A new study shows that a neurologist can deliver effective specialised care to people with Parkinson’s disease via telemedicine in the USA. For patients with the condition, these “virtual house calls” could allow them to live independently while effectively managing the symptoms of the disease.
“The idea that we can provide care to individuals with Parkinson’s disease regardless of where they live is both a simple and revolutionary concept,” says ) neurologist Ray Dorsey, senior author of the study, University of Rochester Medical Center (URMC), USA, which is published in the Neurology: Clinical Practice. “This study demonstrates that, by employing essentially the same technology that grandparents use to talk to their grandchildren, we can expand access to the specialised care that we know will improve patients’ quality of life and health.”
The study was supported by the Verizon Foundation, Medtronic, and the patient networking website PatientsLikeMe.
“Dorsey’s work with Parkinson’s disease patients exemplifies the type of forward-thinking, technology-driven innovation that the Verizon Foundation seeks to support,” said Anthony A Lewis, Verizon’s mid-Atlantic region vice president of state government affairs. “Technology can equalise access to quality healthcare and bring much needed services to chronically ill patients who may not otherwise receive such care because of geographic or financial reasons.”
Geography is often a determining factor in whether a person with Parkinson’s sees a specialist, it says in a press release. Neurologists with training in movement disorders like Parkinson’s disease tend to be concentrated in major academic medical centres. Additionally, the nature of the disease—particularly the impact on movement, balance, and coordination—can make a long trip to the doctor’s office unfeasible.
“We have an ample supply of neurologists in the country to take care of people with Parkinson’s, but because of distance, disability, and the distribution of doctors, many patients have a difficult time seeing a specialist,” said Dorsey.
Working with PatientsLikeMe, the study invited people with Parkinson’s who lived in the five states where Dorsey is licensed to practice medicine (California, Delaware, Florida, Maryland, and New York) to receive one free telemedicine consultation in their own home.
The participants downloaded secure web-based video conferencing software developed by California-based Vidyo. The technology, which is akin to Skype, only requires an Internet connected computer and a webcam.
Using this system, Dorsey saw more than 50 people with Parkinson’s disease, ranging from individuals who were getting a third opinion to those that were seeing a neurologist for the very first time. Virtually all of the visits resulted in treatment recommendations, including increasing exercise (86%), changes in current medications (63%), the addition of new medications (53%), and discussions about potential surgical options (10%). Patient satisfaction with the telemedicine care exceeded 90%.
While demonstrably effective, one of the key barriers to the wider adoption of this approach is the fact that Medicare does not pay for telemedicine care provided to people in their homes. Also, out-of-state physicians are not authorised to provide remote care to patients in many states.
Dorsey and his colleagues are now extending the programme with the support of the National Parkinson’s Foundation and support from the Patient Centered Outcomes Research Institute. The new study, called Connect.Parkinson, plans to enrol approximately 200 patients with Parkinson’s disease beginning next year. Participants will either receive their usual care from a physician in their community or additional remotely-delivered care from a Parkinson’s disease centre of excellence in their state.
“This research demonstrates that we can reach anyone, anywhere with a given condition,” Dorsey states. “If we can successfully remove the barriers to telemedicine, this approach will ultimately allow more patients with Parkinson’s disease to live independently in their homes, while getting the care they need.”
