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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

Willows, Thomas; Dizdar, Nil; Nyholm, Dag; Widner, Håkan LU ; Grenholm, Peter; Schmiauke, Ursula; Urbom, Anna; Groth, Kristina; Larsson, Jörgen and Permert, Johan, et al. (2017) In Journal of Parkinson's Disease 7(4). p.719-728
Abstract

Background: Levodopa-carbidopa intestinal gel (LCIG; Duodopa®) 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... (More)

Background: Levodopa-carbidopa intestinal gel (LCIG; Duodopa®) 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.

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publication status
published
subject
keywords
Advanced Parkinson's disease, duodenal levodopa-carbidopa infusion, Duodopa, healthcare resource utilization, home titration, LCIG, levodopa-carbidopa intestinal gel, routine patient care, telemedicine, video communication system
in
Journal of Parkinson's Disease
volume
7
issue
4
pages
10 pages
publisher
IOS Press
external identifiers
  • scopus:85032832773
ISSN
1877-7171
DOI
10.3233/JPD-161048
language
English
LU publication?
no
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d2550390-e411-49ec-926a-a93b54fcb8d8
date added to LUP
2017-12-01 12:39:25
date last changed
2018-01-07 12:27:07
@article{d2550390-e411-49ec-926a-a93b54fcb8d8,
  abstract     = {<p>Background: Levodopa-carbidopa intestinal gel (LCIG; Duodopa®) 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.</p>},
  author       = {Willows, Thomas and Dizdar, Nil and Nyholm, Dag and Widner, Håkan and Grenholm, Peter and Schmiauke, Ursula and Urbom, Anna and Groth, Kristina and Larsson, Jörgen and Permert, Johan and Kjellander, Susanna},
  issn         = {1877-7171},
  keyword      = {Advanced Parkinson's disease,duodenal levodopa-carbidopa infusion,Duodopa,healthcare resource utilization,home titration,LCIG,levodopa-carbidopa intestinal gel,routine patient care,telemedicine,video communication system},
  language     = {eng},
  number       = {4},
  pages        = {719--728},
  publisher    = {IOS Press},
  series       = {Journal of Parkinson's Disease},
  title        = {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},
  url          = {http://dx.doi.org/10.3233/JPD-161048},
  volume       = {7},
  year         = {2017},
}