A small study of 20 people with Parkinson's disease suggests that "virtual house calls" using Web-based video conferencing provide clinical benefits comparable to in-person physician office visits, while saving patients and their caregivers time and travel.
"It appears we can use the same technology Grandma uses to chat with her grandson to provide her with valuable medical care in her home," says study leader Ray Dorsey, M.D., M.B.A., an associate professor of neurology at the Johns Hopkins University School of Medicine. "If this proof-of-concept study is affirmed, the findings open the door to a new era where anyone anywhere can receive the care she needs."
A report on the study, conducted by researchers at Johns Hopkins and the University of Rochester Medical Center is being published online in JAMA Neurology.
Dorsey cautions that wider use of virtual house calls is not without hurdles. For example, under current Medicare rules, physicians are not reimbursed for providing remote care directly into the home. There are also licensing issues.
Doctors may not treat patients in states in which they are not licensed, so that means a patient from, say, Delaware, could come to Johns Hopkins in Baltimore for treatment, but a Johns Hopkins physician could not conduct a virtual house call with that same patient without a Delaware medical license.
"Reimbursement and licensure issues are trailing innovation and, if anything, act as a hindrance," Dorsey says. "There's really a disconnect."
For the study, Dorsey and his colleagues at Johns Hopkins and the University of Rochester Medical Center enrolled 20 of their Parkinson's disease (PD) patients who had home Internet access. Nine were randomly selected to receive three virtual house calls, while 11 were scheduled for three in-person visits to a physician's office over the course of seven months.
Roughly the same number of patients made their scheduled visits (one in-person patient missed a visit because of a car accident on the way to the appointment), and quality-of-life changes did not differ between the two groups. The researchers also found that the care was no better — but no worse — for those seen "virtually" or in person.
They also found that, compared to in-person visits, each telemedicine visit saved participants and their caregivers on average 100 miles of travel and three hours of time.
PD is a disorder of the brain that leads to shaking (tremors), slowness of movement, stiffness and difficulty walking. PD usually develops after age 50 and is one of the most common nervous system disorders of the elderly, affecting an estimated 500,000 Americans. That number is expected to nearly double over the next generation, Dorsey notes.