Encuesta nacional de telemedicina para neurólogos durante la pandemia del covid-19 en Colombia / National telemedicine survey for neurologists during the COVID-19 pandemic in Colombia

RESUMEN INTRODUCCIÓN: Durante la pandemia de covid-19, la telemedicina, inicialmente vista como inadecuada, ahora se muestra como una de las respuestas durante este tiempo exigente en la medicina. OBJETIVO: El objetivo de este estudio es evaluar el impacto de la atención médica en neurología con la telemedicina durante la pandemia del covid-19 en Colombia. MATERIALES Y MÉTODOS: Se realizó un estudio observacional descriptivo. La información fue obtenida a través de una encuesta anónima dirigida a neurólogos que laboraran en Colombia. RESULTADOS: Se obtuvieron 120 encuestas diligenciadas; 70 (58%) fueron del género femenino. La carga laboral por la atención médica a través de la telemedicina se percibió aumentada en 70 (58.3%) de los encuestados. 76 (63,9%) de los encuestados piensa que la telemedicina es una herramienta que se debería seguir utilizando en la práctica diaria de la neurología, pero con mejoras. Las enfermedades neuromusculares, desmielinizantes y trastornos de movimiento no se consideraron una buena opción para evaluar por telemedicina. Por otro lado, la epilepsia y la demencia se consideraron una buena opción para evaluar por primera vez. DISCUSIÓN: 76 (64%) de los encuestados está de acuerdo en que la telemedicina debe continuar después de la pandemia, pero deben realizarse mejoras para una atención de mejor calidad. Se recomienda realizar nuevos estudios para evaluar de forma sistemática la precisión de la teleneurología en comparación con las consultas en persona. CONCLUSIONES: La telemedicina es una herramienta útil en la práctica neurológica pero requiere mejoras en el proceso para aumentar su eficacia, seguridad y calidad.

SUMMARY INTRODUCTION: During the COVID-19 pandemic, telemedicine, initially viewed as inadequate, can now be considered as one of the solutions during this demanding time in medicine. OBJECTIVES: The main objective of this study is to evaluate the impact of medical attention in neurology with telemedicine during the COVID-19 pandemic. MATERIALS AND METHODS: This is an observational descriptive study. Data was obtained by an anonymous survey aimed at working Neurologists in Colombia. RESULTS: Of the 120 questionnaires collected, 70 (58%) were answered by women. The data shows that 70 (58.3%) of participating doctors in this study perceived their patient workload volume increased. Data collected reveals seventy-six (63,9%) of the doctors in this study felt that outpatient telemedicine, with some improvements, can continue to be a useful tool in the daily practice of Neurology. Neuromuscular and demyelinating diseases, and movement disorders were not considered a good option to assess via telemedicine. However, Epilepsy and Dementia were considered a good option for first-time evaluation. DISCUSSION: 76 (64%) of the doctors agreed the practice of telemedicine should continue, even when the pandemic is no longer a factor, however, improvements should be made for a better quality of attention. Additional studies are required to evaluate accuracy of teleneurology in comparison to face-to-face outpatient consultation. CONCLUSION: Telemedicine is a useful tool in Neurology outpatient evaluation, but improvement is needed to assure quality and safety.

Telemedicine in neurology: current evidence / Telemedicina na neurologia: evidências atuais

ABSTRACT Background: Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. Objective: This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. Methods: A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed. Results: Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. Conclusion: Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.

RESUMO Introdução: A telemedicina surge pela primeira vez na neurologia como uma ferramenta para facilitar o acesso ao tratamento do acidente vascular cerebral (AVC) Agudo. Mais recentemente, inúmeras evidências têm surgido acerca da eficácia e da segurança do uso da telemedicina em várias outras áreas da neurologia. Com o advento da pandemia de COVID-19 e a necessidade de isolamento social, as autoridades brasileiras flexibilizaram a regulamentação da telemedicina, permitindo assim que inúmeros pacientes com doenças neurológicas possam ter acesso ao tratamento, com menor risco de exposição à contaminação pelo SARS-CoV-2. Objetivo: O objetivo deste artigo foi avaliar criticamente as evidências correntes acerca da segurança e eficácia do uso da telemedicina em diversas áreas da neurologia. Métodos: Este artigo foi uma revisão de artigos indexados no PubMed, buscando os termos telemedicina, cefaleias, esclerose múltipla, doenças vestibulares, doenças cerebrovasculares, epilepsia, doenças neuromusculares, demência e desordens do movimento. Os artigos mais relevantes em cada uma das áreas foram criticamente analisados. Resultados: Diversos artigos foram identificados e analisados em todas as áreas anteriormente citadas. Os principais achados quanto às contribuições da telemedicina, para o diagnóstico e tratamento das condições, foram apresentados, indicando potenciais benefícios da telemedicina em todas as áreas buscadas. Conclusão: As evidências atuais indicam que a teleneurologia é uma potencial ferramenta para ampliar o acesso ao cuidado em inúmeras áreas da neurologia.

Telesalud Y Telemedicina Para El Manejo De La Epilepsia / Telehealth And Telemedicine For The Management Of Epilepsy

Resumen Introducción: La epilepsia es una de las enfermedades neurológicas crónicas más frecuente, con cifras cercanas a los 70 millones de casos a nivel mundial; para la cual la telesalud y la telemedicina se enmarcan como modelos prometedores que pueden traer múltiples beneficios. Objetivo: Evaluar los esquemas iniciales que se han planteado desde la telemedicina y la telesalud en el manejo del paciente con epilepsia y los beneficios que tienen en el manejo. Metodología: Se realizó una búsqueda de literatura científica en (PubMed, Cochrane library y LILACS). Se presentan diferentes modelos de telesalud y telemedicina implementados en el manejo del paciente con epilepsia y se describen los principales beneficios en terminos de aceptabilidad, costos y resultados clínicos. Conclusiones: La investigación actual de estos modelos de atención para el manejo del paciente con epilepsia tiene el potencial de reducir de forma efectiva la brecha de diagnóstico y tratamiento, con posibilidad de reducir los costos en la atención tanto para las instituciones, el sistema de salud, los pacientes y sus familias e integrar de forma armónica la educación en el autocontrol de la enfermedad, demostrando que existe una necesidad de un enfoque más personalizado para estimular el uso de estas herramientas.

Abstract Introduction: Epilepsy is one of the most frequent chronic neurological diseases, with figures close to 70 million cases worldwide; for which telehealth and telemedicine are framed as promising models that can bring multiple benefits. Objective: To evaluate the initial schemes that have been proposed from telemedicine and telehealth in the management of the patient with epilepsy and the benefits that they have in the management. Methods: A search of scientific literature was carried out in (PubMed, Cochrane library and LILACS). Different models of telehealth and telemedicine implemented in the management of patients with epilepsy are presented and the main benefits in terms of acceptability, costs and clinical results are described. Conclusions: Current research of these models of care for the management of patients with epilepsy has the potential to effectively reduce the diagnostic and treatment gap, with the possibility of reducing costs in care for the institutions, the health system, patients and their families and harmoniously integrate with education in the self-control of the disease. Proving that there is a need for a more personalized approach to stimulate the use of these tools