Alzheimer's, Dementia & Mental Health
Telemedicine Advances to Provide Care for
Parkinson’s Patients in Nursing Homes
Neurologists can effectively deliver
care for Parkinson’s patients via web camera that allows them to
interact with and visually assess patients
| |
 |
|
| |
See link to video in story below |
|
June 17, 2009 - A unique and innovative
telemedicine project is providing distant nursing home patients with
Parkinson’s disease access to neurologists at the University of
Rochester Medical Center (URMC).A pilot study of the project – the
results of which were released this month at the International Congress
of Parkinson’s Disease and Movement Disorders in Paris – demonstrates
that the system can improve the quality of life and motor function of
patients.
“This study shows that we can effectively deliver
care for Parkinson’s patients via telemedicine,” said URMC neurologist
Ray Dorsey, M.D.“This system enables us to reach and provide a high
level of care to patients who might otherwise not have access to a
specialist.”
Dorsey and his colleague
Kevin Biglan, M.D. oversee the project and divide patient
responsibilities between them.The effort is a joint initiative between
URMC and the
Presbyterian Home for Central New York in New Harford, a 250 bed
nursing home near Utica and about 150 miles from Rochester.
When the nursing home opened in 2001, it was the
first in the nation to offer specialized care to people with Parkinson’s
and other movement disorders in a nursing home setting.
For years, the Parkinson’s patients at the home
would typically make 10 trips a year to Syracuse, Albany or Rochester to
see a movement disorders specialist.
Tony Joseph, the administrator of the Presbyterian
Home says that these trips were exhausting for the home’s elderly
patients. “I knew there had to be a better way,” said Joseph.
Joseph knew of Dorsey and Biglan through their work
with the Parkinson Support Group of Upstate New York and approached them
to seek their help in devising a solution.They struck an approach that
utilized telemedicine to conduct patient visits that otherwise would
have been burdensome or not possible for patients.
The expertise for such a project already existed in
the Medical Center. URMC has one of the largest
Movement and Inherited Neurological Disorders programs in the nation
with more than 10 physicians and has been designated a Center of
Excellence by the National Parkinson Foundation and the Huntington’s
Disease Society of America.
The Medical Center has also been an
innovator in the field of telemedicine. The system employed for the
project was built on a technological backbone developed at URMC and is
used to conduct remote pediatric and dental evaluations on patients in
schools, day care centers, and other locations.
The system is essentially low tech, low cost
solution and consists of a laptop, software, and a web camera that
allows the physicians to interact with and visually assess patients.
While such remote evaluations have their
limitations, Parkinson’s disease was an ideal candidate for such a
system. “Parkinson’s is a very visual disease,” said Biglan.“You don’t
necessarily have to physically touch patients to understand how they are
doing.”
Patients are brought to a room in the nursing home
with a flat screen television so they can see the physicians.All the
doctors in Rochester require on their end is a computer equipped with a
web camera.Telemedicine “visits” are just like regular office visits and
consist of an update on the patient’s health, a review of medications,
any potential complications, and a standardized motor skills evaluation
(balance, gait, coordination, and stiffness) conducted by the physician
with the assistance of a trained nurse at the Presbyterian Home.At the
end of the visit, recommendations are discussed with the patient and
faxed to the nursing home.
An initial pilot project, funded by the
Presbyterian Home, followed 14 patients for 6 months and then evaluated
the outcomes of those who received telemedicine care with those who did
not.The study found that telemedicine patients had significant
improvements in quality of life and motor function.In addition, those
receiving telemedicine had trends toward higher satisfaction with their
care.
The project with the Presbyterian Home was so
successful that Joseph decided to continue funding the effort for
another year with the help of a grant from New York State. Dorsey and
Biglan also hope to expand the project to other nursing homes in upstate
New York.One of the key obstacles to the wider adaption of telemedicine
for Parkinson’s and other diseases is payment for services.While studies
of other projects have shown that telemedicine can reduce the overall
cost of care, current reimbursement is limited to specific regions (for
example, it excludes New Hartford as not sufficiently rural) and
generally does not cover the cost of care provided.
If broadly adopted, telemedicine has the potential
to reshape the way individuals with Parkinson’s disease think about
their care and, ultimately, where to live. Currently, people often have
to live near medical centers to receive the specialty care they
need.Telemedicine has the potential to change that.In addition,
telemedicine can facilitate the participation of individuals in clinical
trials by reducing the travel and time burden on participants and their
caregivers.
“The number of people with Parkinson’s will double
over the next 25 years,” said Biglan.“This should be a wake up call to
the medical community and government to invest in innovative ways to
bring care to this population.Telemedicine represents a tremendous
opportunity to expand access to specialized care and improve the quality
of life of patients regardless of where they live."
