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Science News

“Virtual” Office Visits Save Travel and Time for People with Parkinson’s Disease

People living with Parkinson’s disease may benefit from a consultation with a specialist via online video conferencing from home, providing an alternative to traveling to an in-person appointment. These findings appear in a study funded in part by PDF and were published on March 11 in JAMA Neurology.

People with Parkinson’s disease receive the best care with regular visits to a movement disorders specialist. But for those who live far from an academic medical center, such visits can involve significant travel time, expense and discomfort.

This study is one of the first to investigate whether “virtual house calls" to the homes of people with PD, also known as telemedicine, are feasible and beneficial. Investigators led by E. Ray Dorsey, M.D., M.B.A., at Johns Hopkins Medicine, recruited 20 participants who were receiving regular outpatient care for PD at either Johns Hopkins or the University of Rochester, New York.  On average, participants were about 65 years old, and had moderately advanced PD; more than 70 percent were men, almost all were white, and all had experience using the Internet and email.

All participants visited a specialist in-person for an initial evaluation using standard assessments.  Then, over the course of seven months, 11 participants returned to the doctor’s office for in-person visits and nine participants video conferenced using special computer software that ensured confidentiality.

Results

  • Overall, participants in both groups completed more than 90 percent of their scheduled visits.
  • None of the individuals in the video conference group had a situation that necessitated an in-person visit during the course of the study, for example a need for a blood test.
  • Participants in both groups spent about the same amount of time interacting with their doctors.
  • Researchers measured the benefit on participants’ quality of life and PD symptoms, and found the same results for participants, regardless of whether they saw a doctor in-person or via video conference.
  • Compared with in-person visits, each "virtual" visit saved participants, on average, 100 miles of travel and three hours of time.
  • On a follow-up questionnaire, participants reported that they liked the convenience of video conferencing but had concerns about the difficulty of establishing a personal bond with the physician.

What Does It Mean?

Although the number of participants was small, the results of this study provide encouragement that video conferencing with a specialist can provide similar benefits to people with PD as in-person visits, while reducing the time and expense of seeing the doctor.  However, some aspects of PD, such as rigidity and difficulties with balance, cannot be assessed visually. In these cases, in-person visits with a specialist will continue to be an important piece of PD care.

Currently, only the minority of people living with PD are evaluated by movement disorders specialists who have years of training in Parkinson's and similar disorders. The rest are cared for by primary care providers, geriatricians and  general neurologists (those who have not specialized in movement disorders, and rather see a wide range of patients). A previous study covered by PDF science news demonstrated that when people with PD seek the care of neurologists, this care may reduce their hospitalizations versus care from a primary care provider. Virtual office visits may be a realistic alternative for those who live far away from specialists, or alternatively, may complement regular visit to the local doctor or general neurologist.

Before virtual visits become a reality, as a next step, researchers must conduct studies with larger numbers of participants, and with participants of more varied socioeconomic backgrounds. In addition, issues surrounding technology and insurance reimbursement and rules in the United States that require doctors and the person being treated to be in the same state, will need to be resolved.

Learn More

Are you interested in telemedicine? During next month's Merinoff Symposium in April, led by The Feinstein Institute for Medical Research in Manhasset, NY, PDF's Executive Director, Robin Anthony Elliott, will moderate a panel on the future of telemedicine and how it can help improve life with Parkinson's. PDF Research Advocates Jay and Marilyn Phillips will also present on the panel.

Learn About Symposium

Reference: Dorsey ER, Venkataraman V, Grana MJ, Bull MT, George BP, Boyd CM, Beck CA, Rajan B, Seidmann A, Biglan KM. Randomized Controlled Clinical Trial of “Virtual House Calls” for Parkinson Disease. JAMA Neurology doi:10.1001/jamaneurol.2013.123 http://dx.doi.org/10.1001/jamaneurol.2013.123.

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Source Date: Mar 13 2013