In itself it is a simple office from which a major medical project is planned and coordinated. A computer, a laptop and two tablets – that’s all you need for an innovation in neurological palliative care. Of course, this is an understatement when one becomes aware of the complexity and future possibilities of telemedicine.
The Agatharied Hospital in the Upper Bavarian district of Miesbach, together with various partners, has launched a project that is unique in Germany. The declared aim of the “Tanne” project is to provide comprehensive care for seriously ill people in Bavaria. The Federal Joint Committee (GBA), the most important organ of the joint self-administration of doctors and health insurance companies, has provided a total of more than 2.1 million euros for this purpose. “Currently, many patients with neurological diseases are cared for at home or in nursing homes without specialist help being available.” This is how Christiane Weck, senior physician and co-initiator of the project, describes it. That should change now.
A telemedicine center is to be built in Agatharied, part of the 8,000-inhabitant community of Hausham. To this end – according to the plan – outpatient palliative care teams and hospices from all over Bavaria will be connected to the neurological specialist center in Agatharied. Specialists in Agatharied can advise people with severe neurological illnesses via the so-called video consultation, a mobile video system – 24 hours a day. It does not matter whether the patient is at home or in a hospice. “These are often very immobile people who cannot simply be brought to the hospital quickly,” explains neurologist Weck. The end phase of neurological diseases is often characterized by immobility due to spasticity or paralysis. In sparsely populated areas in Bavaria in particular, online advice can guarantee fast supply.
The idea goes back to Stefan Lorenzl, chief physician of neurology and palliative medicine in Agatharied. The 54-year-old looks downright enthusiastic when he talks about his ambitious project. There used to be numerous inquiries about neurological patients in the palliative phase, he says. However, they were difficult to answer by phone. “If there is no neurologist at the other end, it’s difficult to assess – seeing the patients makes it a lot easier,” says Lorenzl. The relatives are also actively involved. Since neurologically ill people often suffer from inability to speak, family members can serve as “mouthpieces”. “That is very exciting, but also challenging,” says the chief doctor.
Palliative medicine has been in a state of upheaval for years. In the past it was almost exclusively oncological clinical pictures that were of importance. Now other diseases are also increasingly included in palliative care. Nevertheless, neurological diseases still play a subordinate role. According to Lorenzl, this is due to the fact that there are still few neurologists active in the palliative field. “It’s traditionally in the hands of oncology and anesthesia,” he says. The medical study is intended to help expand the treatment of terminally ill people. “We want to show that palliative care at home for people with neurological diseases is a future project,” says Lorenzl. People should not be left alone in this phase of life.
The project has been in the clinical phase since mid-May. Two pilot phases have already been completed. A total of 15 outpatient teams and hospices are currently connected to the hospital. “We hope that through the video consultation we can get a better grip on the burden of symptoms than teams that have not yet used this method,” says Weck. To check this, the participating teams and hospices are compared to a control group that does not make use of the online counseling. Questionnaires for patients, doctors and relatives should enable a systematic comparison. The Evangelical University of Ludwigsburg is significantly involved in the scientific evaluation.
According to one employee, there is a need for clarification in relation to the patient-doctor relationship, which could be restricted by the video consultation. “If the consultations take place via video, close contact may be lost in the care,” said the spokeswoman. It is still too early for an exact result. “So far the impression has been that the patients are very satisfied.” The specialists in Agatharied have also received a positive response. “The teams are happy that they can no longer describe the problems to us, but really show them,” says Weck. The system is well received by patients, for whom transport is often an enormous burden. “People are relieved when they don’t have to come to the practice – we can clarify that via video instead.”
Not all potential participants are enthusiastic. Some also lack the capacities
According to Weck, telemedical care not only has advantages for patients, but also benefits in terms of health economics: “It avoids hospital admissions and keeps costs low,” she says. In addition, the project aims to consolidate structures. It is a “learning system”, says chief physician Lorenzl. This strengthens the neurological skills of the hospices and palliative care teams. This is also done through specially designed training courses. “There are fewer and fewer inquiries from the teams that are looked after over a longer period of time,” explains Lorenzl. That is exactly what you want to achieve. This means that significantly more teams can be involved. “We absolutely want to get more patients into palliative care,” he says.
However, not everyone is enthusiastic about the showcase project. Some outpatient teams and hospices have explicitly declined the offer. Others show interest, but currently do not have enough capacity. Even after the start of the study, some participants jumped out. This is probably due to the high level of pollution during the pandemic. In addition, weck suspects that many institutions are not necessarily “research-oriented”. In addition, you have to struggle with sound or quality problems again and again. The specialist neurologist cannot hide a hint of disappointment. “It’s difficult right now,” says Weck, “it’s starting more slowly than expected.” But that is normal, she says, “of course you are very euphoric at first.”
Stefan Lorenzl is optimistic. For him this is just the beginning. He assumes that the demand will increase after the study is completed. The long-term goal is even nationwide networking. There have already been individual inquiries from other federal states. Lorenzl hopes that other specialist areas such as dermatology or urology will also rely on telemedicine: “Medical care will change significantly in the future.”