Telemedicine is a relatively new development in health care that has been made possible by technological advancements. Yet, despite optimism, it has been only slowly adopted as a means of health care delivery.
Telemedicine for stroke care
Rapid response in stroke care is one of the few situations that is widely believed to have benefitted from the advantages of telemedicine capabilities. And even the administration of TPA for stroke does not always require telemedicine, because physicians are often on site to evaluate stroke rapidly and accurately.
Teleneurology beyond stroke
When it comes to practical use of telemedicine, physicians demand convincing evidence that it improves patient outcomes. Payers may require verification of cost effectiveness before authorizing care. Evidence of the benefits is not necessarily easily extrapolated from one medical condition to another. Justification for telemedicine care necessitates studying the outcomes for specific medical conditions, as the results are likely to differ for different illnesses.
Teleneurology For Parkinson disease
Parkinson disease (PD) care lends itself in several ways to telemedicine:
. PD is not a fatal disease
. the medication is relatively safe
. many of the symptoms can be observed without a hands-on physical examination
. patients are usually able to provide a descriptive history of disease symptoms and adverse effects of medication.
The frequent need for medication adjustments makes telemedicine visits, which can be scheduled in between in-person visits, a potentially practical and convenient solution for patients.
A number of studies have evaluated the utility of telemedicine in the management of PD. A recently published 12-month randomized controlled trial involving 149 patients with PD reported that patients rated their telemedicine visits as strongly favorable, while physicians rated them as moderately favorable.1 Overall, the most common patient and physician complaint was in regards to technical problems with the software.
Another 1-year randomized controlled trial followed 195 patients with PD.2 The authors reported that virtual house calls were feasible, and noted no substantial change in quality of life among the participants. Patients experienced a median savings of 38 miles and 88 minutes per virtual house call. In terms of demographics, 73% of the patients were college educated. Given the software complaints noted in the other study, it may be interesting to know whether patient experience with computers influences patient and physician satisfaction with virtual visits.
Overall, the reported benefit of telemedicine visits for PD is neither remarkably impressive nor disappointingly unsatisfactory. It is unrealistic to expect outcomes and satisfaction to be better than they would be for in-person visits, as current telemedicine care does not offer any superior features to onsite care beyond convenience. The fact that overall satisfaction seems to be about equal to clinic visits suggests that telemedicine is a reasonable option for patients.
Have you considered adopting telemedicine in your clinic practice?
1. Mammen JR, Elson MJ, Java JJ. Patient and Physician Perceptions of Virtual Visits for Parkinson's Disease: A Qualitative Study. Telemed J E Health. 2017 Aug 1. doi: 10.1089/tmj.2017.0119. [Epub ahead of print].
2. Beck CA, Beran DB, Biglan KM. National randomized controlled trial of virtual house calls for Parkinson disease. Neurology. 2017;89::1152-1161.