“Consults in the hospital are becoming more focused and meaningful”
“Both the prevalence and incidence of Parkinson’s are rising, partly due to an aging population, while there are not necessarily more healthcare providers; so you have to organize care in a different way.” For example, PhD student Anke Wijers of the Zuyderland Hospital summarizes the importance of the Sanacoach Parkinson succinctly. She is conducting PhD research into the effect on the quality of care and the cost-effectiveness of this digital monitoring tool.
The immediate reason to talk to her about this tool is the recently launched national implementation study of the Sanacoach Parkinson in five Dutch hospitals. The aim of the study: to map in detail the pros and cons of remote care for this condition. Wijers: “We hope to show that the Sanacoach Parkinson can improve the quality of care and at the same time significantly reduce the number of physical appointments in the hospital.”
More responsibility
The Sanacoach is aimed at ‘patient empowerment’: informing the patient well about his illness, so that he can deal with it better and manage himself more actively. “The patient’s complaints are monitored with the periodic health check. This is an extensive questionnaire that you as a patient fill in once every three months. This takes about three quarters of an hour.” The questionnaire results in a score on a Likert scale on 16 domains. Both patient and caregiver can see what is going well and what is going less, and whether something is going better or worse than before. As a healthcare provider, you can also see how, for example, a change in medication will work out. “Suppose you have started medication against hallucinations, then you can set up that you only check that aspect every week for a month to see how it is going and whether it is sufficiently effective,” says Wijers. “And if there are new or increasing complaints, the program will ask them again by default six weeks later, to see if they are permanent.” With a concrete question, practical or care-related, the patient does not have to wait until he can fill in the questionnaire again: via the program, patient and care provider can send each other a message directly. The app also has a number of knowledge modules (so-called knowledge courses) on issues such as response fluctuations, cognition and certain drugs.
Less on the poli, less costs
The project has been in development for several years now. An article appeared in 2016 in Medical Contact about what was then called MyParkinsoncoach.1 Its developer, Sananet, recently changed its name to Sanacoach Parkinson, following similar applications for other diseases, such as the Sanacoach IBD.
Wijers explains how she came into contact with the subject: “I am a neurologist in training, but I am also very interested in the organization of care. A few years ago I and five others mapped out a future strategy for the Zuyderland Hospital in a project. An important issue was how to better organize care for chronic patients. In that context, the cost-effectiveness of MijnParkinsoncoach had to be investigated. That’s what I started doing.”
A retrospective study showed that PwPs visited the outpatient clinic by 29% and that healthcare costs went down.2 Wijers: “I have now made my PhD project from an extensive prospective study in five peripheral hospitals into the Sanacoach Parkinson. We have included about 130 patients, hopefully there will be at least 250. In the course of 2025 I hope to be able to publish the results.”
Confronting Questions
Wijers is therefore unable to submit study results yet, but already has a good impression of the appreciation by healthcare providers and patients. “Consults in the hospital are becoming more focused and meaningful,” she says. “Patients come up with a specific complaint, which has often already been discussed in advance via the app; and patients who are doing well rarely or never come, instead of coming every few months as standard.” She also sees disadvantages: “The answers to the quarterly questionnaires have to be read and interpreted, often by nurses. You sometimes hear that I didn’t choose the profession for that.”
Patients are generally satisfied. “They find the contact with the hospital good and accessible. However, some find the questions too confronting. You should ask about all the possible symptoms and signs of Parkinson’s, even if someone doesn’t have them. Not everyone wants to think about that every three months. Some also find 45 minutes for the questionnaire a lot of time, although you can fill it in whenever you want.” Wijers adds: “This kind of feedback allows us to constantly think about further improvements.”
References:
- Tissingh G, Hoff J, Jie LJ, et al. Telemonitoring improves Parkinson’s care. Medical Contact. 2016;71:21.
- Wijers A, Hochstenbach L, Tissingh G. Telemonitoring via questionnaires reduces outpatient healthcare consumption in Parkinson’s disease. Mov Disord Clin Pract. 2021;8:1075-82.