by Health Editorial Staff
The results of the survey conducted by Sin and Aism. Remote visits are used in almost half of the centers but structural barriers remain which hinder their diffusion
If anyone still has doubts about the usefulness of telemedicine, they should take a look at the data from a new survey concerning multiple sclerosis centers in Italy: in almost half (45%) of these, televisit has in fact become a tool has now entered daily clinical practice. With a good level of satisfaction from patients (67%), but also from doctors.
The survey, launched in May 2023, involved 66 centers that manage the treatment of approximately 50% of people with MS in Italy, and investigated, through the compilation of a questionnaire administered electronically, both the current experience of neurologists’ use of televisit tools and the barriers, incentive factors and professionals’ perspectives regarding the diffusion of this modality of care delivery also with the aim of improving adherence and proximity of access. These are indications clearly expressed by the PDTA (Diagnostic Therapeutic Care Paths) for MS created by Agenas.
A journey that began during the Covid pandemic
The results of the State of the art survey and prospects for telemedicine in the management of patients with Multiple Sclerosis promoted by the Italian Society of Neurology (Sin), the Italian Multiple Sclerosis Association (Aism) and Biogen, in collaboration with ILHM-Unict (Advanced Study Center in Innovation, Leadership and Health Management) and with the contribution of Professor Valeria Tozzi of Cergas of SDA Bocconi, were presented today in Rome.
The aim of the survey, carried out as part of the broader EcoSM project on a sample of multiple sclerosis centers that manage half of the people with MS in Italy, is to photograph the current situation regarding the use and impact of televisits, which today it represents the most concrete experience of telemedicine tested in neurology, with a group of early adopters who, starting from the pandemic emergency, continue to use these tools and who today can therefore share indications and lessons learned.
Where the journey was started
The innovative path towards the adoption of televisits has started, but mainly in the Neurology Units operating in hospitals, university hospitals and IRCCS. The data collected highlights that today the innovation process is well underway, with 45% of those interviewed already using televisit tools with a good level of patient satisfaction (67%). Useful data to improve adherence and proximity to access to care for approximately 137,000 people in Italy living with this complex neurological disease. Numbers which, according to the most well-known innovation diffusion models, fall within a threshold value, beyond which the innovation process finds itself at a crossroads and therefore requires a change of pace for real and broad consolidation.
Follow-up and monitoring the phases of greatest use of televisiting
The adoption of televisit practices for the treatment of MS has not only represented a contingent response to the Covid emergency, but the Centers are continuing to experiment with the usefulness of this path even after the pandemic. Follow-up and monitoring are confirmed as the phases of the patient journey with the greatest use of televisits. According to the respondents’ opinion, all MS treatment and follow-up activities can be provided remotely with the exception of diagnosis (follow-up visits, anamnestic visits, evaluation of laboratory or instrumental analyses, post-therapy monitoring and follow-up visits). psychological support). The worsening of the patient’s condition (EDSS degree – Disability Scale) does not change the attitude of doctors who have already begun to experiment with the usefulness of tele-visits even for the most serious cases, especially in follow-up activities and monitoring over time (they represent approximately 63% of cases of tele-visits provided to people in an advanced stage of illness)
The snapshot taken by the investigation clearly shows us that we are at a crucial moment in which we must act. The data collected show that televisiting has now reached a good level of use in the care and monitoring paths of people with multiple sclerosis, but structural barriers remain that hinder its uniform and consolidated diffusion – stated Claudio Gasperini, coordinator of the Research Group MS study of the Italian Society of Neurology—. Today’s meeting is an important opportunity to involve institutions and decision-makers so that the conditions are created for a full structural integration of telemedicine in the management of multiple sclerosis, in line with the PDTA for MS published by Agenas and achieved thanks to collaboration of the MS Working Group (GLaSM). A practice that can facilitate the clinician’s work to the benefit of the patient. Not only that – adds Gasperini – the use of telemedicine in MS, in consideration of the characteristics of this highly complex chronic neurological disease, can also represent an extensible pilot model applicable to other multi-system or chronic diseases.
What are the barriers to adopting telemedicine
Almost all (87%) of the centers involved in the survey that declared not to use telemedicine indicated the absence of adequate operating conditions as a barrier to its use. The majority of respondents believe that the lack of a specific form of financing for television (40%), the lack of adequate technological equipment or the necessary connectivity (60%) are important barriers to the use of this technology. Among the conditions necessary for the effective provision of telemedicine, the following are confirmed: the preliminary contact activities of the patient (considered relevant by 87% of the sample), the advance sending of reports and tests (73%), the technical conditions of provision of the televisit in terms of audio and image quality (87%), the acquisition of patient consent (90%), the presence of a caregiver (77%).
Access to e-health and new digital tools – comments Mario Alberto Battaglia, general director of Aism and president of Fism – falls within the mission lines defined in the Aism 2025 Agenda for Multiple Sclerosis and Related Pathologies, where we highlight the importance of working on the development of interdisciplinary and person-centred care pathways. E-health, from this point of view, can improve the care and quality of life of patients and their families and the photograph that was presented today is an important starting point for starting the organizational and management interventions necessary to overcome the infrastructural and regulatory barriers that hinder the consolidated, systematic and uniform use of telemedicine across the entire national territory. In particular, – specifies Battaglia – we hope for interventions in the codification and pricing of television visits in the Regions; in the development of common protocols to be integrated into the PDTA, as well as a training plan for operators, people with MS and caregivers.
Collective commitment
A collective commitment, therefore, that which doctors and patients called for at today’s meeting, which also involves the world of industry as an active participant in a collective commitment to support the innovative process. The EcoSM project (Digital ecosystem of assistance and monitoring of patients with Multiple Sclerosis) started in February 2020 with a first pilot phase and then merged into a second phase at national level, represents an example of public-private partnership in support of innovation. The first phase of the project took place between February 2020 and June 2021, thanks to the collaboration between SIN, Biogen and AiSDeT (Italian Association of Digital Health and Telemedicine), and involved the Multiple Sclerosis Center of the Policlinico G Rodolico-San University Hospital Marco of Catania.
The objective of this first pilot phase was to make an analysis of the current process of taking care of the person with MS (“as is” phase) and then propose a new care path (“to be” phase) which includes the use of telemedicine and e-health tools. The work carried out led to the publication of a Feasibility Manual, which develops a feasibility analysis at a technical, economic and cultural level for the telemedicine monitoring of people with MS. The manual describes the strategic reasons, organizational methods, technological infrastructures and costs relating to the implementation of telemedicine in the management of this complex neurological disease.
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November 28, 2023 (modified November 28, 2023 | 4:54 pm)
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