New findings from a nationwide program that links neurologists with patients with Parkinson's disease in their homes via video conferencing shows that telemedicine can successfully deliver quality care. The study, which appears today in the journal Neurology, points to a new way to improve care for people who suffer from the disease, but may have not have access to a neurologist.
"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," said Ray Dorsey, M.D., the David M. Levy Professor of Neurology at the University of Rochester Medical Center (URMC) and lead author of the study. "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."
"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," said Peter Schmidt, Ph.D., Senior Vice President, Chief Research and Clinical Officer of the Parkinson's Foundation. "The Parkinson's Foundation aims to narrow these gaps in Parkinson's care, which is why we are working with experts from URMC, a Parkinson's Foundation Center of Excellence."
The results in the paper come from the Connect.Parkinson project, a research study funded by the federal Patient-Centered Outcome Research Institute. Connect.Parkinson is led by URMC in collaboration with the Parkinson's Foundation and with additional support from PatientsLikeMe, the Michael J. Fox Foundation for Parkinson's Research, SBR Health, Vidyo, and IDSolutions. The study is the first national randomized controlled clinical trial of telemedicine for Parkinson's disease.
It is estimated that 40 percent of people who have Parkinson's disease do not see a neurologist soon after diagnosis. This places them at significantly greater risk of falls leading to hip fractures, ending up in a nursing home or hospital, and even death. This challenge of providing care to these individuals will become ever greater as the population ages--it is projected that the number of people with Parkinson's disease will double by 2030.
The most significant barriers to appropriate care for Parkinson's patients are distance and disability. Most movement disorder specialists are located in academic medical centers in large urban areas. Most patients live in suburban and rural areas, have impaired mobility and driving ability, and are faced with the challenge of making frequent trips to the doctor's office - a task that becomes more difficult as the disease progresses.
The goal of the Connect.Parkinson study was to see if telemedicine would allow neurologists to deliver care to patients in the comfort of their homes. A total of 195 individuals with Parkinson's from across the U.S. were selected to participate in the study. Participants either received care through their primary care physician or had that care supplemented with up to four visits via video conference with the neurologist they had not seen before.
Parkinson's disease particularly lends itself to telemedicine because many aspects of the diagnosis and treatment of the disease are "visual" - meaning that the interaction with the doctor primarily consists of listening to the patient and observing them perform certain tasks such as holding their hands out or walking.
The researchers found that the telemedicine visits were as effective as in-person visits in the doctor's office, with the quality of life reported by the participants as no better or worse for people who received care in their homes compared with those who received standard care. The virtual house calls also saved patients an average of 169 minutes and nearly 100 miles of travel per visit.
While the current study is one of several that have demonstrated the potential benefits of telemedicine, widespread adoption of this technology is hindered by federal healthcare policies. Approximately two-thirds of Parkinson's patients are on Medicare. However, the program does not reimburse for in-home telemedicine care. Legislation has been introduced in Congress to allow Medicare to expand reimbursement for telemedicine.
"We can shop, bank, make travel reservations, take classes, and buy groceries via the internet from the comfort of our own homes, but too many patients still cannot access health care," said Dorsey. "Telemedicine is an option if you are a veteran, a member of the Armed Services, a Medicaid beneficiary, or a Canadian, but not if you have a chronic condition and are a Medicare beneficiary."
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Additional co-authors of the study researchers from URMC, the Parkinson's Foundation, Simone Consulting, Johns Hopkins School of Medicine, the University of Pennsylvania Perelman School of Medicine, the University of California San Francisco, Northwest Neurology, Oregon Health and Science University, Baylor College of Medicine, Augusta University, Duke Medical Center, Massachusetts General Hospital, Struther's Parkinson's Center, Beth Israel Deaconess Medical Center, the University of Miami, Northwestern University, the Feinstein Institute of Medical Research, the Medical University of South Carolina, the University of Kansas Medical Center, the Parkinson's Institute, the Mayo Clinic, the University of California Berkeley, the Karolinska Institute in Sweden, and PatientsLikeMe. The study was funded with support from the Patient-Centered Outcome Research Institute.
Journal
Neurology