For patients with Parkinson disease (PD), access to care may be limited by distance, disability, and distribution of physicians. It is estimated that 40% of Medicare beneficiaries with PD have not seen a neurologist.
It is known that access to neurological care is associated with improved outcomes for patients with PD. Medicare beneficiaries with PD who do not see a neurologist are 14% more likely to fracture a hip, 21% more likely to be placed in a skilled nursing facility, and 22% more likely to die. In addition, patients with PD who are treated by a PD specialist are 3 times more likely to be satisfied with their care compared with those seeing a general neurologist.
Communications technologies, including the use of simple web-based video assessments such as Skype, can be utilized to compensate for geographic barriers to PD care. Clinical assessments made using web-based technologies have been shown to be reliable. In addition, several telemedicine models have, according to researchers, “demonstrated value or promise in neurology.” However, the feasibility and possible benefits of providing care directly in patient’s homes, virtual house calls, are unclear.
Researchers recently conducted a 7-month, 2-center, randomized controlled trial to assess the feasibility, effectiveness, and economic benefits of using telemedicine to provide specialty care to patients with PD in their homes. They reported trial results in JAMA Neurology [2013;70(5):565-570].
The study setting was patients’ homes and outpatient clinics at 2 academic medical centers. The study cohort included 20 patients with PD who had access to the Internet at home. They were randomly assigned to telemedicine (n=9) or in-person care (n=11). The 2 groups were similar in terms of demographic and clinical characteristics at baseline.
The primary outcome variable was feasibility, measured by the percentage of telemedicine visits completed as scheduled. Secondary outcome measures were clinical benefit (measured by the 39-item Parkinson’s Disease Questionnaire [PDQ-39]), and economic value (measured by time and travel).
There were 27 scheduled telemedicine visits during the study period from September 30, 2011, through January 24, 2012. Of those, 25 (93%) were completed. The 2 missed visits were due to inadequate Internet signal associated with a specialist using a new site. In addition, 1 visit had poor audio quality requiring the patient to use the telephone for voice communication.
There were 33 scheduled in-person visits, of which 30 (91%) were completed. The 3 missed visits were due to a work conflict, a desire to minimize travel, and a car accident on the way to a visit.
There was no difference in quality of life between the 2 groups as measured by the PDQ-39 (4.0-point improvement in the telemedicine group vs 6.4-point improvement in the in-person visit group). On average, each telemedicine visit saved participants 100 miles of travel and 3 hours of time.
In summary, the researchers commented, “Using web-based video conferencing to provide specialty care at home is feasible, provides value to patients, and may offer similar clinical benefits to that of in-person care. Larger studies are needed to determine whether the clinical benefits are indeed comparable to those of in-person care and whether the results observed are generalizable.”