Do Video House Calls with a Specialist Help Get Care to People with Parkinson's Disease?

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What was the research about?

Nearly 1 million people in the United States have Parkinson’s disease. People with Parkinson’s disease may have poor balance or shaking in their hands, legs, or faces. These symptoms often get worse over time. Many patients don’t live near a doctor with special training to treat this disease. As the disease gets worse, it gets harder for patients to travel to see a specialist. Caregivers often travel with patients.

The research team wanted to learn if video house calls with specialists were convenient and improved quality of life for people with Parkinson’s disease. The team also wanted to learn if video house calls improved quality of care, reduced travel time, and reduced burden on caregivers due to the demands of care.

What were the results?

The research team found that video house calls were a convenient way for people with Parkinson’s disease to get care from specialists. Most patients reported being satisfied or very satisfied with care they received during video house calls.

After 12 months, the team didn’t find any differences between patients who received video house calls and those who didn’t in quality of life, quality of care, or amount of caregiver burden.

Compared with patients who had in-person visits at clinics, patients who used video house calls spent less time traveling to doctor visits. Patients who used video house calls also spent more time talking with specialists during visits.

Who was in the study?

The study included 195 adults with Parkinson’s disease and 111 of their caregivers. The average patient age was 66. Patients had had Parkinson’s disease for an average of eight years.

What did the research team do?

The research team assigned people with Parkinson’s disease to one of two groups by chance. Both groups received educational materials and care from their regular doctors. One group of patients also talked to a specialist up to four times through video house calls. Patients received a link to download secure software for video house calls. The research team gave webcams to patients who didn’t have them. Specialists sent recommendations for care to patients’ regular doctors.

The research team asked patients if the video house calls were convenient. The team also asked patients in both groups about their quality of life and if they were satisfied with their care. The research team then asked caregivers about the burden of being a caregiver. The team also kept track of how much time patients in the study spent getting to their visits and talking with their doctors.

What were the limits of the study?

The number of patients in the study was small. Also, patients in the study had higher levels of education and greater access to specialists than many patients with Parkinson’s disease do. Future studies could look at the benefits of video house calls for patients with Parkinson’s disease or other health conditions who lack access to specialists.

Patients in the study needed to have basic computer skills and an internet connection to set up the video house calls. Also, some states may not be able to use video house calls because of laws about doctors from other states providing care using video calls. In states with these laws, patients may have trouble setting up video house calls with specialists.

How can people use the results?

Patients with Parkinson’s disease or those who care for them could ask their regular doctors about using video house calls to meet with a specialist. Video house calls may not be available in some parts of the country.

Objective

To assess whether a telemedicine intervention—video house calls with specialists—is feasible, improves quality of life, enhances quality of care, and reduces burden on caregivers and the amount of time and travel required for specialist visits

Study Design

This randomized controlled trial assessed the feasibility and efficacy of video house calls for people with Parkinson’s disease. The study had two primary outcomes. The first was feasibility, which the research team defined as the percentage of patients who completed at least one video house call and the overall percentage of video house calls completed as scheduled. The second outcome was patient quality of life, as measured by the 12-month change in responses to the patient-reported Parkinson’s Disease Questionnaire. The study’s secondary outcomes were patient-reported quality of care, caregiver burden, and amount of time and travel required for specialist visits. People with Parkinson’s disease, caregivers, and advocacy organizations provided input to the research team throughout the study.

The study participants were 195 people with Parkinson’s disease and 111 of their primary caregivers, including family members or friends who help on a regular basis. Patients in the study were predominantly white (96 percent) and college educated (73 percent). The average patient age was 66, and patients had had Parkinson’s disease for an average of eight years.

Researchers randomly assigned patients to one of two groups. Patients in the intervention group received care from a specialist via video house calls in addition to educational materials and usual care from a primary care doctor. Each patient received one to four video house calls. Video house calls were similar to in-person visits: specialists assessed patients, made treatment recommendations, and sent consultation notes to patients and their primary care doctors. However, because some state laws prohibit doctors from prescribing medicine during video house calls, the specialists did not prescribe medicine.

Patients in the control group received usual care from their primary care doctors as well as educational materials about Parkinson’s disease. At the end of the study, the research team offered these patients a one-time video house call with a Parkinson’s disease specialist.

Patients in both groups completed surveys at baseline and after 12 months. Patients in the intervention group also completed a survey after each video house call. Patients’ caregivers completed assessments of caregiving burden at baseline and after 12 months.

Results

Feasibility of video house calls. Among patients in the intervention group, 98 percent completed at least one video house call and 87 percent completed all four. More than 95 percent of patients reported being “satisfied” or “very satisfied” with the care they received during the video house calls and with the convenience, comfort, and overall quality of the video house calls. More than 50 percent of patients preferred video house calls to in-person visits, and about 20 percent were neutral.

Comparisons with usual care. There were no statistically significant differences between the intervention and control groups in quality of life, quality of care, or caregiver burden. Compared with patients in the control group, patients in the intervention group spent less time overall (including travel and waiting time) on Parkinson’s disease appointments (p <0.0001) and a higher proportion of their appointment time interacting with their doctors (p <0.0001).

Limitations

Compared with the general population of people with Parkinson’s disease, people in the study had higher education levels, greater access to specialists, and more familiarity with the internet. It may be difficult to use video house calls with patients or doctors who have less access to, or familiarity with, the internet. The specialists communicated recommendations to the patients’ primary care doctors; however, the study did not track how often specialists made recommendations or whether primary care doctors acted on these recommendations.

Conclusions and Relevance

Video house calls provide feasible and convenient access to specialists for people with Parkinson’s disease. However, this small study did not show greater benefits for quality of life, quality of care, or caregiver burden as compared to usual care. Some state laws restricting doctors from providing care in other states may limit the applicability of the findings.

Future Research Needs

Future research could examine whether telemedicine can improve clinical outcomes and quality of life for people with Parkinson’s disease. Future studies could also look at whether video house calls are a feasible approach for increasing access to specialty care among different demographic subgroups.