Experiences of remote consulting for patients and neurologists during the COVID-19 pandemic in Scotland

BackgroundRemote consulting is an emerging model in managing chronic neurological conditions and has been widely implemented during the COVID-19 pandemic. The objective of this national survey was to investigate the initial experiences of remote consulting for neurologists and patients with established neurological conditions under follow-up during the first COVID-19 phase.MethodsIn collaboration with the Scottish Association of Neurological Sciences and the Neurological Alliance of Scotland, we conducted a web-based survey of neurologists and patients between October and November 2020.FindingsData was available for 62 neurologists and 201 patients. The consensus among neurologists was that remote consulting is a satisfactory way of delivering healthcare in selected groups of patients. For practical and technical reasons, there was preference for phone over video consultations (phone 63% vs video 33%, p=0.003). The prevailing opinion among clinicians was that considerable training interventions for remote consultation skills are required (‘yes’ 63% vs ‘no’ 37%, p=0.009) to improve clinician consultation skills and successfully embed this new model of care.Most patients perceived remote consultations as safe, effective and convenient, with 89% of patients being satisfied with their remote consultation experience. Although traditional face-to-face consultations were the favoured way of interaction for 62% of patients, a significant proportion preferred that some of their future consultations be remote.InterpretationAlthough not a replacement for face-to-face consultations, this survey illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations for doctors and patients. More research is required to identify overall safety and applicability.

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Patient and clinician satisfaction with video consultations during the COVID-19 pandemic: an opportunity for a new way of working

Journal of Orthodontics ◽

10.1177/1465312520973677 ◽

2020 ◽

pp. 146531252097367

Author(s):

Emer Byrne ◽

Simon Watkinson

Keyword(s):

Teaching Hospital ◽

Service Evaluation ◽

Remote Consultation ◽

Cross Sectional ◽

Face To Face ◽

Level Of Satisfaction ◽

The Future ◽

Clinician Satisfaction ◽

High Level ◽

Remote Consultations

Objective: To assess satisfaction of patients and clinicians with virtual appointments using Attend Anywhere for their orthodontic consultation and to identify any areas where the technology could be further utilised. Design: Service evaluation involving descriptive cross-sectional questionnaire. Setting: Orthodontic Departments at Royal Blackburn Teaching Hospital and Burnley General Teaching Hospital. Participants: Patients and clinicians involved in video consultations. Methods: Patient- and clinician-specific questionnaires were designed and those involved in virtual clinics were invited to complete these at the end of their consultation. The questionnaires focused on setting up and connecting to the virtual clinic, assessing if the correct types of patients were involved in the clinics and satisfaction with these types of remote consultations. Results: A total of 121 questionnaires (59 patient and 62 clinician) were completed. Of the patients, 93% found the instructions provided to access the consultation easy to follow and 70% of clinicians did not report any connection issues. In 90% of cases, a virtual appointment was seen to be appropriate by the clinician. Respondents showed a high level of satisfaction with 76% of patients saying a remote consultation was more convenient than face-to-face, and 66% reporting they would, if appropriate, like more appointments like this in the future. Conclusion: The overall satisfaction among patients with virtual clinics introduced during the COVID-19 pandemic was generally high. The majority of patients would, where appropriate, prefer more virtual appointments in the future in comparison to face-to-face appointments and it was found to be more convenient for the patient.

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Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

Health Technology Assessment ◽

10.3310/hta21040 ◽

2017 ◽

Vol 21 (4) ◽

pp. 1-62 ◽

Cited By ~ 12

Author(s):

Paul Little ◽

Beth Stuart ◽

FD Richard Hobbs ◽

Jo Kelly ◽

Emily R Smith ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Weight Reduction ◽

Cost Effective ◽

Health Technology ◽

Control Group ◽

Random Numbers ◽

Web Based ◽

Face To Face

BackgroundBehavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.ObjectivesTo estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice.DesignIndividually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.SettingPrimary care general practices in the UK.ParticipantsPatients with a body mass index of ≥ 30 kg/m2(or ≥ 28 kg/m2with risk factors) identified from general practice records, recruited by postal invitation.InterventionsPositive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls).Main outcome measuresThe primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months.ResultsA total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control,n = 227; POWeR+F,n = 221; POWeR+R,n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg;p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg;p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51;p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74;p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI –£129 to £195) for POWeR+F and –£25 (95% CI –£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+.Study limitationsMaintenance of weight loss after 1 year is unknown.Future workIdentifying strategies for longer-term engagement, impact in community settings and increasing physical activity.ConclusionClinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective.Trial registrationCurrent Controlled Trials ISRCTN21244703.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.

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Comparing Rheumatology Consultation Patterns Across Telehealth Platforms and Face-to-Face Clinic in the Military Health System

Military Medicine ◽

10.1093/milmed/usab531 ◽

2021 ◽

Author(s):

Michael F Loncharich ◽

David F Desena ◽

Angelique N Collamer ◽

Jess D Edison

Keyword(s):

Health System ◽

Inflammatory Arthritis ◽

Military Health System ◽

Military Health ◽

Web Based ◽

Face To Face ◽

Medical Evacuation ◽

Antibody Positivity ◽

The Military

ABSTRACT Objective To compare patterns of rheumatology consultations and outcomes across four different platforms in the Military Health System (MHS): face-to-face, synchronous telehealth, and two asynchronous telehealth platforms. Methods We conducted a retrospective review comparing face-to-face rheumatology consults during 2019 with teleconsultations from three virtual systems in the MHS: an asynchronous email-based system from May 2006 to Feb 2018, a web-based platform from 2014 to 2018, and synchronous telehealth consults from March 2020 to March 2021. Consults were reviewed for diagnosis, and if medical evacuation was required for consults originating OCONUS or if face-to-face follow-up was required for synchronous teleconsults. Diagnoses of interest included inflammatory arthritis, noninflammatory arthritis, crystalline arthritis, myositis, lupus, vasculitis, fibromyalgia, antibody positivity without diagnosis, symptoms without specified diagnosis, and a composite of other rheumatic diseases. Results Leading diagnoses across platforms were inflammatory arthritis, noninflammatory arthritis, and a composite of other diagnoses. Consultation modality influenced the type of cases seen. Inflammatory arthritis accounted for significantly more consults in the synchronous telehealth (38.4%) and email-based (40.9%) models than in the web-based (23.7%) and face-to-face (32.0%) models. The composite of other diagnoses was the leading diagnosis for the asynchronous web-based model (32.9%), which was significantly more than the synchronous telehealth and face-to-face consults. Synchronous models saw significantly more cases of crystalline arthritis, vasculitis, and fibromyalgia. Email-based consultations resulted in medical evacuation in 25 cases and prevented evacuation in 5. Web-based consultations prompted medical evacuation in 100 cases. In the synchronous model, face-to-face follow-up was recommended in 142 (15%) cases. Conclusions Modality of consultation influences the type of cases seen. Both synchronous and asynchronous telerheumatology models were able to answer the consult question without referral for face-to-face evaluation in 79.9-85.0% of consults, suggesting teleconsultation is a viable method to increase access to high-quality rheumatology care.

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The Impact of the COVID-19 Lockdown on Weight Loss and Body Composition in Subjects with Overweight and Obesity Participating in a Nationwide Weight-Loss Program: Impact of a Remote Consultation Follow-Up—The CO-RNPC Study

Nutrients ◽

10.3390/nu13072152 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2152

Author(s):

Sébastien Bailly ◽

Odile Fabre ◽

Rémy Legrand ◽

Laurent Pantagis ◽

Monique Mendelson ◽

...

Keyword(s):

Weight Loss ◽

Body Composition ◽

Overweight And Obesity ◽

Weight Loss Program ◽

Dose Effect ◽

Remote Consultation ◽

Consultation Group ◽

The Impact ◽

Remote Consultations

The aim of this study was to assess the impact of the nationwide total lockdown (LD) in France on weight loss and body composition modifications in subjects participating in a weight loss program and to evaluate the impact of remote consultations on participants’ adherence to the weight loss program. The CO-RNPC study was a prospective multicentre cohort study including participants undergoing a two to six months program. The rate of weight loss in kg/week was computed before (15 days), during (99 days) and after LD (15 days). In the 1550 completing participants, body weight decreased from 87.1 kg [IQR 77.0; 100.2] to 82.3 kg [72.1; 94.3] resulting in a difference of −4.79 kg [−4.48; −5.10] (p < 0.01), with a corresponding reduction in waist circumference by 4 cm ([0; 9], p < 0.01). The median weight loss was 4.4 kg [0.5; 9.4] in those who used remote consultations, and 1.4 kg [0.8; 5.7] in the no remote consultation group (p < 0.01). In this large prospective cohort, we observed that the rate of weight loss was reduced during LD. This reduction was counterbalanced in participants involved in a remote consultation follow-up with a dose-effect response based on the number of remote consultations.

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P070 Tele-consultations from the patient’s perspective: during the pandemic and beyond

Rheumatology ◽

10.1093/rheumatology/keab247.068 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Natasha Cleaton ◽

Sabrina Raizada

Keyword(s):

Older Patients ◽

Significant Proportion ◽

Clinical Excellence ◽

Vulnerable Groups ◽

British Society ◽

Younger Patients ◽

Telephone Consultation ◽

Face To Face ◽

Increased Risk

Abstract Background/Aims The current COVID-19 pandemic has challenged healthcare systems worldwide stimulating a transformation of NHS services to cope with increased acute demand, while aiming to minimise viral transmission. A significant proportion of rheumatology patients are considered ‘clinically extremely vulnerable’ and are at increased risk of COVID-19. With this in mind, alongside national guidance from the British Society for Rheumatology and the National Institute of Clinical Excellence we adapted our services in response to COVID by mostly suspending face-to-face appointments for follow up patients, instead relying on telephone or virtual consultations with a face-to-face appointment if necessary in order to minimise risk to our patients. We aimed to evaluate our use of telephone consultations during the pandemic and gain understanding of our patients views of telephone consultations longer term. Methods We retrospectively surveyed rheumatology patients under active follow-up at the royal Wolverhampton trust who had a telephone consultation with a rheumatology consultant over a 4-week period (11/5/20- 4/6/20). Patients were invited to participate via a SMS text message containing an embedded web-link to the survey. Results were analysed using SPSS version 26. Results Surveys were sent to 1,213 patients; 306 (25.2%) patients completed the survey. Responders were mostly female; the predominant diagnosis was inflammatory arthritis. Ages included: 1 (0.3%) patient 16-29 years, 46 (15.0%) 30-49, 180 (58.8%) 50-69, and 79 (25.8%) aged >70 years. Regarding their telephone consultation, 86.6% of responders were satisfied with the consultation. During the current pandemic 81.4% of responders were pleased to have a telephone consult rather than face-to-face; 57.2% of responders would be happy for their next routine appointment to be a telephone clinic. A significantly higher proportion of patients <50 years preferred telephone consultations when compared to older patients (Chi2 [DF = 3]= 10.075, P = 0.018) and more younger patients had access to a smartphone than those in the older cohort (Chi2 [DF 3]= 20.919, P = <0.001). Conclusion Overall, the short-term switch to telephone consultation was well received by our cohort. The majority of patients were satisfied with their telephone consultation and most were pleased to have a telephone consult rather than a face-to-face appointment in the current pandemic. Just over half would be happy for their next routine appointment to be a telephone consultation, however, a significantly higher proportion of younger patients prefer telephone consultations compared to older patients and a greater number of younger patients have access to a smartphone compared to older patients. Further planning is required to ensure patients in older and other vulnerable groups are not excluded should telephone clinics become a more permanent fixture. Disclosure N. Cleaton: None. S. Raizada: None.

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Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic

Journal of Medical Internet Research ◽

10.2196/19232 ◽

2021 ◽

Vol 23 (9) ◽

pp. e19232

Author(s):

Sarah Damery ◽

Janet Jones ◽

Elaine O'Connell Francischetto ◽

Kate Jolly ◽

Richard Lilford ◽

...

Keyword(s):

Patient Satisfaction ◽

Liver Transplant ◽

Usual Care ◽

Real Time ◽

Process Evaluation ◽

Face To Face ◽

Transplant Patients ◽

Qualitative Process Evaluation ◽

Remote Consultations

Background Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. Objective This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. Methods Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. Results Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that—according to patients—remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. Conclusions Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. Trial Registration ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2953-4

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Survey of CAMHS clinicians about their experience of remote consultation: brief report

BJPsych Open ◽

10.1192/bjo.2020.160 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Anupam Bhardwaj ◽

Anna Moore ◽

Rudolf N. Cardinal ◽

Carol Bradley ◽

Lauren Cross ◽

...

Keyword(s):

Mental Health ◽

National Health Service ◽

Mental Health Services ◽

Health Service ◽

Health Services ◽

Remote Consultation ◽

Face To Face ◽

Remote Consultations ◽

Safe Care ◽

Roll Out

The Covid-19 crisis necessitated rapid adoption of remote consultations across National Health Service (NHS) child and adolescent mental health services (CAMHS). This study aimed to understand practitioners’ experiences of rapid implementation of remote consultations across CAMHS in one NHS trust in the east of England. Data were collected through a brief questionnaire documenting clinicians’ experiences following remote delivery of services. The questionnaire began before ‘lockdown’ and focused on assessment consultations (n = 102) as part of a planned move to virtual assessment. As the roll-out of remote consultations was extended at lockdown, we extended the questionnaire to include all remote clinical contacts (n = 202). Despite high levels of initial concern, clinicians’ reports were positive overall; importantly, however, their experiences varied by team. When restrictions on face-to-face working are lifted, a blended approach of remote and face-to-face service delivery is recommended to optimise access and capacity while retaining effective and safe care.

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The effectiveness of e-learning in patient education delivered to patients with rheumatoid arthritis: The WebRA study—protocol for a pragmatic randomised controlled trial

BMC Rheumatology ◽

10.1186/s41927-021-00226-y ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Line Raunsbæk Knudsen ◽

Kirsten Lomborg ◽

Mwidimi Ndosi ◽

Ellen-Margrethe Hauge ◽

Annette de Thurah

Keyword(s):

Rheumatoid Arthritis ◽

Statistical Analysis ◽

Patient Education ◽

Controlled Trial ◽

Self Management ◽

Web Based ◽

Face To Face ◽

E Learning ◽

Randomised Controlled

Abstract Background Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Change is taking place in the organisation of healthcare systems because of a demographic shift towards ageing populations, an increasing use of technology and advancements in digital technologies, allowing for new interventions. This study will aim to evaluate the effectiveness of a newly developed e-learning patient education programme based on self-management that targets patients with rheumatoid arthritis. Methods A pragmatic multi-centre randomised controlled trial is planned. We intend to recruit approximately 200 patients with a new diagnosis (< 3 months) of rheumatoid arthritis. Participants will be randomised 1:1 to web-based patient education delivered through an e-learning programme at home or standard face-to-face patient education provided at the hospital. The primary outcome is self-efficacy. Secondary outcomes are improved knowledge of rheumatoid arthritis, adherence to medication, health literacy level and quality of life. Outcomes will be measured at baseline and follow-up occurring 1, 3, 6 and 12 months after enrolment. Furthermore, data on healthcare utilisation and utilisation of the e-learning programme will be assessed at the 12-month follow-up. Statistical analysis, including differences between groups, will be evaluated using the chi-square and Kruskal–Wallis tests. Statistical analysis will follow the intention-to-treat principle, and analysis of variance will be used to evaluate the within- and between-groups differences testing the hypothesis of the ‘superiority’ of web-based patient education over standard face-to-face education provided at the hospital. Per protocol analysis will be used to assess the impact of missing data. Enrolment started in February 2021 and will end in June 2022. Discussion The study is expected to contribute to the evidence on the effectiveness of web-based patient education within rheumatic diseases. If the e-learning programme is effective, it will be incorporated into existing services to improve the self-management of patients with rheumatoid arthritis. Further, this mode of providing patient education may impact the organisation of health care for both rheumatic diseases and other chronic diseases by offering different modes of delivering patient education based on the needs and preferences of patients. Trial registration: ClinicalTrials.gov identifier NCT04669340. Registered on November 27, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04669340?term=e-learning&cond=Rheumatoid+Arthritis&draw=2&rank=1. See Additional file 1 for detailed information on the dataset according to the World Health Organization Trial Registration Data Set.

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Telenutrition in oncology: A novel model of care in a geographically diverse network.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.43 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 43-43 ◽

Cited By ~ 1

Author(s):

Michele Leigh Szafranski ◽

Beth York ◽

Tara Eaton ◽

Wendy G. Brick ◽

Chasse Margot Bailey-Dorton

Keyword(s):

Telephone Counseling ◽

Healthcare Team ◽

Care Providers ◽

Registered Dietitians ◽

Model Of Care ◽

Nutritional Interventions ◽

Face To Face ◽

Novel Model ◽

Patient Barriers

43 Background: Telehealth is growing as a way for qualified providers to reach patients closer to home. Dietitians have been using telephone counseling to support cancer patients for years, but recently consults via videoconference have emerged to better duplicate in office, face-to-face service. Telenutritionallows Registered Dietitians (RDs)who are also Certified Oncology Specialists in Nutrition (CSOs) to provide patients consults at their regular medical oncologist’s office. As part of its goal to provide expert care to oncology patients in regional settings, genetics counselors, social workers, and Palliative Care providers at Levine Cancer Institute (LCI) are currently using a telehealth model to provide services traditionally available only in metro areas. Methods: RDs located within the LCI Network receive consults from regional sites in NC based on established criteria. LCI RDs use Vidyo to teleconference between LCI locations to meet with patients, caregivers, and the healthcare team to establish an appropriate plan of care. Appointments are scheduled directly on the virtual schedule by the referring office. Consents are signed and scanned into the chart. Assessment is completed using the same protocol and policy as face-to-face consults, and follow up can conducted via teleconference or phone, based on patient preference and the clinical judgement of the RD. Patient satisfaction surveys are completed at the end of each telenutritionsession and sent to the RD. Results: LCI initially started telenutritionwith one regional site in 2014, completing 3 consults with one RD housed at its main location. In 2015, three additional sites were added, as well as an additional RD housed regionally, and 22 consults were completed. 22 consults have been completed year to date in 2016. Conclusions: Early feedback from patients and providers suggest telenutrition may be an effective method to deliver quality nutritional interventions to patients in the comfort of their regular oncology office. Formal study is needed to explore patient barriers to care, reimbursement for services, expense of equipment, and feasibility of program expansion.

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e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study (Preprint)

10.2196/preprints.30652 ◽

2021 ◽

Author(s):

Miharu Nakanishi ◽

Syudo Yamasaki ◽

Kaori Endo ◽

Junko Niimura ◽

Canan Ziylan ◽

...

Keyword(s):

Neuropsychiatric Symptoms ◽

Psychosocial Interventions ◽

Control Group ◽

Web Based ◽

Face To Face ◽

Training Course ◽

People With Dementia ◽

Quasi Experimental ◽

E Learning

BACKGROUND Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. OBJECTIVE The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. METHODS A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. RESULTS A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (χ21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=–0.61, P=.69). CONCLUSIONS The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated.

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