPJ.0000000000000882.
Neurologists around the country and the world are rapidly transitioning from traditional in-person visits to remote neurologic care because of the coronavirus disease 2019 pandemic. Given calls and mandates for social distancing, most clinics have shuttered or are only conducting urgent and emergent visits. As a result, many neurologists are turning to teleneurology with real-time remote video-based visits with patients to provide ongoing care. Although telemedicine utilization and comfort has grown for many acute and ambulatory neurologic conditions in the past decade, remote visits and workflows remain foreign to many patients and neurologists. Here, we provide a practical framework for clinicians to orient themselves to the remote neurologic assessment, offering suggestions for clinician and patient preparation before the visit; recommendations to manage common challenges with remote neurologic care; modifications to the neurologic examination for remote performance, including subspecialty-specific considerations for a variety of neurologic conditions; and a discussion of the key limitations of remote visits. These recommendations are intended to serve as a guide for immediate implementation as neurologists transition to remote care. These will be relevant not only for practice today but also for the likely sustained expansion of teleneurology following the pandemic.
由于2019年冠状病毒病大流行，美国乃至全球的神经科医生正迅速从传统的面对面诊疗转向远程神经科护理。鉴于社交距离的呼吁和要求，大多数诊所已关闭或仅进行紧急和急诊诊疗。因此，许多神经科医生开始采用远程神经科诊疗方式，通过与患者进行基于实时远程视频的诊疗来提供持续护理。尽管在过去十年中，远程医疗在许多急性和门诊神经科疾病中的应用和接受度有所提高，但远程诊疗和工作流程对许多患者和神经科医生来说仍然陌生。在此，我们为临床医生提供一个实用框架，帮助他们熟悉远程神经科评估，提供就诊前临床医生和患者准备的建议；应对远程神经科护理常见挑战的建议；远程进行神经科检查的调整，包括针对各种神经科疾病的亚专科特殊考虑；以及对远程诊疗关键局限性的讨论。这些建议旨在作为神经科医生向远程护理过渡时立即实施的指南。这些建议不仅适用于当下的实践，也适用于疫情后远程神经科诊疗可能的持续扩展。
