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 disease symptoms.
“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,” says University of Rochester Medical Center (URMC) neurologist Ray Dorsey, MD, MBA, senior author of the study, which was published in 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.”
More than 40% of people with Parkinson’s disease do not see a neurologist, placing these individuals at greater risk of poor health outcomes. For example, people with the disease who do not see a specialist are 20% more likely to fall and fracture a hip, 20% more likely to end up in a skilled nursing facility, and 20% more likely to die.
Geography often is a determining factor in whether a person with Parkinson’s sees a specialist. Neurologists with training in movement disorders such as Parkinson’s 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.
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 videoconferencing software developed by California-based Vidyo. The technology, which is akin to Skype, requires only 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 who were seeing a neurologist for the first time. Virtually all of the visits resulted in treatment recommendations, including increasing exercise (86%), changes in current medications (63%), the addition of new medications (53%), and discussions about potential surgical options (10%). Patient satisfaction with the telemedicine care exceeded 90%.
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 physician primarily consists of observing the patient perform certain tasks, such as holding their hands out and walking and listening to the patient’s history.
While demonstrably effective, one key barrier to the wider adoption of this approach is the fact that Medicare does not pay for telemedicine care provided to people in their homes. Also, out-of-state physicians are barred from providing remote care to patients in many states.
These barriers prevent the potential savings—both in terms of cost and time—that can be realized by care delivered via telemedicine. A previous URMC study showed that not only did telemedicine visits cost less than providing care in a traditional setting such as a clinic or a hospital, but the virtual house calls saved patients an average of more than three hours and 100 miles of travel per visit when factoring in travel to and from the doctor’s office.
Dorsey and his colleagues now are extending the program with the support of the National Parkinson’s Foundation and the Patient Centered Outcomes Research Institute. The new study, called Connect.Parkinson, plans to enroll approximately 200 individuals with Parkinson’s disease. Participants either will receive their usual care from a physician in their community or additional remotely delivered care from a Parkinson’s disease center of excellence in their state.
— Source: University of Rochester Medical Center
Humana, a health and well-being company, and Healthsense, a provider of aging services technologies, have completed member enrollment in a remote monitoring pilot program that will measure the impact in-home sensors and remote monitoring technology have on improving health outcomes and reducing frailty and fall-related hospital admissions for Medicare members with chronic health conditions.
Humana Cares/Senior Bridge, Humana’s national chronic care management division, identified and enrolled 100 Humana Medicare Advantage members in Florida, North Carolina, South Carolina, Kentucky, and West Virginia in the activities of daily living year-long in-home pilot aimed at helping members remain independent and in their homes.
The Healthsense eNeighbor remote monitoring system reports changes in the members’ normal patterns of movement and activity to Humana care managers through in-home sensors that measure routine daily activities such as sleeping, eating, and toileting.
“We know that daily activities ... can tell you a lot about a person’s health,” says Gail Miller, vice president of telephonic care management operations for Humana Cares/Senior Bridge. “With the information relayed to us from the Healthsense in-home sensors, we’re able to quickly act on the alerts we receive. This is especially important in cases where you have a member with multiple chronic conditions living alone and a timely response can drastically change a health outcome."
The sensors, which are placed discreetly around the home, work with Healthsense software to establish the typical levels of daily activity, or a routine, for each member. Through passive monitoring, this routine becomes the benchmark for establishing when members may need assistance without asking them to check in, push a button, or pull a cord.
— Source: Healthsense