Randomized controlled clinical trial of "virtual house calls" for Parkinson disease.

IMPORTANCE

The burden of neurological disorders is increasing, but access to care is limited. Providing specialty care to patients via telemedicine could help alleviate this growing problem.

OBJECTIVE

To evaluate the feasibility, effectiveness, and economic benefits of using web-based videoconferencing (telemedicine) to provide specialty care to patients with Parkinson disease in their homes.

DESIGN

A 7-month, 2-center, randomized controlled clinical trial.

SETTING

Patients' homes and outpatient clinics at 2 academic medical centers.

PARTICIPANTS

Twenty patients with Parkinson disease with Internet access at home.

INTERVENTION: Care from a specialist delivered remotely at home or in person in the clinic.

MAIN OUTCOME MEASURES: The primary outcome variable was feasibility, as measured by the percentage of telemedicine visits completed as scheduled. Secondary outcome measures included clinical benefit, as measured by the 39-item Parkinson Disease Questionnaire, and economic value, as measured by time and travel.

RESULTS

Twenty participants enrolled in the study and were randomly assigned to telemedicine (n = 9) or in-person care (n = 11). Of the 27 scheduled telemedicine visits, 25 (93%) were completed, and of the 33 scheduled in-person visits, 30 (91%) were completed (P = .99). In this small study, the change in quality of life did not differ for those randomly assigned to telemedicine compared with those randomly assigned to in-person care (4.0-point improvement vs 6.4-point improvement; P = .61). Compared with in-person visits, each telemedicine visit saved participants, on average, 100 miles of travel and 3 hours of time.

CONCLUSION AND RELEVANCE: Using web-based videoconferencing to provide specialty care at home is feasible, provides value to patients, and may offer similar clinical benefit to that of in-person care. Larger studies are needed to determine whether the clinical benefits are indeed comparable to those of in-person care and whether the results observed are generalizable.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01476306.