Abstract
Background
The Covid-19 pandemic led to many consultations being conducted remotely. Cognitive impairment is recognised as a potential barrier to remote healthcare interactions and is common but heterogeneous in Parkinson’s. Little is known about these consultations in real life. We explored the experiences of remote consultations for people with Parkinson’s and cognitive impairment, investigating the perspectives of people with Parkinson’s, caregivers and healthcare professionals.
Method
Semi-structured interviews were conducted remotely (video or telephone) with 11 people with Parkinson’s and cognitive impairment, 10 family caregivers and 24 Healthcare Professionals in 2020-2021, using purposive sampling. Interviews were audio-recorded, transcribed and analysed using thematic analysis.
Results
Four themes were identified: (1) The Nature of Remote Interactions; (2) Challenges Exacerbated by Being Remote; (3) Expectation versus Reality; and (4) Optimising for the Future. Remote consultations were considered ‘transactional’ and less personal, with difficulties building rapport, and perceived to have a different role to in-person consultations. The loss of non-verbal communication and ability of Healthcare Professionals to ‘sense’ led to remote consultations being perceived as riskier by all groups. Specific to this population, issues arise from both communication and cognitive impairment; balancing of the person with Parkinson’s and caregiver voice; and around significant discussions, for example, regarding the future. Remote consultations were reported to have been more successful than anticipated in all three groups. Obstacles were not always as expected, for example age was less of a barrier than anticipated. Potential improvements for these three groups and healthcare services were identified, for example, consideration of camera positioning for video calls; and service flexibility to allow consultations to be timed to optimal medication function.
Conclusion
Advantages and challenges of remote consultations for this population are identified. Consultations could be improved with increased support, practice, preparation, awareness of issues, and more time and flexibility within services.
Comments
Remote consultation in Parkinson's patient with cognitive impair
I have been doing remote consultation on this speciality for last 24 months and have experience of around 20 patients from India 9most consultations are video consultation in presence of family member). Usually pre consultation - prescriptions, active drug list, any relevent blood test results, feedback from familty about last few months is very helpful. Cognition can be assessed by talking to family members and patients about their ability to remember recent important events. I can easily assess their transfer, gait , Tremor, slowness, body posture, voice, speech and any EDS & apthy from family. I found it useful andvhave good feedback from family.
Dr Sandip Raha
Virtual [telephone] Geriatric clinics in a busy University Hospi
During the covid-19 pandemic we had to minimise the face-to-face consultations of older people with frailty syndromes and multimorbidity. The use of telephone consultations following a structured approach with the CGA in mind, helped to deliver a reasonable clinical care, and to identify acutely unwell people living alone, isolating at home, causing the prompt referral to the emergency services [from their own GP surgery to the emergency ambulance call I made from clinic], in full communication with patients.
However, given the complex needs of the older population, patients with cognitive impairment and /or sensory loss [deafness and blindness] that precluded their full interaction with the clinician by phone and the important review of their medications. Hence, these older people cohort was not obtaining real benefits of this virtual approach. We could not do the physical examination either, key in many of the clinical conditions affecting our older population. Compounding these, were social isolation -either due to covid-19 or not having relatives or neighbours looking after their general life needs.
Therefore, the use of these "virtual" clinics should be left for non-complex adults, mainly in follow-up appointments, rather than the older people with complex multimorbidity and frailty syndromes.
Dr Carmen Martin-Marero
Video consultation
Agree that lot can be done virtually. I have been doing video consultations many years for patients in India. During the pandemic I couldn’t travel hence did more of the same.