Optimizing telemedical care in neurological outpatients by characterizing the patients’ needs in the physician–patient relationship—content analysis of guideline- based interviews

DOI: https://doi.org/10.1186/s12883- 021- 02329- y

Abstract-Summary The use of new concepts in patient care, such as video-consultations, reminder sys- tems, and online evaluation portals, is becoming increasingly important in the phy- sician–patient relationship and outpatient care.

The patients commented on the benefits and challenges of integrating new con-

cepts of medical care.

They identified advantages of telemedical care, including time savings (7 of 16; 43,8%) for both the patient and the physician, the prospect of more intensive (4 of 16; 25%) care, and the possibility for a quick response in case of urgent needs (3 of 16; 18.8%).

For individual neurological patients’ needs, telemedical and telecommunication structures could be discussed, which support the patients’ specific requirements, such as answering questions while having a recall (2 of 16; 12.5%) and avoiding the journey (8 of 16; 50%).

Patients are rejecting evaluation portals and are skeptical of telecare in the treat-

ment of neurological diseases.

The perception of telemedical care and the successful integration of new medical

care concepts depend on fulfilling the individual patient’s needs.

We could characterize the properties of optimal telemedical care for neurological

patients.

Extended: The use of moderators could intervene to make these portals more

trustworthy.

We can confirm this for neurological patients, too. This study shows neurological patients’ openness to this form of therapy. The needs of neurological outpatients and conclusions for optimizing clinical

pathways were identified.

Introduction/Background The risk of neurological diseases increases with the age of the patients (e.g., the prevalence of dementia [377] or Parkinson’s disease [378]).

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5 Future Directions

Limited facilities and increasing need for neurological care in an aging popula- tion with decreasing mobility in rural regions could imply a greater need for the extensive use of telemedical approaches such as expert chats, video, or telephone consultations, as has been shown before [379–381].

While socioeconomic considerations (such as reimbursement) and medicolegal aspects (such as the legal status of telemedical examinations in regularly scheduled outpatients) have prevented the widespread use of telemedicine in everyday practice previously, the COVID-19 pandemic caused the need for minimizing physical doctor- patient contact [382].

To optimize the use of a new armamentarium of digital tools affecting the doctor- patient relationship, we aimed to characterize the individual patient’s needs in a neurological setting.

Material and Methods The interviews were conducted with patients over the age of 18 years.

Before the interview began, patients had to sign an informed consent form, and

they were briefed about the objectives of the study and possible ethical concerns.

The patients were asked to share their thoughts, including expectations and con- cerns regarding the use of reminder systems, online evaluation portals, and the use of telemedicine.

Based on our research questions, the following questions were asked in the

guideline-based interviews.

Based on the data and objectives of the study, a qualitative content analysis according to Mayring’s [383] was chosen to answer the research questions with the help of the technique of inductive category formation.

For answering the first research question, all text passages in which the patient in

any way referred to reminder systems were categorized (selection criterion).

Results To structure everyday life was also mentioned as a leading positive advantage of the reminder systems (3 of 16 interviews; 18.8%).

For almost 50% of the neurological patients, no added value of the reminder systems could not be directly recognized because they note down the appointments independently or are not forgetful (ever 7 of 16 interviews; 43.8%).

For the calls, the personal form of contact was emphasized (3 of 16 interviews; 18.8%), or the fact that even a missed phone call will not be forgotten (4 of 16 inter- views; 25%), the main advantage of the text message was the possibility to read it at a convenient time for the patient (4 of 16 interviews; 25%) and that it will be read in any case (4 of 16 interviews; 25%).

Time-saving for patients (7 of 16 interviews; 43.8%) and avoiding the journey (8

of 16 interviews, 50%) were found most often.

Discussion This is one of the strengths of this study, as it shows that there is no blanket approval or rejection of telemedical care for this group of patients.

5.3

Tele-Medicine

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We should use telemedical care in such situations more often and discuss the

possibilities more openly with neurological patients.

Former studies show no deterioration of the physician–patient relationship in patients receiving telemedical care [384, 385], a fact that has to be discussed with neurological patients in advance.

This supports the thesis that neurological patients see a chance for telemedical

treatment, especially for follow-up appointments.

This study is the first to show that telemedical care can satisfy the individual

needs for both types of neurological patients.

The study shows that neurological patients with their various needs were aware

of the opportunities and possibilities of “digital medicine”.

This study shows that suitable telemedical tools exist for different needs of

patients, which determine the choice.

Conclusions We could identify different needs for a physician–patient relationship in neurologi- cal patients.

For both types of patients, there are telemedical instruments. Neurological patients seem to be sceptical about the telemedical treatment for

patients with complex (e.g., neurological) and psychiatric disorders.

There is no preferred way of getting reminded for neurological patients.

Acknowledgement A machine generated summary based on the work of Hamann, Till; Lemke, Stella; Kropp, Peter; Rimmele, Florian; Jürgens, Tim P.; Frielitz, Fabian 2021  in BMC Neurology.

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