+
+

Idiopathic Parkinson’s disease (PD) is a neurodegenerative disorder for which medications and surgical interventions can often greatly ameliorate symptoms and lead to improved quality of life. Despite the fact that specialized care is required in most PD cases, approximately 40% of patients with PD will never see a neurologist, likely in part due to difficulty with specialist access outside of large metropolitan centers. Telemedicine visits have increased in popularity for a variety of medical conditions, but outside of stroke they have been explored only on a limited basis for neurologic conditions. Beck and colleagues (2017) aimed to see if PD patients could expand their access to specialists and have their care improved by using telemedicine.

+

The authors conducted a randomized trial of 195 patients with PD. During the 12-month trial, patients were randomized to usual care or usual care plus the addition of 4 virtual visits with a PD specialist. These virtual visits included PD-specific examinations and recommendations for medication changes and other interventions. The primary outcomes involved both feasibility (the proportion of patients who completed the virtual visits) and efficacy (as measured by a PD quality of life scale).

+

The patients in the trial were largely Caucasian (96%), typically had a college level of education (73%), and had an average age of 66 years. Nearly three-quarters had seen a PD specialist in the year prior to randomization.

+

A total of 98% of the patients completed at least one virtual visit, and 91% of the total scheduled visits were completed. The number of visits to the local in-person clinician was similar in the two groups. There was no significant difference in overall quality-of-life improvements between the intervention and the usual care groups. Compared with usual care, the telemedicine visits saved patients time (median, 88 min per visit) and travel (median, 38 miles round trip per visit). Changes in caregiver burden were no different between the two groups.

+

Clinical outcomes were not significantly different between the two groups using a variety of measures, including frequency of emergency department and hospital visits. However, the patient self-reported global impression of change was significantly better in those randomized to the telemedicine intervention (p = .002). Participants had a high (97%) satisfaction with the virtual visits, and those in the intervention group preferred these virtual visits to in-person ones (p<.0001).

+

This well-done trial is one of the first to examine telehealth visits in a chronic neurologic condition. The results demonstrate that remote care can be delivered in PD with outcomes at least equivalent to care delivered in person. A large portion of these participants were already seeing a PD specialist, and therefore the goal of determining feasibility for a group of patients without access to neurologists was not met; perhaps the group would have demonstrated a more robust clinical response to the intervention if they were patients without PD specialist access. In addition, the large proportion of educated, likely computer-savvy participants emphasizes that these types of remote interventions could widen some disparities in care that already exist in those patients with less education or lower socioeconomic status. These issues will need to be explored in future telehealth trials of chronic neurologic disorders.

Reference +
+
Beck  CA  et al.: National randomized controlled trial of virtual house calls for Parkinson disease. Neurology, 2017
[PubMed: 28814455]