An article published in the journal Neurology last week
confirms that James Parkinson’s legacy has been well and truly digitised.
Researchers in the USA completed a randomised controlled
trial of tele-medicine for Parkinson’s disease. Tele-medicine is where the
patient and physician are not face to face in a consulting room, but using
technology similar to Skype or Facetime to have a consultation at the mutual
convenience of both parties. The study showed that it is possible for
physicians not only to listen to the patient’s problems, but also to examine
them (using internationally recognised Parkinson’s specific examinations), and
recommend medication changes that are then prescribed by the local GP.
Although quality of life for the patient and care giver was
not better in the tele-medicine group compared to the face-to-face group, it
did not get worse either. The telemedicine group felt they had excellent
rapport with their ‘eDoc’, and it saved them a huge amount of time (and
therefore money) by not having to travel to a regional neuroscience centre.
Although the UK and US are geographically very different, we
do have some equivalent problems on this side of the pond. The Neurological
Alliance has reported that the lack of neurologists is a major problem for
people in the UK with neurological problems. Movement disorder specialists tend
to be found only in regional referral hospitals. People with Parkinson’s in
both countries have much greater difficulty than most patients in getting to
appointments, particularly as the condition progresses.
This paper is also of particular relevance to the PREDICT-PD
team. It shows that there is a very large desire and abillity of people with
Parkinson’s to engage with online research. We will be recruiting 10,000 people
from 60-80 to take part in PREDICT-PD. The researchers in this study were
overwealmed by potential participants and even head to turn away almost 1 in 5
participants.
Important things for these researchers, and us too though,
is that there is a potential bias due to the “digital divide” – the participants
in this study were mainly white, well educated and willing and able to work online.
We mustn’t leave behind people that don’t fit this mould.
National randomized controlled trial of virtual house calls for Parkinson disease
Objective: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable.
Methods: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire–39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings.
Results: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] −2.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70–120; p < 0.0001) and 38 miles per visit (95% CI 36–56; p < 0.0001).
Conclusions: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience.
ClinicalTrials.gov identifier: NCT02038959.
Classification of evidence: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.
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