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Meoni S, Moro E. The impact of COVID-19 pandemic on patients with Huntington's disease and care-givers: A French survey. eNeurologicalSci 2024; 36:100517. [PMID: 39161890 PMCID: PMC11332790 DOI: 10.1016/j.ensci.2024.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
Although the impact of the first wave of the COVID-19 pandemic on people with several neurological diseases has been largely investigated, little is available concerning people with Huntington's disease (HD). The main objective of the study was to interview people with HD and their caregivers in the Auvergne-Rhone Alpes region, France. The interview consisted of 16 items concerning general and medical information, and the impact of the first wave of COVID-19 pandemic on the medical care of people with HD and on their caregivers. The questionnaire was made available as online survey from October 1st, 2020 until November 15th, 2020. Fifty-two subjects participated (13 men, 39 women, mean age of 47.3 ± 15.5 years). Almost half participants (48%) experienced a worsening of pre-existing symptoms, with new-onset symptoms in the 44% of cases. The most frequent worsening was reported in gait and balance issues (67%), fatigue (58%), anxiety (50%), and depression (50%). The 70.8% of participants reported an inappropriate overall care of HD due to long delays to access medical care (30%) and other health care teams (60%). More than half of the participants (54.2%) reported that the COVID-19 pandemic had a negative impact on their caregiver/family. Our findings emphasize the negative impact of the first wave of COVID-19 pandemic on the healthcare of HD population and their caregivers. Not only some symptoms were aggravated, but new symptoms appeared during the pandemic. In the future, health policies should be considered to improve the care of patients with rare diseases such as HD.
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Affiliation(s)
- Sara Meoni
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut of Neurosciences, 38000 Grenoble, France
- “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
| | - Elena Moro
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut of Neurosciences, 38000 Grenoble, France
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van Lonkhuizen PJC, Heemskerk AW, Meijer E, van Duijn E, de Bot ST, Klempir J, Landwehrmeyer GB, Mühlbäck A, Hoblyn J, Squitieri F, Chavannes NH, Vegt NJH. Development of the Huntington Support App (HD-eHelp study): a human-centered and co-design approach. Front Neurol 2024; 15:1399126. [PMID: 39011363 PMCID: PMC11246862 DOI: 10.3389/fneur.2024.1399126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction eHealth seems promising in addressing challenges in the provision of care for Huntington's disease (HD) across Europe. By harnessing information and communication technologies, eHealth can partially relocate care from specialized centers to the patients' home, thereby increasing the availability and accessibility of specialty care services beyond regional borders. Previous research on eHealth (development) in HD is however limited, especially when it comes to including eHealth services specifically designed together with HD gene expansion carriers (HDGECs) and their partners to fit their needs and expectations. Methods This article describes the qualitative human-centered design process and first evaluations of the Huntington Support App prototype: a web-app aimed to support the quality of life (QoL) of HDGECs and their partners in Europe. Prospective end-users, i.e., HDGECs, their partners, and healthcare providers (HCPs), from different countries were involved throughout the development process. Through interviews, we captured people's experiences with the disease, quality of life (QoL), and eHealth. We translated their stories into design directions that were further co-designed and subsequently evaluated with the user groups. Results The resulting prototype centralizes clear and reliable information on the disease, HD-related news and events, as well as direct contact possibilities with HCPs via an online walk-in hour or by scheduling an appointment. The app's prototype was positively received and rated as (very) appealing, pleasant, easy to use and helpful by both HDGECs and partners. Discussion By involving end-users in every step, we developed a healthcare app that meets relevant needs of individuals affected by HD and therefore may lead to high adoption and retention rates. As a result, the app provides low-threshold access to reliable information and specialized care for HD in Europe. A description of the Huntington Support App as well as implications for further development of the app's prototype are provided.
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Affiliation(s)
- Pearl J C van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Erik van Duijn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Jiri Klempir
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | | | - Alzbeta Mühlbäck
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- Isar-Amper-Klinikum, Huntington-Zentrum-Süd, Klinik Taufkirchen, Munich, Germany
| | - Jennifer Hoblyn
- St. John of God Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
- Centro Malattie Neurologiche Rare (CMNR), Italian League for Research on Huntington (LIRH) Foundation, Rome, Italy
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niko J H Vegt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Shiino S, van Wouwe NC, Wylie SA, Claassen DO, McDonell KE. Huntington disease exacerbates action impulses. Front Psychol 2023; 14:1186465. [PMID: 37397312 PMCID: PMC10312388 DOI: 10.3389/fpsyg.2023.1186465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Impulsivity is a common clinical feature of Huntington disease (HD), but the underlying cognitive dynamics of impulse control in this population have not been well-studied. Objective To investigate the temporal dynamics of action impulse control in HD patients using an inhibitory action control task. Methods Sixteen motor manifest HD patients and seventeen age-matched healthy controls (HC) completed the action control task. We applied the activation-suppression theoretical model and distributional analytic techniques to differentiate the strength of fast impulses from their top-down suppression. Results Overall, HD patients produced slower and less accurate reactions than HCs. HD patients also exhibited an exacerbated interference effect, as evidenced by a greater slowing of RT on non-corresponding compared to corresponding trials. HD patients made more fast, impulsive errors than HC, evidenced by significantly lower accuracy on their fastest reaction time trials. The slope reduction of interference effects as reactions slowed was similar between HD and controls, indicating preserved impulse suppression. Conclusion Our results indicate that patients with HD show a greater susceptibility to act rapidly on incorrect motor impulses but preserved proficiency of top-down suppression. Further research is needed to determine how these findings relate to clinical behavioral symptoms.
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Affiliation(s)
- Shuhei Shiino
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Scott A. Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Daniel O. Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Katherine E. McDonell
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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Onishchenko R, Clarke PJ, Marshall C, Wyant KJ, Kotagal V. Neighborhood Social Determinants of Health in Patients Seen in Neurology Movement Disorders Clinics. Neurol Clin Pract 2023; 13:e200142. [PMID: 37064586 PMCID: PMC10101706 DOI: 10.1212/cpj.0000000000200142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/12/2022] [Indexed: 03/18/2023]
Abstract
Background and Objectives Chronic health conditions are influenced by social determinants of health (SDH) including neighborhood-linked markers of affluence. We explored whether neighborhood socioeconomic factors differ in people with different types of clinical movement disorders (MDs). Methods We conducted a retrospective study of patients seen in MD clinics at our center in 2021. Patient data were linked to the US National Neighborhood Data Archive linked to US census tract data. We evaluated variations in neighborhood socioeconomic factors across 8 different categories of MDs. Results Compared with the neighborhoods of patients with Parkinson disease, neighborhoods of patients with cerebellar ataxias, functional movement disorders, and Huntington disease were characterized by higher proportions of people earning less than 15,000 US dollars/year, people receiving public assistance, and people with less than a high school diploma. Discussion Neighborhood-linked SDH vary among different MDs. These findings have implications for public health interventions aimed at improving the care of people affected by MDs.
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Affiliation(s)
- Regina Onishchenko
- Department of Neurology (RO, CM, KJW, VK), Institute for Social Research (PJC), University of Michigan; Department of Epidemiology (PJC), University of Michigan School of Public Health; and Veterans Affairs Ann Arbor Health System (VAAAHS) & VAAAHS Geriatric Research Education and Clinical Center (GRECC) (VK), Ann Arbor, MI
| | - Philippa J Clarke
- Department of Neurology (RO, CM, KJW, VK), Institute for Social Research (PJC), University of Michigan; Department of Epidemiology (PJC), University of Michigan School of Public Health; and Veterans Affairs Ann Arbor Health System (VAAAHS) & VAAAHS Geriatric Research Education and Clinical Center (GRECC) (VK), Ann Arbor, MI
| | - Carly Marshall
- Department of Neurology (RO, CM, KJW, VK), Institute for Social Research (PJC), University of Michigan; Department of Epidemiology (PJC), University of Michigan School of Public Health; and Veterans Affairs Ann Arbor Health System (VAAAHS) & VAAAHS Geriatric Research Education and Clinical Center (GRECC) (VK), Ann Arbor, MI
| | - Kara J Wyant
- Department of Neurology (RO, CM, KJW, VK), Institute for Social Research (PJC), University of Michigan; Department of Epidemiology (PJC), University of Michigan School of Public Health; and Veterans Affairs Ann Arbor Health System (VAAAHS) & VAAAHS Geriatric Research Education and Clinical Center (GRECC) (VK), Ann Arbor, MI
| | - Vikas Kotagal
- Department of Neurology (RO, CM, KJW, VK), Institute for Social Research (PJC), University of Michigan; Department of Epidemiology (PJC), University of Michigan School of Public Health; and Veterans Affairs Ann Arbor Health System (VAAAHS) & VAAAHS Geriatric Research Education and Clinical Center (GRECC) (VK), Ann Arbor, MI
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Pfalzer AC, Watson KH, Ciriegio AE, Hale L, Diehl S, McDonell KE, Vnencak-Jones C, Huitz E, Snow A, Roth MC, Guthrie CS, Riordan H, Long JD, Compas BE, Claassen DO. Impairments to executive function in emerging adults with Huntington disease. J Neurol Neurosurg Psychiatry 2023; 94:130-135. [PMID: 36450478 DOI: 10.1136/jnnp-2022-329812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The clinical diagnosis of Huntington disease (HD) is typically made once motor symptoms and chorea are evident. Recent reports highlight the onset of cognitive and psychiatric symptoms before motor manifestations. These findings support further investigations of cognitive function across the lifespan of HD sufferers. METHODS To assess cognitive symptoms in the developing brain, we administered assessments from the National Institutes of Health Toolbox Cognitive Battery, an age-appropriate cognitive assessment with population norms, to a cohort of children, adolescents and young adults with (gene-expanded; GE) and without (gene-not-expanded; GNE) the trinucleotide cytosine, adenine, guanine (CAG) expansion in the Huntingtin gene. These five assessments that focus on executive function are well validated and form a composite score, with population norms. We modelled these scores across age, and CAP score to estimate the slope of progression, comparing these results to motor symptoms. RESULTS We find significant deficits in the composite measure of executive function in GE compared with GNE participants. GE participant performance on working memory was significantly lower compared with GNE participants. Modelling these results over age suggests that these deficits occur as early as 18 years of age, long before motor manifestations of HD. CONCLUSIONS This work provides strong evidence that impairments in executive function occur as early as the second decade of life, well before anticipated motor onset. Future investigations should delineate whether these impairments in executive function are due to abnormalities in neurodevelopment or early sequelae of a neurodegenerative process.
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Affiliation(s)
- Anna C Pfalzer
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly H Watson
- Psychology and Human Development, Vanderbilt University Peabody College of Education and Human Development, Nashville, Tennessee, USA
| | - Abagail E Ciriegio
- Psychology and Human Development, Vanderbilt University Peabody College of Education and Human Development, Nashville, Tennessee, USA
| | - Lisa Hale
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spencer Diehl
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katherine E McDonell
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cindy Vnencak-Jones
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Huitz
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Abigail Snow
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marissa C Roth
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Cara S Guthrie
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Heather Riordan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey D Long
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Bruce E Compas
- Psychology and Human Development, Vanderbilt University Peabody College of Education and Human Development, Nashville, Tennessee, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Mohanty D, Schmitt P, Dixon L, Holiday V, Hedera P. Patient and Caregiver Perspectives on Telehealth Use in a Multidisciplinary Huntington's Disease Clinic: A Single-Institution Experience. J Huntingtons Dis 2022; 11:415-419. [PMID: 35964200 DOI: 10.3233/jhd-220547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The coronavirus pandemic saw technology evolve as outpatient clinics faced restriction of in-person visits. Reliance on telemedicine using two-way audio-video communication significantly increased. Telemedicine was observed to be convenient, cost-effective, reduced no-show rates, and fostered sustained engagement. Enhanced flexibility from short notice scheduling benefitted patients and their caregivers. Greater time value was perceived by patients, and reduced reliance on caregivers. Disadvantages included barriers of access to internet connectivity or equipment. OBJECTIVE We aimed to retrospectively survey patients with Huntington's disease (HD) seen via telehealth in our HDSA Center for Excellence Multidisciplinary clinic. We evaluated usability, learnability, interface quality, reliability, and future use. METHODS This qualitative survey used the 21-item Telehealth Usability Questionnaire. Close-ended responses ranged from strongly disagree to strongly agree scored on Likert scale (1 through 7). Averages were calculated to examine attitudes towards telemedicine. Spearman correlation test was performed to detect attitude biases between patients and caregivers. RESULTS Respondents were more likely than not to strongly agree with survey statements. Average attitude score of 5.92 (range 2.95-7.00) suggested favorability and improved convenience when telehealth was used in complement to in-person visits, without detriment to patient-provider communication. Spearman correlation coefficient between patient and family/caregiver groups was 0.023, which is below the cutoff of 0.344 for a = 0.05 at N = 24. This suggests there was no bias between patient and caregiver attitudes. CONCLUSION This study demonstrated telehealth is favored by caregivers and patients with HD. This population with specific physical, cognitive and psychiatric needs can benefit from adaptive systems that enhance compliance.
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Affiliation(s)
- Diksha Mohanty
- University of Louisville School of Medicine, Louisville, KY, USA.,University of Louisville Health, Frazier Rehabilitation Institute, Louisville, KY, USA
| | - Philipp Schmitt
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Laura Dixon
- University of Louisville School of Medicine, Louisville, KY, USA.,University of Louisville Health, Frazier Rehabilitation Institute, Louisville, KY, USA
| | - Victoria Holiday
- University of Louisville School of Medicine, Louisville, KY, USA.,University of Louisville Health, Frazier Rehabilitation Institute, Louisville, KY, USA
| | - Peter Hedera
- University of Louisville School of Medicine, Louisville, KY, USA.,University of Louisville Health, Frazier Rehabilitation Institute, Louisville, KY, USA
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Mantese CE, da Silva Aquino ER, Domingues RB. Comment on "Patients' Postjudice of Tele-Neurology for Movement Disorders". Mov Disord Clin Pract 2022; 9:1008-1009. [PMID: 36247914 PMCID: PMC9547137 DOI: 10.1002/mdc3.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Emanuelle Roberta da Silva Aquino
- Comissão Aberta de TelemedicinaAcademia Brasileira de NeurologiaSão PauloBrazil
- Departamento de NeurologiaUniversidade de São PauloSão PauloBrazil
| | - Renan Barros Domingues
- Comissão Aberta de TelemedicinaAcademia Brasileira de NeurologiaSão PauloBrazil
- Neurology Regional Director, Americas Medical Services/UHGSão PauloBrazil
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Schneider SA, Hennig A, Martino D. Relationship between COVID-19 and movement disorders: A narrative review. Eur J Neurol 2021; 29:1243-1253. [PMID: 34918437 DOI: 10.1111/ene.15217] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The scientific literature on COVID-19 is increasingly growing. METHODS In this paper, we review the literature on movement disorders in the context of the COVID-19 pandemic. RESULTS First, there are a variety of transient movement disorders that may manifest in the acute phase of COVID-19, most often myoclonus, with more than 50 patients described in the literature. New onset parkinsonism, chorea, and tic-like behaviours have also been reported. Movement disorders as a side effect after COVID-19 vaccination are rare, occurring with a frequency of 0.00002-0.0002 depending on the product used, mostly manifesting with tremor. Current evidence for potential long-term manifestations, for example, long COVID parkinsonism, is separately discussed. Second, the pandemic has also had an impact on patients with pre-existing movement disorder syndromes, with negative effects on clinical status and overall well-being, and reduced access to medication and health care. In many parts, the pandemic has led to reorganization of the medical system, including the development of new digital solutions. The movement disorder-related evidence for this is reviewed and discussed. CONCLUSIONS The pandemic and the associated preventive measures have had a negative impact on the clinical status, access to health care, and overall well-being of patients with pre-existing movement disorders.
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Affiliation(s)
| | - Anita Hennig
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary and Hotchkiss Brain Institute, Calgary, Alberta, Canada
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Lee SJ, Hale LM, Huitz E, Claassen DO, McDonell KE. Improving Patient Outreach by Defining Telehealth Suitability in a Tertiary Huntington's Disease Clinic. J Huntingtons Dis 2021; 10:479-484. [PMID: 34719505 DOI: 10.3233/jhd-210498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has increased the need for remote healthcare options among patients with Huntington's disease (HD). However, since not every HD patient is suitable for telehealth, it is important to differentiate who can be seen virtually from who should remain as in-person. Unfortunately, there are no clinical guidelines on how to evaluate HD patients for telehealth eligibility. OBJECTIVE To standardize the teleneurology selection process in HD by implementing a screening tool that accounts for patient-specific factors. METHODS We organized various indications and contraindications to teleneurology into a flowchart. If any indications or contraindications were met, patients were assigned to telehealth or maintained as in-person, respectively. If no indications or contraindications were met, patients were given the option of telehealth or in-person for their upcoming appointments. In two implementation cycles, we tested this screening tool among all HD patients scheduled for clinic visits, aided by chart review and phone interview. RESULTS In a cohort of 81 patients, telehealth acceptance among eligible patients increased from 45.0%to 83.3%. Frequency of telehealth visits increased from a pre-intervention baseline of 12.8%to 28.2%. CONCLUSION Teleneurology utilization among HD patients more than doubled across our study. Our intervention promotes consistency and patient-centeredness in HD clinical care and streamlines the overall telehealth selection process. Future studies can seek to reduce telehealth no-shows and also evaluate the utility of the motor and psychiatric criteria included in our screening tool.
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Affiliation(s)
- Sean J Lee
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Lisa M Hale
- Division of Behavioraland Cognitive Neurology, Department of Neurology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
| | - Elizabeth Huitz
- Division of Behavioraland Cognitive Neurology, Department of Neurology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
| | - Daniel O Claassen
- Division of Behavioraland Cognitive Neurology, Department of Neurology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
| | - Katherine E McDonell
- Division of Behavioraland Cognitive Neurology, Department of Neurology, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
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