Author:
Beck Christopher A.,Beran Denise B.,Biglan Kevin M.,Boyd Cynthia M.,Dorsey E. Ray,Schmidt Peter N.,Simone Richard,Willis Allison W.,Galifianakis Nicholas B.,Katz Maya,Tanner Caroline M.,Dodenhoff Kristen,Aldred Jason,Carter Julie,Fraser Andrew,Jimenez-Shahed Joohi,Hunter Christine,Spindler Meredith,Reichwein Suzanne,Mari Zoltan,Dunlop Becky,Morgan John C.,McLane Dedi,Hickey Patrick,Gauger Lisa,Richard Irene Hegeman,Mejia Nicte I.,Bwala Grace,Nance Martha,Shih Ludy C.,Singer Carlos,Vargas-Parra Silvia,Zadikoff Cindy,Okon Natalia,Feigin Andrew,Ayan Jean,Vaughan Christina,Pahwa Rajesh,Dhall Rohit,Hassan Anhar,DeMello Steven,Riggare Sara S.,Wicks Paul,Achey Meredith A.,Elson Molly J.,Goldenthal Steven,Keenan H. Tait,Korn Ryan,Schwarz Heidi,Sharma Saloni,Stevenson E. Anna,Zhu William
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)