Telehealth Management in Movement Disorder: A Retrospective Study

Abstract

Background:Management of chronic diseases such as movement disorders can be challenging. Nurse-administered telephone follow-up programs have demonstrated clinical and cost efficacy in a variety of health care models. However, their efficacy in movement disorders has not been sufficiently addressed. This observational study fills a knowledge gap by reporting the nature of individuals utilizing a nurse-administered telephone service and the reasons for and the outcomes of calls.Method:Consecutive calls received by the clinic for a 12-month duration were recorded. A sample of 312 calls from 132 patient charts was analyzed. Variables for analysis and coding schema were determined a-priori and included demographic information as well as information around the reasons for and outcomes of calls. The narratives of documented calls were reviewed retrospectively and responses coded for analysis by a separate researcher. Data was analyzed using descriptive statistical methods.Result:Patients made the majority of calls (49%). 27% of calls related to worsening symptoms and another 35% of calls related to medication issues or renewals. The mean call duration was 15.93 minutes. The majority of calls were received mid-way between clinic visits (M = 89.24 days). The nurse resolved 84% of calls independently. The mean number of calls per patient was 2.93. Issues reported by patients were resolved (approximately 90%) without need for follow-up emergency, family, or subspecialty clinic visits.Conclusion:The results underscore the complexity of medical issues in a movement disorders population. The current study provides support for a nurse-administered telephone follow-up program in movement disorders.

Emergency Room Visit Prevention for Older Patients with Parkinsonism in a Geriatric Clinic

“…Similar to the other two studies, the majority of our calls were related to worsening of symptoms and issues related to medications. 3,43 Top reasons for all 337 calls in our study were NMS (28%), followed by medication issues (24%) which included ADE (21%) and drug interactions (3%), and lastly MS (18%). Our findings contrast with the TI study in a younger group of PWP (age 67.9), where MS was the most common reason (27%), followed by medication issues (22.4%), and NMS (10.4%) despite a similar duration of disease (9.8 years in their study vs. 9.5 years in ours).…”

“…While literature has shown that PWPD and their caregivers would benefit from more support for symptom management, caregiver stress, wellness strategies, and future planning, there is still lack of widespread availability of such support. 36 TI services 3 and utilization of telemedicine have been proposed to address some of these unmet needs. [37][38][39][40][41] A review of the literature revealed three studies in TI in Movement Disorders Centers.…”

“…[37][38][39][40][41] A review of the literature revealed three studies in TI in Movement Disorders Centers. 3,42,43 One study noted that neuropsychiatric symptoms like anxiety and sleep disorders predicted frequent phone calls in nondemented PWPD. 42 Another study of TI staffed by fellows and neurologists highlighted that patients with PD and atypical parkinsonism contributed disproportionately, compared to other movement disorders, to the phone calls.…”

“…43 The study on a nurserun TI service reported on the reasons for calls and the outcomes and emphasized the complexity of medical issues faced by PWP and the need for more widespread availability of TI support. 3…”

“…While the majority of cases of parkinsonism assessed in movement disorders clinics are due to PD, some are caused by secondary parkinsonism (drug-induced, vascular) and atypical parkinsonisms. 3 A subset of patients referred to such clinics may be diagnosed with other entities such as essential tremor as well. The atypical parkinsonisms, including multiple systems atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy Bodies, have more rapid progression with shorter life expectancies compared to PD.…”