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Virtual Housecalls for Patients With Parkinson’s?

Virtual housecalls to patients with Parkinson's disease are not only feasible and efficient, but patients appear to like them. Details from a national study tell the story here.

References:

1. Dorsey ER, George BP, Leff B, Willis AW. The coming crisis: obtaining care for the growing burden of neurodegenerative conditions. Neurology. 2013;80:1989–1996.2. Wootton R. Twenty years of telemedicine in chronic disease management--an evidence synthesis. J Telemed Telecare. 2012;18:211-220.3. Beck CA, Beran DB, Biglan KM, et al. National randomized controlled trial of virtual house calls for Parkinson disease. Neurology. 2017;12;89:1152-1161.

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Nearly half of people with Parkinson's Disease do not receive specialty care from a neurologist, which may be associated with increased morbidity, loss of independence, and premature mortality.1 Telemedicine may help, but its utility in chronic conditions has yet to be established.

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A recent literature review of 141 RCTs suggested evidence for telehealth in chronic conditions is weak and contradictory.2
 

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In a national study, 195 participants (average age 66) with PD were randomized to usual care or usual care plus 4 video conferencing visits with a remote neurologist. Feasibility outcome was considered positive if 80% of the intervention group completed at least 1 virtual visit, and 80% of virtual visits were completed as scheduled. Efficacy outcome was defined as a change in PD questionnaire-39 (assesses quality of life).
 

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• Feasibility similar to published no-show rates for in-person appointments; 98% of telemedicine group completed at least 1 virtual visit; 91% of total virtual visits completed

• No difference between telemedicine group and usual care for quality of life (p = 0.78); quality of care (p=0.79); or caregiver burden (p=0.90)

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• Change in clinical outcomes similar for telemedicine vs usual care (MDS-UPDRS, geriatric depression scale, Montreal cognitive assessment: p=0.16-0.96)

.  No difference in frequency of hospital admissions (p=0.32) or ED use (p=0.38)

• 50% of telemedicine group vs 32% of usual care group reported feeling at least “a little better” (p = 0.002)

• No deaths, harm, or safety issues identified

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• Time and distance saving: median 88 minutes and 38 miles saved for each virtual housecall vs usual care (both p< 0.0001)

• 97% of patients and 86% of physicians were satisfied or very satisfied with virtual visits

• 55% of participants preferred virtual visits vs 18% preferred in-person visits (p < 0.0001)

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Gait was assessed gait remotely, which may have technological limitations; and results may not generalize to all patients with PD.
 

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Patients could only receive care from physicians licensed in their state.
 

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“The remote delivery of specialty care to individuals with PD directly in their homes is feasible, and while their addition did not improve (or hinder) quality of life in this study, their convenience and comfort warrant further investigation and implementation. Virtual house calls address the Institute of Medicine's vision for high-quality health care and were found to be timely, efficient, and patient-centered. Future efforts must address the digital divide and policy barriers to ensure that this new care model can address inequities in access to care,” first author Christopher Beck, PhD, of University of Rochester, NY, and colleagues with the Connect Parkinson Investigators.

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