- A comprehensive review of telehealth programs serving people with Parkinson’s disease finds that researchers still aren’t certain whether a virtual care program is better than a more reliable office-based visit.
Still, the researchers - Joel L. Eisenberg and Jyhgong Gabriel Hou of the Pennsylvania-based Lehigh Valley Heath Network’s Department of Neurology and Peter J. Barbour of the University of South Florida’s Morsani College of Medicine – say the advantages of telehealth will someday outweigh the obstacles. And to prepare for it, they laid out a design for the ideal telemedicine program.
“(W) are closer than ever to making virtual visit assessment as good as in-person examination with wider access to care, increased convenience for patients, and seamless communication between members of the treatment team,” they wrote.
In a study recently published in Smart HomeCare Technology and Telehealth, Eisenberg and his colleagues found both benefits and drawbacks in connected care programs. And in a familiar refrain to telemedicine advocates, they concluded that not enough evidence exists to choose one method of care over the other.
That’s an important distinction to make, considering the number of people across the globe who are diagnosed with Parkinson’s is expected to double between 2005 and 2030.
The report focused on 13 studies, conducted between 2006 and 2017, in which people living with Parkinson’s disease (PD) were treated via telehealth, including virtual care platforms and, on occasion, mHealth tools, such as wearables.
“Telemedicine … is particularly well-suited for evaluation of PD as assessment of PD is primarily observational,” Eisenberg and his colleagues reported. “It may not be appropriate to make an initial diagnosis using remote evaluation, but it has been suggested that the use of telemedicine could be more cost effective and convenient than in-person follow-up visits for PD and other neurologic conditions.”
“Other technologies that have proven useful for the management of PD include wearable monitors, accelerometers and sensors, often adapted from a patient’s smartphone and providing treatment teams with a clearer understanding of symptoms over time,” they added. “Smart phone technologies hold great promise for the future management of PD, but current telemedicine for the management of PD is limited to the delivery of healthcare through synchronous, real-time video conferencing between patient and provider.”
According to an analysis of those programs, Eisenberg and his colleagues found that virtual care platforms save both providers and patients time and money, are more convenient, reduce access issues, are well-received by patients and provide care that is equivalent to in-person care.
However, they noted that technical issues, including a lack of high-speed Internet connectivity in rural and remote areas and sub-optimal video quality for clinical evaluations, plague providers trying to establish a sustainable remote patient monitoring program.
“It remains unclear whether the home assessment is more accurate because it reflects a patient’s natural environment, or if an office assessment is more accurate because clinicians can see the patients more clearly,” they reported.
In addition, each state has different licensing guidelines, while government and private payers have different ideas on whether such services should be reimbursed, further hindering telehealth adoption.
“The complexities of reimbursement for telemedicine visits remain a major barrier for the widespread adoption of the technology,” they concluded.
Designing the Ideal Telemedicine Program for Parkinson’s Care
Recognizing that advances in connected health should someday make telehealth more acceptable, Eisenberg and his colleagues laid out their blueprint for an ideal telemedicine program for Parkinson’s disease care management and coordination.
“A successful telemedicine program will need to be based in a remote clinic with the resources to construct reliable video conferencing,” they wrote, noting the platform must have high-definition video recording capabilities at both ends. “This will ensure consistently adequate communication with a movement disorder specialist. Before a virtual visit is scheduled, patients would be seen in person to establish a relationship with a movement disorder specialist and to give informed consent to receive care via telemedicine.”
“The treatment room must be large enough to allow patients to walk freely for accurate assessment of gait,” they noted. “It is also imperative that the room be well-lit, allowing the movement disorder specialist to detect fine tremor and facial movements. Patients with PD may be at an increased risk of falling, and as such, the facility should be set up with patient safety in mind.”
Once the clinic is established, they wrote, the treatment team should be established. It should include at least one neurologist trained in treatment movement disorders, as well as technical support and nurses or nurse practitioners trained to assist in the examination. Remote clinic staff should also be trained to reconcile medications, including ensuring that prescriptions that are e-mailed directly to the pharmacy are picked up by the patients.
The ideal telemedicine practice, Eisenberg and his team said, should include a practice manager.
“A practice manager is valuable not only in managing patient visit schedules along with the schedules of each individual staff member, but also in helping to integrate the telemedicine schedule with the physician’s schedule for in-person visits,” they wrote. “A staff member well-versed in billing practices for telemedicine can be utilized to avoid confusion regarding the complexities of reimbursement. Technology support personnel should be present or readily available both for system setup and troubleshooting problems related to the video conferencing equipment and network connectivity.”
Finally, the program should not exist in a vacuum, but be ready to integrate with other services vital to the patient’s care management.
“This remote clinic may serve as a multi-disciplinary PD treatment center, in which physical therapists, occupational therapists, clinical psychologists, speech and language pathologists, and other specialty practitioners can operate to streamline care for patients,” they concluded. “Ideally, this remote clinic will work with community outreach organizations and social workers to recruit and coordinate telemedicine care for underserved patients.”
Along with their blueprint for the ideal telemedicine program, Eisenberg and his colleagues called on the healthcare industry to produce more definitive studies that focus on how telehealth and telemedicine can address care gaps for Parkinson’s disease treatment.
“The current research on telemedicine for the delivery of care to patients with PD has laid an effective groundwork, but there are areas yet unexplored,” they wrote. “Future research will need to include larger patient samples including patients from diverse ethnic backgrounds, individuals with lower levels of education and income, and patients with more severe levels of disability before a thorough assessment of telemedicine can be made. Research will also need to be conducted to more thoroughly understand how smartphones and emerging technologies can be used for remote monitoring and treatment.”