By Maxine Bookbinder
June 18, 2015 | The
National Parkinson Foundation and University of Rochester researchers are
collaborating on a year-long study comparing the efficacy of telemedicine to
in-person community care and updating the term "house call" for the 21st century.
The Connect.Parkinson research study is the first national,
controlled clinical trial of telemedicine that aims to deliver care from a
neurologist to the patient in his or her home.
The 200 patients were primarily receiving community-based
care; a majority visited only primary care physicians for their Parkinson’s
treatment or saw a neurologist no more than once a year.
Almost 7,000 patients die annually because they lack access
to a neurologist, according to Peter Schmidt, Ph.D., National Parkinson
Foundation Senior Vice-President and Chief Mission Officer. “Forty percent of
Parkinson’s patients don’t see a neurologist at least annually. Our hypothesis
for this study is that care provided by telemedicine will be better than what
most patients currently receive. We hope to find a statistically significant
difference. The (telemedicine) patients should be doing better.”
Many patients don’t visit neurologists either because of
proximity, cost, or the misconception that their symptoms cannot be lessened. “Expert care makes a huge difference in people’s lives,” says Dr. Schmidt,
“but they mistake ‘incurable’ for ‘nothing really helps.’”
According to a 2011 Neurology
paper by Allison W. Willis, M.D. (doi: 10.1212/WNL.0b013e31822c9123),
Parkinson’s patients seen by a neurologist experienced a 20% reduced risk of
hip fractures, nursing home placement, and death. In addition, patients who
visit a neurologist at least twice over a four-year period “offered an 18%,
42%, and 55% cost benefit for inpatient, nursing facility, and hospice costs,
respectively.”
Dr. Schmidt says in most other telemedicine studies,
patients usually begin with a visit to a clinic in an academic medical center
and then return home. In the Parkinson’s
study, patients randomized to receive telemedicine care will see a movement
disorder neurologist on their home computer in 30-minute visits for treatment
advice every four months. They may also continue to see their community-based
doctor.
The control group patients will continue treatment with
their community-based caregiver and receive one free neurological evaluation
for treatment advice at the end of the study. Patients in both groups will have
a beginning and ending blinded rater.
Care at the Kitchen
Table
Dr. Schmidt predicts that the telemedicine patients will be
more satisfied with the ability to receive quality care while sitting at their kitchen
tables. “They will get better care from neurologists. Patients can tell if
their doctor is an expert in their condition. We’ve seen patients travel 3 or
more hours door-to-door for a 30 minute visit.”
The telemedicine patients are also more likely to receive better
medication advice, says Dr. Schmidt. “The challenge of optimizing both the dose
and the frequency of Parkinson’s medications is difficult for non-specialists,
often resulting in over or under-dosing. Patients who do not see specialists
often take higher dosages than recommended because their doctors erroneously
theorize that more meds at higher doses will help minimize symptoms. Often, the expert simplifies the patient’s
medicine.”
The telemedicine provider is SBR Health, a Boston virtual
healthcare company. The study was designed to cover patient privacy as required
by HIPPA.
The year-long enrollment goal was reached May 2015 and was
considered a milestone due to its unique nature, says Dr. Schmidt. Participants
were recruited online only, starting with Google ads targeting patients in
specific zip codes who either did not access neurologists or did so
infrequently. Approximately 1,000 patients or family members expressed interest
in participating in this study.
Chronic conditions affect approximately 140 million
Americans and account for more than 75% -- $120 billion – in yearly spending.
By demonstrating the impact of video technology on patient care, Dr. Schmidt
hopes to increase collaboration among healthcare organizations and transform
care, reducing healthcare costs while increasing patient access to experts as
well as survival rates.
“For many patients today, access to expert care is difficult
and time consuming,” says Dr. Schmidt. “We are working to change the paradigm
and demonstrate that the highest quality care can be delivered anywhere.”