Innovating Care in Multiple Sclerosis: Feasibility of Synchronous Internet-Based Teleconsultation for Longitudinal Clinical Monitoring.

Nima Sadeghi,Corinne Cuvelier,Piet Eelen,Marie B D’Hooghe,Miguel D’Haeseleer,Katinka Van Gils,Jeroen Van Schependom,Guy Nagels

doi:10.3390/jpm12030433

Abstract

The ‘coronavirus disease of 2019’ crisis has recently forced an expedited adoption of teleconsultation (TC) in most medical domains. Short-term digital interventions have generally been associated with feasibility, clinical benefits, user satisfaction, and cost-effectiveness in patients with multiple sclerosis (MS) but outcomes after repeated utilization over extended periods need to be further evaluated. In this feasibility study, 60 subjects with MS were 1:1 randomized to receive standard care augmented by four TCs using an audiovisual Internet platform (intervention) versus standard care alone (controls), over a period of 12 months. Effects on functional status, medical costs, and satisfaction were explored as secondary outcomes. Eighty-nine out of 108 scheduled TCs (82.4%) were completed, and 26 patients could complete at least one TC (86.7%), meeting our prespecified feasibility target of 80%. The intervention did not lead to significant differences in functional status (with the potential exception of fatigue) nor medical costs. Most interventional patients declared themselves to be (very) satisfied about the quality of care and technical aspects associated with the TCs. Our results demonstrate that longitudinal clinical monitoring using real-time audiovisual TC over the Internet is feasible and well-received by patients with MS. Such an approach can be a promising new care strategy.

Highlights

We present the first ever study, to our knowledge, demonstrating the feasibility of synchronous TC using an audiovisual Internet platform, when repeatedly applied for the clinical monitoring of individuals with multiple sclerosis (MS) over a substantial time period
The appraisal of general care, technical quality, and convenience, as related to the digital visits, was excellent in the majority of patients and healthcare providers involved in the interventional arm
These results are in line with a recent and designed trial among subjects with Parkinson disease—representing another frequently occurring chronic disorder of the central nervous system—living throughout the United States of America, in which 98% of the 97 participants randomized to the intervention group completed at least one digital visit, and 91% of the 388 planned digital visits were completed as scheduled

Summary

Introduction

Modern society, including the way we practice medicine, has been shaped by the technological progress inherited from the three industrial revolutions that have taken place since the mid-eighteenth century. Telemedicine (TM)—sometimes referred to as e-health or digital medicine—can be defined as the exchange of medical information between patients and healthcare providers, who are in separate locations, by means of electronic communication technology [1]. In 2020, digital medicine has undergone an expedited adoption, as the ‘coronavirus disease of 2019’ (COVID-19) rapidly evolved into a global crisis, for which unprecedented social isolation and mobility restrictions have been installed as key measures of constrain [6,7], with teleconsultation (TC) becoming an essential escape scenario for a vast proportion of our health system [8–10]

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