EXPERT ANALYSIS FROM ANA 2016
BALTIMORE (FRONTLINE MEDICAL NEWS) – The broadening of access to medical care through telemedicine that’s been occurring for acute neurologic conditions such as stroke has begun to expand to care for more chronic conditions such as Parkinson’s disease and poststroke recovery, according to presentations given at the annual meeting of the American Neurological Association.
Telemedicine care for patients with Parkinson’s appears feasible and acceptable to both patients and clinicians alike, based on recent findings. Ray Dorsey, MD, of the University of Rochester (N.Y.) initiated the Connect.Parkinson study with his colleagues in 2014 to compare usual care enhanced with educational materials against others who received usual care, educational materials, and four virtual sessions with a Parkinson’s disease specialist from 1 of 18 neurology centers nationwide. Some of the participants who lived far away from one of these centers would not otherwise have received such specialized care ( Telemed J E Health. 2016;22[7]:590-8 ).
Most of the 195 randomized participants were white (96%) and college educated (73%), and 73% had seen a Parkinson’s specialist within the previous year. Of the nearly 400 virtual house calls, 91% were completed as scheduled.
The participating physicians had concerns about the quality of the video connection, but otherwise were satisfied with the care delivered to the patients. Surveys of participants revealed no differences between the two groups in quality of life and quality of care. About 80% of those who received virtual calls preferred this contact to the regular office visits.
The development of smartphone apps that allow aspects of diseases like Parkinson’s to be monitored are also enabling high-quality, diagnostic telecare. A pilot study of an Android smartphone Parkinson’s disease app by Dr. Dorsey and his colleagues demonstrated its utility in tests of voice, postural sway, gait, finger tapping, and reaction time ( Parkinsonism Relat Disord. 2015;21[6]:650-3 ).
Since that study was completed, an iOS smartphone version of the app, called mPower, has been developed and has enrolled many Parkinson’s disease patients. The technology is being tested to virtually gauge Parkinson’s disease symptoms and the effects of medications on them. This has opened the door to the world of virtual clinical trials and longitudinal studies targeting genetic subpopulations, Dr. Dorsey said at the meeting.
Telehealth can also be bundled into a program of health care delivery following hospital discharge. A tangible example of the use of services including telecare in poststroke care is the Comprehensive Post-Acute Stroke Services (COMPASS) program that is being developed under the codirection of Cheryl Bushnell, MD, at Wake Forest Baptist Medical Center, Winston-Salem, N.C.
The telehealth portion of COMPASS – in the form of regular phone calls and web-based feedback – enables better stroke care following hospital discharge by keeping track of common complications that are partly responsible for a readmittance rate of around 25% within 90 days of hospital discharge and tracking physiological aspects like blood pressure, diabetes, diet, exercise, and smoking.
The pilot demonstration of the potential of the program was pivotal in securing funding for a cluster-randomized pragmatic trial . The trial will randomize hospitals to normal discharge or discharge followed by regular poststroke contact. Patient functional status at 90 days post stroke will be assessed for 1 year. After the year, the hospitals randomized to COMPASS care delivery will continue this care, and the hospitals offering normal discharge will also adopt this poststroke service care. Patient outcome will be followed for another year.
The anticipated patient enrollment is 5,400. Results from the first year of the 2-year study are expected in Spring 2018. “COMPASS will have an impact on the post-acute stroke care pathway. After evaluating the effectiveness, the goal is to disseminate and scale to other settings,” Dr. Bushnell said at the meeting.
Dr. Dorsey receives research support from Excellus BlueCross BlueShield, Google, and the Verizon Foundation. He has received compensation for consulting services for Medtronic and owns stock options in ConsultingMD. Dr. Bushnell acknowledged salary support from the COMPASS program, which receives funding from the Patient-Centered Outcomes Research Institute.
