The COVID-19 pandemic and neurology: A survey on previous and continued restrictions for clinical practice, curricular training, and health economics.

COVID-19 brain health curricular training health economics lockdown period neurological care

Journal

European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311

Informations de publication

Date de publication:
01 Dec 2023
Historique:
revised: 03 11 2023
received: 01 10 2023
accepted: 14 11 2023
pubmed: 1 12 2023
medline: 1 12 2023
entrez: 1 12 2023
Statut: aheadofprint

Résumé

The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023. An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects. We collected 430 responses from 79 countries. Most health care professionals were aged 35-44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues. Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE
The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023.
METHODS METHODS
An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects.
RESULTS RESULTS
We collected 430 responses from 79 countries. Most health care professionals were aged 35-44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues.
CONCLUSIONS CONCLUSIONS
Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.

Identifiants

pubmed: 38038262
doi: 10.1111/ene.16168
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

Références

Akhvlediani T, Jelcic I, Taba P, Pfausler B, Steiner I, Sellner J. What did we learn from the previous coronavirus epidemics and what can we do better: a neuroinfectiological point of view. Eur J Neurol. 2020;27(11):e69-e72.
Cavallieri F, Sellner J, Zedde M, Moro E. Neurologic complications of coronavirus and other respiratory viral infections. Handb Clin Neurol. 2022;189:331-358.
WHO Coronavirus Dashboard [Internet]. 2023. Accessed August 30, 2023. https://covid19.who.int/
Kaye AD, Okeagu CN, Pham AD, et al. Economic impact of COVID-19 pandemic on healthcare facilities and systems: international perspectives. Best Pract Res Clin Anaesthesiol. 2021;35(3):293-306.
Okeagu CN, Reed DS, Sun L, et al. Principles of supply chain management in the time of crisis. Best Pract Res Clin Anaesthesiol. 2021;35(3):369-376.
Gupta V, Santosh KC, Arora R, Ciano T, Kalid KS, Mohan S. Socioeconomic impact due to COVID-19: an empirical assessment. Inf Process Manag. 2022;59(2):102810.
Boro E, Stoll B. Barriers to COVID-19 health products in low-and middle-income countries during the COVID-19 pandemic: a rapid systematic review and evidence synthesis. Front Public Health. 2022;10:928065.
Magesh S, John D, Li WT, et al. Disparities in COVID-19 outcomes by race, ethnicity, and socioeconomic status: a systematic-review and meta-analysis. JAMA Netw Open. 2021;4(11):e2134147.
Rozenfeld Y, Beam J, Maier H, et al. A model of disparities: risk factors associated with COVID-19 infection. Int J Equity Health. 2020;19(1):126.
Ramchandani R, Kazatchkine M, Liu J, et al. Vaccines, therapeutics, and diagnostics for covid-19: redesigning systems to improve pandemic response. BMJ. 2021;375:e067488.
Batista C, Hotez P, Amor YB, et al. The silent and dangerous inequity around access to COVID-19 testing: a call to action. EClinicalMedicine. 2022;43:101230.
Sellner J, Jenkins TM, von Oertzen TJ, et al. A plea for equitable global access to COVID-19 diagnostics, vaccination and therapy: the NeuroCOVID-19 Task Force of the European Academy of Neurology. Eur J Neurol. 2021;28(11):3849-3855.
Sellner J, Jenkins TM, von Oertzen TJ, et al. Primary prevention of COVID-19: advocacy for vaccination from a neurological perspective. Eur J Neurol. 2021;28(10):3226-3229.
Helbok R, Chou SH, Beghi E, et al. NeuroCOVID: it's time to join forces globally. Lancet Neurol. 2020;19(10):805-806.
Tatar M, Shoorekchali JM, Faraji MR, Seyyedkolaee MA, Pagan JA, Wilson FA. COVID-19 vaccine inequality: a global perspective. J Glob Health. 2022;12:03072.
Moro E, Priori A, Beghi E, et al. The international European Academy of Neurology survey on neurological symptoms in patients with COVID-19 infection. Eur J Neurol. 2020;27(9):1727-1737.
Fanciulli A, Leys F, Krbot Skoric M, et al. Impact of the COVID-19 pandemic on clinical autonomic practice in Europe: a survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS). Eur J Neurol. 2023;30:1712-1726.
Romoli M, Jelcic I, Bernard-Valnet R, et al. A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details. Eur J Neurol. 2020;27(9):1712-1726.
Frontera JA, Tamborska AA, Doheim MF, et al. Neurological events reported after COVID-19 vaccines: an analysis of VAERS. Ann Neurol. 2022;91(6):756-771.
Triki CC, Leonardi M, Mallouli SZ, et al. Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations. J Neurol. 2022;269(1):26-38.
Pena-Bautista C, Alvarez-Sanchez L, Ferrer-Cairols I, Garcia-Valles L, Baquero M, Chafer-Pericas C. Assessment of COVID-19 lockdown effect on early Alzheimer disease progression. J Neurol. 2023;270:4585-4592.
de Marchi F, Gallo C, Sarnelli MF, et al. Accelerated early progression of amyotrophic lateral sclerosis over the COVID-19 pandemic. Brain Sci. 2021;11(10):1291.
Blakemore RL, Pascoe MJ, Horne KL, et al. Higher perceived stress and exacerbated motor symptoms in Parkinson's disease during the COVID-19 lockdown in New Zealand. N Z Med J. 2021;134(1538):44-51.
Bova SM, Basso M, Bianchi MF, et al. Impact of COVID-19 lockdown in children with neurological disorders in Italy. Disabil Health J. 2021;14(2):101053.
Lester A, Leach P, Zaben M. The impact of the COVID-19 pandemic on traumatic brain injury management: lessons learned over the first year. World Neurosurg. 2021;156:28-32.
Kristoffersen ES, Jahr SH, Faiz KW, Thommessen B, Ronning OM. Stroke admission rates before, during and after the first phase of the COVID-19 pandemic. Neurol Sci. 2021;42(3):791-798.
Rose S. Medical student education in the time of COVID-19. JAMA. 2020;323(21):2131-2132.
Stamelou M, Struhal W, Ten Cate O, et al. Evaluation of the 2020 European Academy of Neurology virtual congress: transition from a face-to-face to a virtual meeting. Eur J Neurol. 2021;28(8):2523-2532.
Niznick N, Lun R, Gotfrit R, et al. Resident match during the COVID pandemic: how have neurology programs adapted?-a survey. Can J Neurol Sci. 2023;50(2):249-256.
Apple R, O'Brien EC, Daraiseh NM, et al. Gender and intention to leave healthcare during the COVID-19 pandemic among U.S. healthcare workers: a cross sectional analysis of the HERO registry. PLoS One. 2023;18(6):e0287428.
de Vries N, Boone A, Godderis L, et al. The race to retain healthcare workers: a systematic review on factors that impact retention of nurses and physicians in hospitals. Inquiry. 2023;60:9580231159318.
Hill CE, Reynolds EL, Burke JF, et al. Increasing out-of-pocket costs for neurologic care for privately insured patients. Neurology. 2021;96(3):e322-e332.
Sen-Crowe B, McKenney M, Elkbuli A. Medication shortages during the COVID-19 pandemic: saving more than COVID lives. Am J Emerg Med. 2021;45:557-559.
Willems LM, Balcik Y, Noda AH, et al. SARS-CoV-2-related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: a German single-center experience. Epilepsy Behav. 2020;112:107483.
Spalletta G, Porcari DE, Banaj N, Ciullo V, Palmer K. Effects of COVID-19 infection control measures on appointment cancelation in an Italian outpatient memory clinic. Front Psychiatry. 2020;11:599844.
Priori A, Baisi A, Banderali G, et al. The many faces of Covid-19 at a glance: a university hospital multidisciplinary account from Milan, Italy. Front Public Health. 2020;8:575029.
Bodini B, Moro E, Jaarsma J, et al. Lessons learned from people with neurological diseases at the time of COVID-19: the EFNA-EAN survey. Eur J Neurol. 2022;29(1):318-323.
Mogharab V, Ostovar M, Ruszkowski J, et al. Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses. Global Health. 2022;18(1):58.
Smith M, Vaughan Sarrazin M, Wang X, et al. Risk from delayed or missed care and non-COVID-19 outcomes for older patients with chronic conditions during the pandemic. J Am Geriatr Soc. 2022;70(5):1314-1324.
Rainero I, Bruni AC, Marra C, et al. The impact of COVID-19 quarantine on patients with dementia and family caregivers: a nation-wide survey. Front Aging Neurosci. 2020;12:625781.
Bao X, Xu J, Meng Q, et al. Impact of the COVID-19 pandemic and lockdown on anxiety, depression and nursing burden of caregivers in Alzheimer's disease, dementia with Lewy bodies and mild cognitive impairment in China: a 1-year follow-up study. Front Psychiatry. 2022;13:921535.
Cagnin A, di Lorenzo R, Marra C, et al. Behavioral and psychological effects of coronavirus disease-19 quarantine in patients with dementia. Front Psychiatry. 2020;11:578015.
Millan M, Nagel S, Gumbinger C, et al. Differential effects of the SARS-CoV-2 pandemic on patients presenting to a neurological emergency room depending on their triage score in an area with low COVID-19 incidence. Eur J Neurol. 2021;28(10):3332-3338.
Bres Bullrich M, Fridman S, Mandzia JL, et al. COVID-19: stroke admissions, emergency department visits, and prevention clinic referrals. Can J Neurol Sci. 2020;47(5):693-696.
Welton J, Stratton G, Schoeninger B, Low MH, Moody A, D'Souza W. Shortages of antiseizure medications in Australia and the association with patient switching, and adherence in a community setting. Epilepsy Behav. 2023;141:109145.
Kaiser DPO, Abdalkader M, Berberich A, Sporns PB, Nguyen TN. Acute shortage of iodinated contrast media: implications and guidance for neurovascular imaging and intervention. Neuroradiology. 2022;64(9):1715-1718.
Ni Ainle F, Middeldorp S, Le Gal G, Hunt BJ. Protecting patients during a shortage of thrombolytic agents. Lancet. 2022;400(10359):1193-1194.
The Lancet Regional Health-Western Pacific. Where are the drugs? The scarcity of medications in the Western Pacific. Lancet Reg Health West Pac. 2023;31:100728.
Phuong JM, Penm J, Chaar B, Oldfield LD, Moles R. The impacts of medication shortages on patient outcomes: a scoping review. PLoS One. 2019;14(5):e0215837.
Bourneau-Martin D, Babin M, Grandvuillemin A, et al. Adverse drug reaction related to drug shortage: a retrospective study on the French National Pharmacovigilance Database. Br J Clin Pharmacol. 2023;89(3):1080-1088.
Bassetti CLA, Endres M, Sander A, et al. The European Academy of Neurology Brain Health Strategy: one brain, one life, one approach. Eur J Neurol. 2022;29(9):2559-2566.
Vallo Hult H, Master Ostlund C, Palsson P, Jood K. Designing for digital transformation of residency education-a post-pandemic pedagogical response. BMC Med Educ. 2023;23(1):421.
Struhal W, Sellner J, EAYNT. European teaching course on autonomic nervous system disorders: reaching out to young physicians. Clin Auton Res. 2009;19(2):130.
Cuffaro L, Carvalho V, di Liberto G, et al. Neurology training and research in the COVID-19 pandemic: a survey of the Resident and Research Fellow Section of the European Academy of Neurology. Eur J Neurol. 2021;28(10):3437-3442.
Ercoli T, Barbato F, Bombaci A, et al. Neurological consequences of COVID-19: a systematic review of the pandemic's impact on neurology training. Brain Sci. 2023;13(8):1188.
Simulescu L, Meijer M, Vodusek DB. With the support of the BioMed Alliance CMEEPCr. Continuing medical education (CME) in time of crisis: how medical societies face challenges and adapt to provide unbiased CME. J Eur CME. 2022;11(1):2035950.

Auteurs

Martin Rakusa (M)

Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia.

Elena Moro (E)

Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, INSERM U1216, Grenoble Alpes University, Grenoble, France.

Tamar Akhvlediani (T)

Neolab Clinic, Tbilisi, Georgia.

Daniel Bereczki (D)

Department of Neurology, Semmelweis University, Budapest, Hungary.

Benedetta Bodini (B)

Neurology Department, St. Antoine Hospital, APHP, Paris, France.
Paris Brain Institute, ICM, CNRS, INSERM, Sorbonne Université, Paris, France.

Francesco Cavallieri (F)

Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

Alessandra Fanciulli (A)

Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

Saša R Filipović (SR)

Institute for Medical Research, University of Belgrade, Belgrade, Serbia.

Alla Guekht (A)

Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
Pirogov Russian National Research Medical University, Moscow, Russian Federation.

Raimund Helbok (R)

Department of Neurology, Johannes Kepler University, Linz, Austria.

Sonja Hochmeister (S)

Department of Neurology, Medical University of Graz, Austria.

Filippo Martinelli Boneschi (F)

Neurology Unit, ASST Santi Paolo e Carlo, Milan, Italy.
Department of Health Sciences, University of Milan, Milan, Italy.

Serefnur Özturk (S)

Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey.

Alberto Priori (A)

Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy.
Clinical Neurology Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo and Department of Health Sciences, University of Milan, Milan, Italy.

Michele Romoli (M)

Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy.

Barbara Willekens (B)

Department of Neurology, Antwerp University Hospital, Edegem, Belgium.
Translational Neurosciences Research Group, University of Antwerp, Wilrijk, Belgium.

Marialuisa Zedde (M)

Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy.

Johann Sellner (J)

Department of Neurology, Landesklinkum Mistelbach-Gänserndorf, Mistelbach, Austria.

Classifications MeSH