Increasing access to specialty care: a pilot, randomized controlled trial of telemedicine for Parkinson's disease.
We conducted a randomized, controlled pilot trial to evaluate the feasibility of providing subspecialty care via telemedicine for patients with Parkinson's disease residing in a remote community located approximately 130 miles from an academic movement disorders clinic. Study participants were randomized to receive telemedicine care with a movement disorder specialist at the University of Rochester or to receive their usual care. Participants in the telemedicine group received three telemedicine visits over six months. Feasibility, as measured by the completion of telemedicine visits, was the primary outcome measure. Secondary measures were quality of life, patient satisfaction, and clinical outcomes. Ten participants residing in the community were randomized to receive telemedicine care (n = 6) or their usual care (n = 4). Four nursing home patients were assigned to telemedicine. Those receiving telemedicine completed 97% (29 of 30) of their telemedicine visits as scheduled. At the study's conclusion, 13 of 14 study participants opted to receive specialty care via telemedicine. Compared with usual care, those randomized to telemedicine had significant improvements in quality of life (3.4 point improvement vs. 10.3 point worsening on the Parkinson's Disease Questionnaire 39; P = 0.04) and motor performance (0.3 point improvement vs. 6.5 point worsening on the Unified Parkinson's Disease Rating Scale, motor subscale; P = 0.03). Relative to baseline, nursing home patients experienced trends toward improvement in quality of life and patient satisfaction. Providing subspecialty care via telemedicine for individuals with Parkinson's disease living remotely is feasible.
Department of Neurology, University of Rochester Medical Center, Rochester, New York 14620, USA. ray.dorsey@ctcc.rochester.edu
E Ray
ER
Dorsey
Lisa M
LM
Deuel
Tiffini S
TS
Voss
Kara
K
Finnigan
Benjamin P
BP
George
Sheelah
S
Eason
David
D
Miller
Jason I
JI
Reminick
Anna
A
Appler
Joyce
J
Polanowicz
Lucy
L
Viti
Sandy
S
Smith
Anthony
A
Joseph
Kevin M
KM
Biglan
D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D010300:Parkinson Disease / Q000523:psychology / Q000628:therapy*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome