Randomized controlled clinical trial of “virtual house calls” for Parkinson disease

Abstract

IMPORTANCE: The burden of neurological disorders is increasing, but access to care is limited. Providing specialty care to patients via telemedicine could help alleviate this growing problem. OBJECTIVE: To evaluate the feasibility, effectiveness, and economic benefits of using web-based videoconferencing (telemedicine) to provide specialty care to patients with Parkinson disease in their homes. DESIGN: A 7-month, 2-center, randomized controlled clinical trial. SETTING: Patients' homes and outpatient clinics at 2 academic medical centers. PARTICIPANTS: Twenty patients with Parkinson disease with Internet access at home. INTERVENTION: Care from a specialist delivered remotely at home or in person in the clinic. MAIN OUTCOME MEASURES: The primary outcome variable was feasibility, as measured by the percentage of telemedicine visits completed as scheduled. Secondary outcome measures included clinical benefit, as measured by the 39-item Parkinson Disease Questionnaire, and economic value, as measured by time and travel. RESULTS: Twenty participants enrolled in the study and were randomly assigned to telemedicine (n = 9) or in-person care (n = 11). Of the 27 scheduled telemedicine visits, 25 (93%) were completed, and of the 33 scheduled in-person visits, 30 (91%) were completed (P = .99). In this small study, the change in quality of life did not differ for those randomly assigned to telemedicine compared with those randomly assigned to in-person care (4.0-point improvement vs 6.4-point improvement; P = .61). Compared with in-person visits, each telemedicine visit saved participants, on average, 100 miles of travel and 3 hours of time. CONCLUSION AND RELEVANCE: Using web-based videoconferencing to provide specialty care at home is feasible, provides value to patients, and may offer similar clinical benefit to that of in-person care. Larger studies are needed to determine whether the clinical benefits are indeed comparable to those of in-person care and whether the results observed are generalizable. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01476306.