Telemedicine in neurology: current evidence

Domingues, Renan Barros; Mantese, Carlos Eduardo Aliatti; Aquino, Emanuelle Roberta da Silva; Fantini, Francisca Goreth Malheiro Moraes; Prado, Gilmar Fernandes do; Nitrini, Ricardo

doi:10.1590/0004-282x20200131

Cited by 32 publications

(30 citation statements)

References 105 publications

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“…As observed in other neurological conditions (e.g., parkinsonism, dementia, epilepsy, headache), TM has replaced in many cases outpatient visits [ 2 – 7 ]. Nevertheless, its use in NM care is yet dramatically underrated with few reports about the use of telemedicine care for neuromuscular diseases affected patients [ 8 ]. Here, we propose to review the approach to neuromuscular patients by analyzing raising evidence on the main cornerstones of TM: clinician-patient interaction, remote clinical assessment, remote monitoring, and digital therapeutics.…”

Section: Introductionmentioning

confidence: 99%

How to manage with telemedicine people with neuromuscular diseases?

et al. 2021

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Introduction COVID-19 pandemic radically transformed our daily clinical practice, raising the need not to lose close contact with patients without being able to see them face-to-face. These issues are even more felt and evident in fragile patients, as those affected by neuromuscular disease. An important help came from new digital technologies that allow clinicians to remotely monitor health status and any deterioration of chronically ill patients. Methods In this mini-review, an initiative of the “Digital Technologies, Web and Social Media Study Group” of the Italian Society of Neurology, we propose to analyze the approach to neuromuscular patients by looking over raising evidence on the main cornerstones of Telemedicine (TM): clinician-patient interaction, remote clinical assessment, remote monitoring, and digital therapeutics. In particular, we explored the strategies developed by researchers and their impact on the physical and emotional status of the patients, with particular focusing on their adherence to the program of virtual monitoring. Results TM plays an important role in each of four stages of approach to neuromuscular disease, having demonstrated validity in keep close clinical patient interaction, clinical assessment, remote monitoring, and telerehabilitation. Nevertheless, there is no remote alternative to electrophysiological testing neither validate tools to assess disability. Conclusion The role of TM in neuromuscular care is yet underestimated but is crucial, beyond the pandemic era. Further development of TM is advisable, through making specific apps, remotely controlled by clinicians, and making more engaging clinicians-patients interaction. Last, it is necessary to ensure adequate internet access to everyone.

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Section: Introductionmentioning

confidence: 99%

How to manage with telemedicine people with neuromuscular diseases?

et al. 2021

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“…In the emergency context, use of telemedicine in neurology is widespread, with expansion of telestroke coverage over the last decade in different countries. However, there are also opportunities for use of telemedicine in managing neurological disorders 23 . These include replacing or complementing in-office evaluations, decreasing the time between follow-up visits, reducing the disparities in access to healthcare and promoting education and training through interactions between PCPs and tertiary referral centers.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine as support for primary care referrals to neurologists: decision-making between different specialists when guiding the case over the phone

Mantese

Aquino

Figueira

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: Brazil’s public health system, the largest in the world, faces great challenges in establishing access to specialized care for all Brazilians. “Regula Mais Brasil” is a structuring project from the Ministry of Health that aims to optimize the referral process for specialized care throughout Brazil and uses telemedicine to support primary care physicians. The high demand for support and referrals in the neurology specialty raises questions about what the difficulties and doubts in managing these patients are and whether the training of the coordinating physician influences the orientation and outcome of referral. Methods: In a retrospective analysis on a database, all teleconsultations in the neurology specialty were evaluated. The diagnoses were categorized using the ICD-10 and according to the specialty of the coordinating teleconsultant for multiple comparisons. Results: In total, 1687 teleconsultations were conducted between January 10 and December 2, 2019, in the cities of Belo Horizonte and Porto Alegre and in the Federal District. The most frequent area of doubt for doctors was about epilepsy. After discussion via telemedicine, 25% of the referrals were avoided and the specialty of the teleconsultant physician did not impact the decision made: 72.3, 72.6 and 66.5%, in relation to approval by neurologists, family doctors and other experts, respectively. Conclusion: Increasing access to specialists, not only for patients but also for doctors, helps in achieving early resolution of issues of greater difficulty for primary healthcare doctors, thus resulting in lower numbers of referrals.

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“…In services whose demand for subspecialists is small or low regional availability of professionals, it is economically unfeasible to maintain them in person at each health unit 20,21 . In this context, the exchange of experience in real-time between the emergency room and other specialists at a distance, such as cardiologists and neurologists, can be crucial for the assertive management of highly complex cases 22,23 . In situations of the health system collapse due to catastrophes related to major accidents or infectious diseases, as in the pandemic by COVID-19, the effectiveness of the call center in the management of human and material resources is notable 24,25 .…”

Section: Editorialmentioning

confidence: 99%