ORLANDO – Patients who had multiple sclerosis for a long time or frequently used the Internet were not as accepting of a pilot telecare program as were newer MS patients who didn’t use computers often, according to a small study.
The difference is partly due to the greater body of knowledge that patients with a longer history of MS have gained over the years, sometimes through going online frequently, said Eunme Cha, an epidemiologist at Johns Hopkins University, Baltimore. She presented her poster at the fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.
Naseem S. Miller/IMNG Medical Media
Ms. Eunme Cha
Participants reported that the program had benefits, such as helping them to keep a daily diary of their symptoms and to communicate with their physicians and nurses.
Ms. Cha and her colleagues at the Washington DC VA Medical Center recruited 20 veterans in Washington to use the Home Automated Telemanagement (HAT) system, an online tool they could access via their home computers.
"I wouldn’t say that this is going to replace the entire doctor visit," Ms. Cha said. "But they come pretty far to see the doctor. Traffic is pretty bad in D.C. Some patients travel an entire day to get to their doctor appointment, so they really liked the fact that they could get things done at home."
Mult. Scler.2012;18:472-80A few studies have shown that telemedicine programs can be helpful in the care management of patients with MS. For instance, a 2012 study of 40 patients found that "telecare is a powerful tool for monitoring MS patients at home, carries the potential to improve health care while reducing costs, and should be considered for implementation as part of the management of chronic neurological diseases" (Mult. Scler. 2012;18:472-80).
"I think telemedicine is going to grow in every field of neurology and in every field of medicine that you don’t have to have a hands-on procedure," said Dr. Robert P. Lisak, professor of neurology at Wayne State University, Detroit, and president-elect of the Consortium of Multiple Sclerosis Centers (CMSC). He was not involved in the study.
But there are challenges to overcome. For example, physicians need to be licensed in every state where they are going to be using telemedicine, Dr. Lisak said in an interview. "But if the politics and the economics can be solved, this is very helpful for people and hospitals that are underserved by subspecialists, and even specialists."
For the pilot study, the research staff visited the patients’ homes, provided them with a link to the MS HAT program, and trained them on the system.
"We asked the patients to log in every day and enter "my diary" so that they can report their symptoms on a daily basis," said Ms. Cha. "And then physicians and nurses can log in to the clinician site and see what the patient has put in. Also, patients can put in questions to doctors and nurses. So we try to facilitate communication between patients and physicians."
The 20 veterans (mean age, 54 years) included 14 men and 12 African Americans. They had MS for a mean of 15 years. Sixteen patients said they used a computer at home, and the same number reported using the Internet daily. The patients had a mean Expanded Disability Scale Score (EDSS) of 5.3. Their MS subtypes included secondary progressive (11 patients), relapsing-remitting (6), and primary progressive (3).
A linear regression analysis showed that the length of time patients had MS, how often patients used a computer at home, and English proficiency were all significant predictors of how well the patients accepted the MS HAT program. Meanwhile, race, age, and years of education had no significant relationship with acceptance of the telecare program.
Patients also reported back the benefits of the program, their concerns, and their suggestions. Some said that they liked the ability to report their symptoms right away, keep track of their symptoms, and refresh their memory. They reported concerns with the length of the daily questionnaire and sometimes the redundancy of the content.
Ms. Cha and her colleagues said that "tailoring this technology to patient needs and preferences may improve its acceptance by veterans in MS."
The team is now looking into conducting a clinical trial, comparing a traditional patient group with those who use the telemedicine program, to see if there are any differences in clinical outcomes and patients’ disease management.
Ms. Cha had no disclosures. Dr. Lisak has received research grants from and has been an advisor for several companies, including Avanir, Bayer, Novartis, Questcor, and Teva.