Telemedicine brings Parkinson's care to "Anyone, Anywhere"

BALTIMORE, USA: A new study shows that a neurologist in an office thousands of miles away can deliver effective specialized care to people with Parkinson's disease.

For individuals with the condition - many of whom have never seen a specialist - these "virtual house calls" could allow them to live independently while effectively managing the symptoms of the disease.

"The idea that we can provide care to individuals with Parkinson's disease regardless of where they live is both a simple and revolutionary concept," said University of Rochester Medical Center (URMC) neurologist Ray Dorsey, M.D., M.B.A., senior author of the study which appears today in the journal Neurology: Clinical Practice.

"This study demonstrates that, by employing essentially the same technology that grandparents use to talk to their grandchildren, we can expand access to the specialized care that we know will improve patients' quality of life and health."

The study was supported by the Verizon Foundation, Medtronic, and the patient networking website PatientsLikeMe.

"Dr. Dorsey's work with Parkinson's disease patients exemplifies the type of forward-thinking, technology-driven innovation that the Verizon Foundation seeks to support," said Anthony A. Lewis, Verizon's mid-Atlantic region vice president of state government affairs. "Technology can equalize access to quality health care and bring much-needed services to chronically ill patients who may not otherwise receive such care because of geographic or financial reasons."

More than 40 per cent of people with Parkinson's disease do not see a neurologist, placing these individuals at greater risk for poor health outcomes. For example, people with the disease who do not see a specialist are 20 per cent more likely to fall and fracture a hip, 20 per cent more likely to end up in a skilled nursing facility, and 20 per cent more likely to die.

Geography is often a determining factor in whether a person with Parkinson's sees a specialist. Neurologists with training in movement disorders like Parkinson's disease tend to be concentrated in major academic medical centers. Additionally, the nature of the disease - particularly the impact on movement, balance, and coordination - can make a long trip to the doctor's office unfeasible.

"We have an ample supply of neurologists in the country to take care of people with Parkinson's, but because of distance, disability, and the distribution of doctors, many patients have a difficult time seeing a specialist," said Dorsey.

Working with PatientsLikeMe, the study invited individuals with Parkinson's who lived in the five states where Dorsey is licensed to practice medicine - California, Delaware, Florida, Maryland, and New York - to receive one free telemedicine consultation in the comfort of their own home.

The participants downloaded secure web-based video conferencing software developed by California-based Vidyo. The technology, which is akin to Skype, only requires an Internet connected computer and a webcam.

Using this system, Dorsey saw more than 50 people with Parkinson's disease, ranging from individuals who were getting a third opinion to those that were seeing a neurologist for the very first time. Virtually all of the visits resulted in treatment recommendations, including increasing exercise (86 per cent), changes in current medications (63 per cent), the addition of new medications (53 per cent), and discussions about potential surgical options (10 per cent). Patient satisfaction with the telemedicine care exceeded 90 per cent.

Parkinson's disease particularly lends itself to telemedicine because many aspects of the diagnosis and treatment of the disease are "visual" - meaning that the interaction with the doctor primarily consists of observing the patient perform certain tasks such as holding his/her hands out and walking and listening to the patient's history.

"James Parkinson wrote the seminal description of the condition in 1817 by watching people walk in the park," said Dorsey. "This is just a 21st century application of that principal of observation."

"This research demonstrates that we can reach anyone, anywhere with a given condition," said Dorsey. "If we can successfully remove the barriers to telemedicine, this approach will ultimately allow more patients with Parkinson's disease to live independently in their homes, while getting the care they need."

Additional co-authors include Kevin Biglan, M.D., M.P.H. with URMC, Vinayak Venkataraman, B.S. and Sean J. Donohue with Johns Hopkins University, and Paul Wicks, Ph.D. with PatientsLikeMe.