Internet Visits with Parkinson’s Specialist Can Be as Effective as In-person Visits, Trial Finds

Virtual house calls with a neurologist can be as effective as in-person visits for Parkinson’s disease patients, offering convenience and comfort, a clinical trial indicates.

The study, “National randomized controlled trial of virtual house calls for Parkinson disease,” was published in the journal Neurology.

The internet has led to what is known as telemedicine, or virtual house calls between physicians and patients in the treatment of certain conditions.

But while “pilot efforts have suggested that virtual house calls are feasible, valuable to patients, and have similar clinical outcomes to in-person care in Parkinson’s disease,” they aren’t used much in chronic conditions like Parkinson’s, researchers said.

The team decided to conduct a clinical trial (NCT02038959) to evaluate whether virtual house calls are feasible for Parkinson’s patients and can improve their health.

Researchers also wanted to know how virtual house calls affect the quality of patients’ care and their quality of life, compared with in-person visits. And they wanted to know whether virtual house calls saved patients’ time, the need for them to travel, and can reduce caregiver burden.

The proportion of patients who completed at least one virtual visit, as well as the number of virtual visits they completed on time, were the two factors researchers considered when evaluating feasibility. The team used patient feedback to determine virtual house calls’ effectiveness. The feedback yardstick was scores on Parkinson’s Disease Questionnaire–39, the most widely used patient reporting scale.

Among the 927 patients who showed interest in the study, 195 were randomized to receive in-person care with their usual provider. Some of the 195 also received video teleconference visits over 12 months with a neurologist they had never seen.

Ninety-eight percent of the 195 patients completed at least one virtual visit. Patients also completed 91 percent of the 388 virtual visits that researchers scheduled. Those results indicated that it’s feasible to provide remote neurological care to Parkinson’s patients.

The virtual calls also saved patients an average of 169 minutes and 38 miles per visit. And 55 percent of patients said they preferred virtual calls over in-person visits.

There was no improvement in patients’ quality of life, however, and researchers reported no quality of care or caregiver-burden benefits. But 83 percent of patients said they were satisfied with their care, and 73 percent said they had seen a doctor in person in the past year.

“So the fact that adding the virtual house calls to people’s care did not improve their quality of life could be because a large proportion were already seeing a specialist and were satisfied with that care,” Dr. Ray Dorsey of the University of Rochester Medical Center in New York said in a press release. “Of course, it’s also possible that virtual house calls are not enough to improve quality of life.”

The researchers noted that their study included mostly well-educated patients who were familiar with the internet. It also excluded the nearly 25 percent of patients who lived in nursing homes. Those factors were potential limitations of the research, the team said.

But they concluded that for “patients with Parkinson’s disease, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits.”