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Initiation of Levod...
Initiation of Levodopa-Carbidopa Intestinal Gel Infusion Using Telemedicine (Video Communication System) Facilitates Efficient and Well-Accepted Home Titration in Patients with Advanced Parkinson's Disease
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- Willows, Thomas (author)
- Karolinska Univ Hosp, Dept Neurol, S-14186 Stockholm, Sweden.,Karolinska University Hospital, Sweden
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- Dizdar Segrell, Nil (author)
- Linköpings universitet,Avdelningen för neuro- och inflammationsvetenskap,Medicinska fakulteten,Region Östergötland, Neurologiska kliniken i Linköping
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- Nyholm, Dag (author)
- Uppsala universitet,Neurologi,Uppsala University, Sweden
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- Widner, Hakan (author)
- Skane Univ Hosp, Dept Neurol, Lund, Sweden.,Skåne University Hospital, Sweden
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- Grenholm, Peter (author)
- Uppsala universitet,Neurologi,Uppsala University, Sweden
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- Schmiauke, Ursula (author)
- Linköpings universitet,Institutionen för klinisk och experimentell medicin,Medicinska fakulteten,Region Östergötland, Neurologiska kliniken i Linköping
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- Urbom, Anna (author)
- AbbVie AB, Solna, Sweden.
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- Groth, Kristina (author)
- Karolinska Univ Hosp, Innovat Ctr, Stockholm, Sweden.;Karolinska Inst, Clintec, Stockholm, Sweden.,Karolinska University Hospital, Sweden; Karolinska Institute, Sweden
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- Larsson, Jorgen (author)
- Karolinska Univ Hosp, Innovat Ctr, Stockholm, Sweden.;Karolinska Inst, Clintec, Stockholm, Sweden.,Karolinska University Hospital, Sweden; Karolinska Institute, Sweden
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- Permert, Johan (author)
- Karolinska Univ Hosp, Innovat Ctr, Stockholm, Sweden.;Karolinska Inst, Clintec, Stockholm, Sweden.,Karolinska University Hospital, Sweden; Karolinska Institute, Sweden
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- Kjellander, Susanna (author)
- AbbVie AB, Solna, Sweden.
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Karolinska Univ Hosp, Dept Neurol, S-14186 Stockholm, Sweden Karolinska University Hospital, Sweden (creator_code:org_t)
- IOS PRESS, 2017
- 2017
- English.
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In: Journal of Parkinson's Disease. - : IOS PRESS. - 1877-7171 .- 1877-718X. ; 7:4, s. 719-728
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Abstract
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- Background: Levodopa-carbidopa intestinal gel (LCIG; Duodopa r) is used for continuous infusion in advanced Parkinson's disease. To achieve optimal effect, the LCIG dose is individually titrated, traditionally conducted during hospitalization in Sweden. However, dose adjustment depends on surrounding conditions, physical activity, and emotional stress, which is why titration at home could be beneficial. Telemedicine (TM) using a video communication system offers alternative titration procedures, allowing LCIG initiation at home. Objective: Study objectives were to show the feasibility of TM for LCIG home titration, evaluate resource use, and assess patient, neurologist, and nurse satisfaction. Methods: Four clinics enrolled 15 patients to observe efficiency and feasibility of TM-based monitoring. Results: Patient median (range) age was 67 (52-73) years and time since diagnosis was 10 (7-23) years. Median time between LCIG initiation and end of TM-assisted titration was 2.8 (2.0-13.8) days. Median time required for home titration by neurologists, nurses, and patients was (hours: minutes) 1 : 14 (0 : 29-1 : 52), 5 : 49 (2 : 46-10 : 3), and 8 : 53 (4 : 11-14 : 11), respectively. Neurologists and nurses considered this to be less time than required for hospital titration. TM allowed patients 92% free time from start to end of titration. Technical problems associated with TM contacts were rare, mostly related to digital link, and quickly resolved. Patients, neurologists, and nurses were satisfied using TM. No serious adverse events were reported; there was one device complaint (tube occlusion). Conclusions: In this study, TM-assisted LCIG titration at home was resource-efficient, technically feasible, well-accepted and was deemed satisfactory by patients, neurologists, and nurses.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Omvårdnad (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Nursing (hsv//eng)
Keyword
- Advanced Parkinson's disease
- levodopa-carbidopa intestinal gel
- LCIG
- duodenal levodopa-carbidopa infusion
- Duodopa
- telemedicine
- video communication system
- home titration
- routine patient care
- healthcare resource utilization
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Willows, Thomas
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Dizdar Segrell, ...
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Nyholm, Dag
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Widner, Hakan
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Grenholm, Peter
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Schmiauke, Ursul ...
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show more...
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Urbom, Anna
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Groth, Kristina
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Larsson, Jorgen
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Permert, Johan
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Kjellander, Susa ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Neurology
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Health Sciences
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and Nursing
- Articles in the publication
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Journal of Parki ...
- By the university
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Uppsala University
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Karolinska Institutet
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Linköping University