The feasibility and efficacy of adjunct telehealth visits with movement disorders

Telehealth, which provides a means for long-distance clinical care, holds immense promise as a patient-centered care delivery model.  This model has the potential to improve access to care in resource-limited settings (e.g., rural areas with few specialty providers) and for patients with limited mobility, transportation barriers, lack of caregivers and low funds.  It may also improve the efficiency of a healthcare encounter by improving the timeliness and flexibility of visits.  However, there are still several barriers to its widespread implementation.  Beck and colleagues, through a randomized-controlled trial, test the feasibility and efficacy of adjunct telehealth visits with a movement disorders specialist compared to standard of care (as planned neurology visits) among participants with Parkinson’s disease to address one of these barriers.  Namely, how does telehealth compare to what we currently do?

Their main findings were that while the virtual visits were feasible, there were no improvements in quality of life (primary outcome) or caregiver burden and quality of care (secondary outcomes) with the addition of these visits.  Almost all (98%) of participants randomized to receive the virtual visit completed at least one visit, and 97% of patients and 86% of physicians were satisfied with the virtual visit.  There were also significant reductions in time spent for a virtual visit with a median of 88 minutes and 38 miles of travel saved.

These results are intriguing and support the patient-centeredness and feasibility of telehealth visits in Parkinson’s disease.  However, these results should be interpreted with some caution. The participants in this study were not reflective of the general population of people with Parkinson’s disease, especially the most vulnerable (i.e. those with limited access to care). Most participants had already seen a specialist (73%), were college-educated (74%) and used internet/email at home (96%).  For context, among older adults earning less than $30,000/year, only 39% use the internet/email and 25% have broadband internet connection at home according to the Pew Research Center. The important question of efficacy of telehealth visits, particularly when used in lieu of regular in-person visits, is still not clear. However, the study raises several important directions for further action in order to understand the true value of telehealth visits including: 1) improving outreach to underserved patients and communities for telehealth participation; 2) measuring the economic/cost impact of telehealth visits; and 3) reducing challenges to adoption of technology for older adults.

Nabila Dahodwala, MD, MS

Nabila Dahodwala, MD, MS

Associate Professor of Neurology, University of Pennsylvania

More Posts