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In people with multiple sclerosis (PwMS), strict follow-up is essential. Telemedicine has the potential to overcome many of the difficulties in routine management. Herein, we present a structured protocol that can be used to remotely manage patients with MS, describing in detail the steps to be taken and exams needed at each stage. A working group...
Context in source publication
Context 1
... phases of the virtual visit are shown in Fig. 1. These include an enrolment phase, document sharing phase, preevaluation phase, the virtual visit itself, and the post-visit phase. The overall protocol structure is shown in Fig. 2. The protocol for the virtual visit was divided into 14 steps to be sequentially carried between the MS center and patient. The virtual visit is initiated by the center's office who contact the patient by telephone and explain the process. The patient then expressed his/her desire to participate, and if affirmed, a starter kit is sent ...
Similar publications
(1) Background: Persons with multiple sclerosis (pwMS) are often characterized as ideal adopters of new digital healthcare trends, but it is worth thinking about whether and which pwMS will be targeted and served by a particular eHealth service like a patient portal. With our study, we wanted to explore needs and barriers for subgroups of pwMS and...
Citations
... One article was published in 2014 [15], two in 2016 [16,17], one in 2018 [18], three in 2020 [19][20][21], four in 2021 [22][23][24][25] and three in 2022 [26][27][28]. Six of the included studies were conducted in the United States [18-21, 24, 27], two in Australia with international participants (the educational intervention was in English) [23,26], two in Italy [25,28], one in Spain [16], one in Germany [22], one in Belgium [15] and one in the United Kingdom [17]. ...
... One article was published in 2014 [15], two in 2016 [16,17], one in 2018 [18], three in 2020 [19][20][21], four in 2021 [22][23][24][25] and three in 2022 [26][27][28]. Six of the included studies were conducted in the United States [18-21, 24, 27], two in Australia with international participants (the educational intervention was in English) [23,26], two in Italy [25,28], one in Spain [16], one in Germany [22], one in Belgium [15] and one in the United Kingdom [17]. ...
... Table 3. Represents in what part of the research article informal carers were mentioned. [16,18,20,21,24,25,27,28] 6studies [15,17,19,22,23,26] F&F appeared in the results or discussion section of the research 11 studies [16][17][18][19][21][22][23][24][25][26][27][28] 2 studies [15,20] ...
Multiple sclerosis (MS) is a common neurological disease that can impact not only individuals diagnosed with the condition but also their informal carers, i.e. family members and friends. This scoping review aimed to map the role that family members and friends of people with multiple sclerosis have had in digital health research. The scoping review was reported according to PRISMA-ScR. The search was done in Scopus, CINAHL, Pubmed, and Web of Science. A total of 14 studies met the inclusion criteria. These studies were about telemedicine, rehabilitative video games, online education, user research, and development. Usually, family members and friends had a side part in the research. One study focused exclusively on them, and in total, in eight studies family and friends were participants in the study. Otherwise, they were accompanying the person with multiple sclerosis, were seen as possible users of the digital solution or they appeared in results by someone else. In this scoping review, it was seen that informal carers can get support and information from digital sources, they are able to act as informal carers in digital environments, healthcare professionals can receive information from them and family and friends can help in remote assessments, and digital solutions can help informal carers and people with MS to connect in a new or better way. Our results highlight that digital health can bring benefits to family members, people with multiple sclerosis, and healthcare.
... Specifically, the software recommended in the implementation phase within the illustrated document is Skype™ [13], as it is free and widely accessible throughout the country. Numerous studies and international scientific experiences have demonstrated the validity of this platform in healthcare settings, having been applied for various purposes with encouraging results: virtual rehabilitation interventions for language disorders, remote synchronous consultations in Ophthalmic Telesurgery, health status monitoring following different kinds of interventions, psychotherapy, virtual consultations in Plastic Surgery, as well as in several clinical settings [14][15][16][17][18][19][20][21][22]. The choice of the platform is therefore based on the evidence of its validity, cost, and widespread availability within the territory. ...
(1) This paper aims to propose a telematic method for assessing the state of disability by a social worker member of the Medico-Legal Commissions of INPS. (2) We have proceeded to delve into and compare the current methods with new strategies to enhance the experience linked to the assessment of the status of disability in terms of timing and accessibility, eliminating the need for a direct visit. (3) The proposed protocol can be applied in cases where patients cannot be physically moved, following a medical visit at home, and when the mere evaluation of documents is sufficient. In both cases, a remote session with the Commission is necessary to fill in the required information about the socio-environmental section. This protocol can be applied to different platforms such as Skype™ since it is free and widely used throughout the country. (4) It should be noted that telemedicine solutions cannot completely replace face-to-face interaction; however, in some limited cases, they can optimize the process and timing, avoiding the need to move or interact only by telephone.
... A comprehensive neurological examination requires 40-60 min on average for each patient, and reducing the time for patient-neurologist encounters could lead to inaccurate diagnosis and poor patient outcomes. A Virtual Visit Assessment (ViVA) following a structured protocol has been suggested for virtual patient management [70]. This protocol, successfully tested during the COVID-19 health emergency, is composed of five steps (including pre-visit with a sharing documents phase, a virtual visit, and a post-visit phase), takes around 54 min to complete and actively involves the caregiver. ...
... This protocol, successfully tested during the COVID-19 health emergency, is composed of five steps (including pre-visit with a sharing documents phase, a virtual visit, and a post-visit phase), takes around 54 min to complete and actively involves the caregiver. Besides the potential benefits in terms of reduced contagion risk, the ViVA model encountered the satisfaction of the patients, allowing the simplification of visit logistics, the re-enforcement of the link between patient and physician while resulting in a limitation of overall costs [70], thus being a valid alternative to the established standard visit. ...
Objective
Multiple sclerosis (MS) is a chronic disease with different clinical courses and a tendency to worsening. The relapsing–remitting MS presents acute onset and relapses of neurological symptoms, followed by their remission. This form can convert to secondary progressive MS (SPMS) with irreversible neurological worsening and disability. The identification of signs, symptoms, markers of progression, and strategies to manage MS patients is mandatory to allow early identification of those at higher risk of conversion to SPMS, for prompt intervention to cope with the progression of the disease.
Methods
A panel of Italian experts from Southern Italy have reviewed the current knowledge on MS and its management and identified the crucial tools for SPMS recognition.
Results
More effective communication between patients and clinicians should be established, with the support of digital tools. Moreover, the improvement in the clinical use of biomarkers for progression (cellular structures and tissue organization, such as neurofilaments and chitinase 3-like 1, axonal and neurons density) and of instrumental analyses for recognition of whole-brain atrophy, chronic active lesions, spinal cord lesions and atrophy, and the improvement the combination of the Expanded Disability Status Scale and the evaluation of cognitive dysfunction are discussed.
Conclusion
Given the availability of a pharmacological option, adequate education both for patients, regarding the evolution of the disease and the specific treatment, and for professionals, to allow more effective and sensitive communication and the best use of diagnostic and management tools, could represent a strategy to improve patient management and their quality of life.
... In one study, a high satisfaction rate was reported with virtual Skype visits. Only in 20%, further in-person evaluation was necessary [29]. In Sweden, the experience of telemedicine in treating MS at the time of COVID has been successful [30]. ...
The recent COVID-19 pandemic has taken the lives of nearly 5.2 million up to now. With no definite treatment and considering close contact as the primary mode of transmission, telemedicine has emerged as an essential medical care platform. Virtual medical communications have offered clinicians the opportunity to visit and follow up on patients more efficiently during the lockdown. Not only has telemedicine improved multiple sclerosis (MS) patients’ health and quality of life during the pandemic, but it could also be used as a cost-effective platform for physical and cognitive MS rehabilitation programs. Cognitive impairment is a common problem among MS patients even at the initial phases of the disease. Rehabilitation training programs such as RehaCom, BrainHQ, Speed of Processing Training (PST), and COGNI-TRAcK have made great strides in improving a wide range of cognitive functions that MS patients are challenged with. Regarding the impact of COVID-19 on the cognitive aspects of MS patients, efforts to implement rehabilitation training applications have been increased. Web-based mobile applications, virtual visits, and telephone follow-ups are examples of such efforts. Having said that, limitations such as privacy, socioeconomic disparities, e-health literacy, study settings, and challenges of neurologic examinationss have been raised. Since most MS patients are young, all the beneficiaries are encouraged to embrace the research in the field to pave the road for more feasible and efficient ways of cognitive enhancement in MS patients.
... This represented a rudimentary first attempt offered by the national health system to remotely manage, at scale, patients isolated at home. Concomitantly, local hospitals implemented or reinforced telemedicine services offered to Italian patients with different chronic conditions (including cardiovascular disease, diabetes, oncological disease, skin disease, neurological or psychiatric disease, and immunological disease) [101][102][103][104][105][106][107][108] . This "health maintenance strategy" provided individualized treatment and helped maintain the patient's health status as close as possible to the ideal. ...
During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients’ privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals’ and patients’ awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.
... In Italy, in the course of the first wave of the COVID-19 pandemic, available telehealth solutions have been used to track and promptly detect potentially infected individuals [14,15] and monitor patients with any critical chronic condition (including heart failure, diabetes, oncological disease, skin disease, neurological or psychiatric disease, immunological disease) restrained at home [16][17][18][19][20][21][22]. However, preliminary reports suggest that the Country was mostly unprepared to implement existing telehealth solutions for this purpose [11,[23][24][25][26]. ...
Background
During the COVID-19 pandemic, telehealth became a vital resource to contain the virus’s spread and ensure continuity of care of patients with a chronic condition, notably arterial hypertension and heart disease. This paper reports the experience based on a telehealth platform used at scale to manage chronic disease patients in the Italian community.
Methods and findings
Patients’ health status was remotely monitored through ambulatory blood pressure monitoring (ABPM), resting or ambulatory electrocardiogram (ECG), spirometry, sleep oximetry, and cardiorespiratory polysomnography performed in community pharmacies or general practitioners’ offices. Patients also monitored their blood pressure (BP), heart rate (HR), blood oxygen saturation (SpO 2 ), body temperature, body weight, waist circumference, blood glucose, and lipids at home through a dedicated smartphone app. All data conveyed to the web-based telehealth platform were used to manage critical patients by doctors promptly. Data were analyzed and compared across three consecutive periods of 2 months each: i) before the national lockdown, ii) during the lockdown (from March 9 to May 17, 2020), and iii) after the end of the containment measures. Overall, 13,613 patients visited community pharmacies or doctors’ offices. The number of overall tests dropped during and rose after the lockdown. The overall proportion of abnormal tests was larger during the outbreak. A significant increase in the prevalence of abnormal ECGs due to myocardial ischemia, contrasted by a significantly improved BP control, was observed. The number of home users and readings exchanged increased during the pandemic. In 226 patients, a significant increase in the proportion of SpO 2 readings and a significant reduction in the entries for all other parameters, except BP, was observed. The proportion of abnormal SpO 2 and BP values was significantly lower during the lockdown. Following the lockdown, the proportion of abnormal body weight or waist circumference values increased.
Conclusions
Our study results support the usefulness of a telehealth solution to detect deterioration of the health status during the COVID-19 pandemic.
Trial registration
The study is registered with ClinicalTrials.gov at number NCT03781401 .
Objectives
This study undertakes a scoping review of research about communication between persons with MS and their health care providers.
Design
PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database’s inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information.
Results
Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making.
Conclusion
This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes.
Practice Implications
Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.
