Do video house calls with a specialist help get care to people with Parkinson's Disease?
Primary outcomes included (1) feasibility, as defined as the percentage of participants who completed at least 1 virtual house call and the overall percentage of virtual house calls completed as scheduled, and (2) efficacy, as measured by the 12-month change in the patient-reported Parkinson's...
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| Format: | eBook |
| Language: | English |
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Washington, DC
Patient-Centered Outcomes Research Institute (PCORI)
2018, [2018]
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| Series: | Final research report / Patient-Centered Outcomes Research Institute
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Primary outcomes included (1) feasibility, as defined as the percentage of participants who completed at least 1 virtual house call and the overall percentage of virtual house calls completed as scheduled, and (2) efficacy, as measured by the 12-month change in the patient-reported Parkinson's Disease Questionnaire 39. All secondary outcomes, which included quality of care, caregiver burden, and time and travel savings, were patient-reported and unblinded (except for the 12-month blindly rated change by an independent rater in the Movement Disorder Society-Unified Parkinson's Disease Rating Scale).1 RESULTS: We randomized 159 individuals with Parkinson disease, and 111 of their care partners participated. Most study participants were white (96%) and college educated (73%), and on average were 66 years old. The Patient Global Impression of Change did improve over 12 months in those randomized to virtual house calls (50% vs 32% randomized to the control group reported feeling at least "a little better"; P = .002). CONCLUSIONS: Virtual house calls offer the opportunity to provide comfortable, convenient specialty care to individuals with Parkinson disease in their homes. Barriers to large-scale implementation of this method include inconsistent reimbursement for providers, state-based licensure laws, and variability in Internet access and connectivity. Despite these barriers, virtual house calls have the potential to offer anyone, anywhere, access to specialists. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02038959 Interested participants were identified by completing an online interest form on our 1-page website or by calling the National Parkinson Foundation's helpline. The University of Rochester coordinating site screened all participants and collected baseline information including demographics, health history, details related to usual care, travel time to visit a specialist, and technology access. After an initial evaluation by an independent rater who remained blind to treatment assignment, we randomized the participants to 1 of 2 arms using R version 3.0.2. Randomization was concealed from sites, stratified by enrolling site, and contained a block size of 4. Individuals in the control arm continued with their usual care in their community, received educational materials about Parkinson disease, and were offered a 1-time virtual house call with a Parkinson disease specialist after their final evaluation. Those randomized to the treatment and control group were comparable except for in their previous use of participating in a video chat: Those in the control group had more previous experience (62% vs 435; P = .012). Of the 97 individuals randomized to the treatment group, 95 (98%) completed at least 1 virtual house call, and 84 (87%) completed all 4 recommended virtual house calls. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% CI, -2.0 to +2.7 points; P = .78), nor did the change in quality of care or caregiver burden. Each virtual house call saved patients a median of 80 minutes (95% CI, 70-120; P < .0001) and 38 miles per visit (95% CI, 36-56; P < .0001). Participants were highly satisfied with the care, convenience, and comfort of virtual house calls. Parkinson disease-related quality of life did not change appreciably over the course of the study in either group. BACKGROUND: Access to care for individuals affected by chronic conditions is limited by distance, disability, the distribution of doctors, and other socioeconomic factors. National large-scale studies of virtual house calls are lacking for Parkinson disease and other chronic conditions. OBJECTIVE: To assess whether the use of virtual house calls to provide care in the homes of patients with Parkinson disease is feasible, improves quality of life, enhances quality of care, and provides additional value to patients and care partners by saving time, reducing travel, decreasing care partner burden, and reducing utilization of health care services. METHODS: We conducted a 12-month national, randomized, controlled trial of virtual house calls for individuals with Parkinson disease comparing usual care with usual care augmented by 4 virtual house calls from a remote specialist in patients' homes. Participants in the intervention arm received care from a Parkinson disease specialist via videoconferencing in their home for up to 4 virtual house calls over 12 months, in addition to their usual care and educational materials. Specialists provided recommendations and sent a consultation note to patients and their physicians. Participants completed a survey after each virtual house call. We conducted all study activities, including recruitment, enrollment, and study visits, remotely. We also asked participants' primary care partners (family members or friends who assisted the participant on a regular basis and were not paid caregivers) to enroll into the study and complete remote assessments of their experiences as care partners. |
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| Physical Description: | 1 PDF file (51 pages illustrations |