Professional Abstract

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

Design Element	Description
Study Design	Randomized controlled trial
Population	195 people with Parkinson’s disease and 111 of their caregivers
Interventions/ Comparators	Video house calls with a Parkinson’s disease specialist plus usual care and educational materials Usual care and educational materials
Outcomes	Primary: feasibility of video house calls, patient quality of life Secondary: quality of care, caregiver burden, and time and travel associated with specialist visits
Timeframe	12-month follow-up for primary outcomes

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.