Neilson Lee E, Wilhelm Jennifer, McDonnell Margaret McLain, Mann Lisa, Kraakevik Jeff A
Department of Neurology, Veterans Affairs Medical Center, 3710 SW US Veterans Road, P3-PADRECC, Portland, OR 97239, USA.
Department of Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Parkway, Mail Code OP32, Portland, OR 97239, USA.
Clin Park Relat Disord. 2022 Oct 8;7:100167. doi: 10.1016/j.prdoa.2022.100167. eCollection 2022.
Parkinson's disease is the second most common neurodegenerative disorder and presents with a heterogeneous group of symptoms. Managing these symptoms requires coordinated care from a neurology specialist and a primary care provider. Access to neurology care is limited for those patients with Parkinson's disease who reside in rural areas given financial and mobility constraints along with the rarity of specialty providers.
To close this gap, we developed and implemented a telehealth-based Project ECHO® (Extension for Community Healthcare Outcomes) program, "Parkinson ECHO," to provide education and support for rural clinicians and allied health members. The sessions focused on a topic within Parkinson's disease diagnosis or management followed by case discussions. We assessed the feasibility of this tele-mentoring educational offering, the favorability of this approach, and the effect it had on clinician confidence in diagnosing and treating Parkinson's disease using Likert-based surveys.
Thirty-three unique participants from 13 Oregon counties and one county in the state of Washington, of whom 70 % served rural and/or medically underserved communities, participated in Parkinson ECHO. There was a 52 % dropout rate based on survey response, though session attendance was higher. Participants were overall satisfied with the format and content of Parkinson ECHO. There were improvements in knowledge and confidence in diagnosing and treating Parkinson's disease which persisted 6 months following the conclusion of the program. Unexpectedly, two participants reported convening a multidisciplinary group to discuss improvements to PD care.
The COVID-19 pandemic was an unexpected obstacle, but the teleconference nature permitted us to complete the program to positive effect. We found Parkinson ECHO did significantly increase participant confidence levels in diagnosing and managing Parkinson's disease.
帕金森病是第二常见的神经退行性疾病，症状表现多样。管理这些症状需要神经科专家和初级保健提供者的协同护理。由于经济和行动限制以及专科医疗服务提供者的稀缺，居住在农村地区的帕金森病患者获得神经科护理的机会有限。
为了缩小这一差距，我们开发并实施了一个基于远程医疗的社区医疗成果拓展（ECHO®）项目“帕金森病ECHO”，为农村临床医生和相关健康专业人员提供教育和支持。课程聚焦于帕金森病诊断或管理中的一个主题，随后进行病例讨论。我们使用基于李克特量表的调查评估了这种远程指导教育课程的可行性、这种方法的受欢迎程度以及它对临床医生诊断和治疗帕金森病信心的影响。
来自俄勒冈州13个县和华盛顿州1个县的33名不同参与者参加了帕金森病ECHO项目，其中70%服务于农村和/或医疗服务不足的社区。根据调查反馈，辍学率为52%，不过课程出席率更高。参与者总体上对帕金森病ECHO的形式和内容感到满意。在诊断和治疗帕金森病方面的知识和信心有所提高，并且在项目结束后的6个月内持续存在。出乎意料的是，两名参与者报告召集了一个多学科小组来讨论改善帕金森病护理的措施。
新冠疫情是一个意外的障碍，但远程会议的性质使我们能够完成该项目并取得积极效果。我们发现帕金森病ECHO确实显著提高了参与者诊断和管理帕金森病的信心水平。
