Zaloum Safiya A, Paris Alvar, Mair Devan, Gutteridge Charles, Ayling Ruth M, Onen Barbara L, Walton Joseph, Workman Anna, Villanueva Nelia, Noyce Alastair J
Centre for Preventive Neurology, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
University of Cambridge, Cambridge, UK.
BMJ Neurol Open. 2024 Jun 3;6(1):e000737. doi: 10.1136/bmjno-2024-000737. eCollection 2024.
Cases of nitrous oxide (NO)-induced myeloneuropathy are increasing at UK hospitals. At our centre, a dedicated ambulatory care pathway, endorsed nationally, was established to treat and monitor patients with NO-myeloneuropathy in 2021 and refined through three audit cycles. We analysed the outcomes of patients on this pathway to better understand factors associated with non-engagement. Alongside, a novel approach using WhatsApp for questionnaire delivery was trialled in an attempt to improve engagement with treatment.
Patients on the NO ambulatory care pathway were identified from MDT meeting lists from 9 September 2022 to 25 April 2023. Clinical data were collected via electronic clinical records, including the most recent neurological examination and reason for discharge from the pathway. Patients identified from MDT lists from 27 January 2023 to 14 March 2023 were approached to participate in weekly 12-item surveys, delivered via WhatsApp. This was approved as a service development project with approval for WhatsApp use given by the chief clinical information officer.
35/56 (62.5%) patients were discharged from ambulatory care due to non-attendance and 17/56 (30.4%) completed their treatment course. The median time from initial presentation to discharge was 49 days. 24/40 (60.0%) of patients with a final neurological examination documented had a residual deficit, with objective sensory deficits most common. 12 patients were approached to receive weekly questionnaires via WhatsApp. 5/8 who expressed interest returned a consent form. All participants were withdrawn due to non-response or participant choice. 1/5 returned more than two surveys.
Despite poor participation in surveys delivered via WhatsApp, novel approaches are needed to improve engagement with patients on the NO ambulatory care pathway.
英国医院中，氧化亚氮（NO）诱发的脊髓神经病病例正在增加。2021年，我们中心制定了一条专门的门诊护理路径，并得到了全国认可，用于治疗和监测NO脊髓神经病患者，该路径经过三个审核周期得到了完善。我们分析了该路径上患者的治疗结果，以更好地了解与不参与治疗相关的因素。与此同时，我们尝试了一种使用WhatsApp发送问卷的新方法，以提高患者对治疗的参与度。
从2022年9月9日至2023年4月25日的多学科诊疗（MDT）会议名单中确定了处于NO门诊护理路径上的患者。通过电子临床记录收集临床数据，包括最近的神经系统检查和出院原因。我们邀请了2023年1月27日至2023年3月14日MDT名单中确定的患者参与通过WhatsApp每周发送的12项调查问卷。这被批准为一个服务开发项目，首席临床信息官批准了使用WhatsApp。
35/56（62.5%）的患者因未就诊而从门诊护理中出院，17/56（30.4%）的患者完成了治疗疗程。从首次就诊到出院的中位时间为49天。有最终神经系统检查记录的患者中，24/40（60.0%）有残留缺陷，客观感觉缺陷最为常见。12名患者被邀请通过WhatsApp接收每周调查问卷。8名表示感兴趣的患者中有5名返回了同意书。所有参与者均因无回复或参与者选择而退出。5名参与者中有1名返回了两份以上的调查问卷。
尽管通过WhatsApp进行的调查参与度较低，但仍需要新方法来提高NO门诊护理路径上患者的参与度。
