‘Virtual’ House Calls for Parkinson’s Patients Effective
Monday, March 11, 2013
A study out today in the journal JAMA Neurology shows that telemedicine check-ups for people with Parkinson’s disease can not only provide effective care but also generate a significant economic benefit. These ‘virtual’ visits with physicians – in which the patient participates from the comfort of their own home – demonstrate that quality specialized care can be effectively delivered to individuals in remote locations.
“This study shows that providing specialty care to people with Parkinson’s disease directly into their homes is feasible, saves patients substantial time and travel, and may offer comparable clinical benefits to in-person care,” said University of Rochester Medical Center neurologist Kevin Biglan, M.D., M.P.H., the senior author of the study.
One of the major challenges in providing care to Parkinson’s patients is geography. The multifaceted nature of the disease with its complex combination of behavioral, cognitive, and physical symptoms often demands that patients receive care from a physician who focuses on treating neurological disorders. In fact, studies have shown that access to specialized neurological care improves outcomes. For example, Medicare beneficiaries with Parkinson’s who do NOT see a neurologist are 14 percent more likely to fracture a hip, 21 percent more likely to be placed in a nursing home, and 22 percent more likely to die. Parkinson’s patients who see a neurologist are also three times more likely to be satisfied with their care.
However, specialists who treat movement disorders such as Parkinson’s tend to be found at larger medical centers. Individuals with the disease who live in rural or underserved areas are less likely to have access to a neurologist nearby. Furthermore, the nature of the disease – particularly the impact on muscle control and coordination – can make it difficult to travel long distances to see a specialist.
The study recruited 20 patients from upstate New York and Maryland who were seen by Biglan and E. Ray Dorsey, M.D., M.B.A. with Johns Hopkins University, respectively. Over the next seven months, half of the patients received in-person care, meaning they visited the doctor’s office for their check-ups. The other half of the participants received care in their homes using a secure internet video technology akin to Skype.
While video-based evaluations can have limitations, the researchers have found that Parkinson’s disease is an ideal candidate for telemedicine. “Parkinson’s is a very visual disease,” said Biglan. “You don’t necessarily have to physically touch patients to understand how they are doing.”
At the end of the seven months, the researchers measured the patients' perception of their quality of life and the level of care they were receiving. They found that the patients who received virtual house calls did as well as those who received in-person care.
The researchers also measure the economic value of allowing individuals to receive care in their own homes. They found that the average telemedicine visit lasted 53 minutes from beginning to end. In contrast, patients who received in-person care spent an average of 255 minutes per visit when factoring in the trip to and from the doctor’s office for a total of 100 miles and 3 hours of travel time over the seven months duration of the study.
While the study demonstrates the potential of providing care to remote patients with chronic conditions such as Parkinson’s, the researchers point out that barriers to the widespread adoption of this model exist. Specifically, licensing and reimbursement requirements make it difficult – if not impossible – to provide care across state lines and for physicians to be reimbursed for telemedicine-based care provided to patients in their homes.
“While policy changes will be necessary to fully implement this model of care, this study shows that quality in-home care is feasible,” said Biglan.
Additional co-authors include Matthew Grana, Micheal Bull, Benjamin George, Christopher Beck, Balaraman Rajan, and Abraham Seidmann with the University of Rochester, and Vinayak Venkataraman and Cynthia Boyd with Johns Hopkins University. The study was supported by grants from Google and Excellus BlueCross BlueShield.