Telemedicine delivers quality care for Parkinson’s disease

Video conferencing with a neurologist from the homes of individuals with Parkinson’s disease was feasible and as effective as in-person care, while providing convenience and comfort to patients, according to findings published in Neurology.

“Over 40% of people with Parkinson’s disease never receive care from a neurologist, yet studies have shown that people who see a neurologist are less likely to be hospitalized with illnesses related to Parkinson’s disease, have greater independence and are less likely to die prematurely,” Ray Dorsey, MD, from the University of Rochester Medical Center in New York, said in a press release.

Virtual house calls are becoming more and more common for episodic conditions, but there is little evidence to support their use for chronic conditions, according to Dorsey and colleagues.

They conducted a 1-year randomized controlled trial to determine if virtual house calls are feasible, beneficial and valuable for patients with Parkinson’s disease. The researchers chose 195 individuals from the National Parkinson Foundation, PatientsLikeMe and the Michael J. Fox Foundation for Parkinson’s Research to participate in the trial. Participants were randomly assigned to either usual care with their primary care physician or usual care supplemented by four virtual visits with a neurologist who they have not visited before. Dorsey and colleagues measured feasibility by calculating the proportion of participants who completed at least one virtual visit and the proportion of virtual visits that were completed as scheduled, and efficacy by the 12-month change in the Parkinson’s Disease Questionnaire–39. They also assessed quality of care, caregiver burden and time and travel savings. The researchers noted that most participants (73%) had seen a specialist recently, were college-educated (73%) and white (96%).

Data showed that the intervention method was feasible, with a majority of participants in the telemedicine group (98%) completing at least one virtual visit via video conferencing from a remote specialist into their homes and 91% of all virtual visits being completed. Quality of life, quality of care and caregiver burden did not improve or worsen in participants receiving virtual house calls. A median of 88 minutes (95% CI, 70-120; P < .0001) and 38 miles per visit (95% CI, 36-56; P < .0001) were saved for each virtual house call. Satisfaction with the virtual house calls was reported by 97% of patients and 86% of neurologists. Just over half (55%) of patients favored virtual visits more than in-person visits.

“The fact that adding the virtual house calls to peoples’ care did not improve their quality of life could be because a large proportion were already seeing a specialist [73%] and were satisfied with that care [83%],” Dorsey said. “Of course, it’s also possible that virtual house calls are not enough to improve quality of life.”

“Virtual house calls for chronic diseases like Parkinson's are not only as effective as in-person care but broader adoption of this technology has the potential to expand access to patient-centered care," he added. “We now have the ability to reach anyone, anywhere but the promise and benefits of telemedicine will not be fully realized until the changes are made in Medicare policy.”

The researchers noted that distance and movement disability of patients with Parkinson’s disease are the most substantial barriers to appropriate care.

“Telemedicine is especially valuable to patients in remote, rural, and underserved areas because it gives them the ability to consult specialists they would otherwise have to travel hours to see,” Peter Schmidt, PhD, coauthor of the study and senior vice president, chief research and clinical officer of the Parkinson’s Foundation, said in a release.

Approximately two-thirds of patients with Parkinson’s disease are on Medicare; however, telemedicine visits are not covered by the program, according to the researchers.

In an accompanying editorial, David Shprecher, DO, Msci, from Banner Sun Health Research Institute and a member of the American Academy of Neurology, wrote: “Virtual house calls have the potential to dramatically increase access to care for people with such a debilitating disease. The 21st Century Cures Act mandated a report on which chronic conditions could be improved most by the expansion of telemedicine. Parkinson’s disease should be considered for this report, and it should expand the definition of telemedicine to include the virtual house call.” – by Alaina Tedesco

Disclosure: Dorsey reports serving on the medical advisory board of and having stock options in Grand Rounds. Please see full study for complete list of all other authors’ relevant financial disclosures.