Neurological Conditions Workshop

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Neurological Conditions Workshop

• Scottish Centre for Telehealth
• November 2007
• Victor Patterson

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Thanks

• Jenny Humphreys
• Josie Faulkner
• Liz Nixon
• Louis Loizou
• Colette Donaghy
• Raeburn Forbes
• Phil McMahon
• Pearl Carleton
• Ann Elliott
• Joann McCullough

• Richard Wootton
• John Craig
• Clive Russell
• Danny McArdle
• Richard Chua
• Mark Henderson
• Lord and Lady Swinfen
• Sinead Gormley
• Helen Evans
• Padhraic Conneally

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What Neurologists Do

• Acute neurological inpatients
• Neurological outpatients
• Management of chronic diseases
• New referrals

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What Neurologists Do

• Acute neurological inpatients
• Neurological outpatients
• Management of chronic diseases
• New referrals

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The Main Neurological Diseases

• Epilepsy
• Stroke
• Multiple sclerosis
• Parkinsons disease
• Alzheimers disease
• Motor Neurone disease
• Traumatic brain injury

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The Problem with Neurologists

• There arent enough of them

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What Epilepsy is

• The commonest serious neurological condition
• Affects 1 in 200 people
• Potentially life-threatening
• Socially disabling
• Patients prevented from driving
• Usually treatable

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In 500 Patients with Epilepsy

• 80 satisfied with their treatment at neurology
  clinics
• BUT
• 60 wanted to see a nurse

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The Two Dimensions of Neurological Disease
Medical
Social
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The Two Dimensions of Epilepsy
.
.
Medical
.
.
.
.
.
.
.
.
Social
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For Chronic Neurological Diseases

• Pure medical models of care are inadequate

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For Epilepsy

• Follow-up from
• A neurologist
• AND
• A nurse specialist

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Problems with Having Epilepsy and Living Rurally

• Unable to drive to urban clinic
• Not enough neurologists or specialist nurses to
  drive to you

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Can Telemedicine Help?
15
OMAGH
BELFAST
ENNISKILLEN
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Telemedicine Often Requires a Change

• From a consultant face-to-face clinic
• TO
• A nurse-led face-to-face clinic supported by a
  distant neurologist using telemedicine

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How it Works
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How Patients are Seenn 1750
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Satisfaction 1
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Satisfaction 2
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Satisfaction 3
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Sustainability
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EconomicsNeurologist Time/100 patients

• Before 39 hours
• After 7.5 hours
• 80 SAVING in consultants time

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Tele-epilepsy in Texas

• No difference in
• number of seizures
• emergency room visits
• hospital admissions
• Between
• Telemedicine and Face-to-face

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Tele-epilepsy This Way

• Effective
• Safety
• Acceptable
• Economic
• Sustainable

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Application to other Neurological Diseases

• Different multidisciplinary teams
• Different telemedicine systems
• Specialist nurse consultation by videolink
• Multidisciplinary care by videolink
• Home based videolink by broadband

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Referral Management
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Problems

• Demand outstrips supply
• Waiting times increase
• Everybody gets fed-up

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Email Telemedicine as a Possible Solution

• Bangladesh
• Finland

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Advantages of Email

• Legible
• Short and to the point
• Accessible from multiple sites
• Can add attachments
• Quick to receive
• Rapid to reply
• Low carbon footprint

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Change in What GPs Say

• from
• I am going to refer you to a neurologist.
• to
• I am going to get an opinion from a neurologist
  about you.

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How it Works

• Anonymity protocol with H C number
• Copy to secretary to put on Hospital system
• Neurologist replies and orders any investigations
• Reply put on Hospital electronic record and in
  chart

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Email System
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Effectiveness
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Is it Safe?

• 121 patients triaged to Advice or Investigations
• follow-up over 2 years

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Safety Results

• No deaths
• No major diagnosis change
• 38 re-referrals
• 3 minor changes in diagnosis

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What patients think
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What GPs think
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Quality
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Quality

• Patient-centredness
• Timeliness
• Safety
• Effectiveness
• Efficiency
• Equity

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Connections in Neurological Care

• Patient
• GP
• Neurologist
• Other professional

• Telephone
• Email
• Videolink

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Thank you