Telemedicine Brings Parkinson’s Care To ‘Anyone, Anywhere’
December 5, 2013
A new study shows that a neurologist in an office thousands of miles away can deliver effective specialized care to people with Parkinson’s disease. For individuals with the condition – many of whom have never seen a specialist – these “virtual house calls” could allow them to live independently while effectively manage the symptoms of the disease.
“The idea that we can provide care to individuals with Parkinson disease regardless of where they live is both a simple and revolutionary concept,” said University of Rochester Medical Center (URMC) neurologist Ray Dorsey, M.D., M.B.A., senior author of the study which appears today in the journal Neurology: Clinical Practice. “This study demonstrates that, by employing essentially the same technology that grandparents use to talk to their grandchildren, we can expand access to the specialized care that we know will improve patient’s quality of life and health.”
More than 40 percent of people with Parkinson’s disease do not see a neurologist, placing these individuals at greater risk for poor health outcomes. For example, people with the disease who do not see a specialist are 20 percent more likely to fall and fracture a hip, 20 percent more likely to end up in a skilled nursing facility, and 20 percent more likely to die.
Geography is often a determining factor in whether a person with Parkinson’s sees a specialist. Neurologists with training in movement disorders like Parkinson’s disease tend to be concentrated in major academic medical centers. Additionally, the nature of the disease – particularly the impact on movement, balance, and coordination – can make a long trip to the doctor’s office unfeasible.
“We have an ample supply of neurologists in the country to take care of people with Parkinson’s, but because of distance, disability, and the distribution of doctors, many patients have a difficult time seeing a specialist,” said Dorsey.
Working with the patient networking website PatientsLikeMe, the study invited individuals with Parkinson’s who lived in the five states where Dorsey is licensed to practice medicine – California, Delaware, Florida, Maryland, and New York – to receive one free telemedicine consultation in the comfort of their own home.
The participants downloaded secure web-based video conferencing software developed by California-based Vidyo. The technology, which is akin to Skype, only requires an internet connected computer and a webcam.
Using this system, Dorsey saw more than 50 people with Parkinson disease, ranging from individuals who were getting a third opinion to those that were seeing a neurologist for the very first time. Virtually all of the visits resulted in treatment recommendations, including increasing exercise (86 percent), changes in current medications (63 percent), the addition on new medications (53 percent), and discussions about potential surgical options (10 percent). Patient satisfaction with the telemedicine care exceeded 90 percent.
Parkinson’ disease particularly lends itself to telemedicine because many aspects of the diagnosis and treatment of the disease are “visual” – meaning that the interaction with the doctor primarily consists of observing the patient perform certain tasks such as holding their hands out and walking and listening to the patient’s history.
“James Parkinson wrote the seminal description of the condition in 1817 by watching people walk in the park,” said Dorsey. “This is just a 21st century application of that principal of observation.”
The authors contend that this approach could also be applied to a number of other chronic conditions, from autism to Alzheimer disease, from diabetes to congestive heart failure. Collectively, chronic conditions affect over 140 million Americans and are responsible for 84 percent of health care expenditures.
While demonstrably effective, one of the key barriers to the wider adoption of this approach is the fact that Medicare does not pay for telemedicine care provided to people in their homes. Also, out-of-state physicians are barred from providing remote care to patients in many states.
These barriers prevent the potential savings – both in terms of cost and time – that can be realized by care delivered via telemedicine. A previous URMC study showed that not only did telemedicine visits cost less than providing care in a traditional setting such as a clinic or a hospital, but the virtual house calls saved patients an average of more than three hours and 100 miles of travel per visit when factoring in travel to and from the doctor’s office.
Dorsey and his colleagues are now extending the program with the support of the National Parkinson’s Foundation and support from the Patient Centered Outcomes Research Institute. The new study, called Connect.Parkinson, plans to enroll approximately 200 individuals with Parkinson’s disease beginning next year. Participants will either receive their usual care from a physician in their community or additional remotely-delivered care from a Parkinson’s disease center of excellence in their state.
“This research demonstrates that we can reach
“The idea that we can provide care to individuals with Parkinson disease regardless of where they live is both a simple and revolutionary concept,” said University of Rochester Medical Center (URMC) neurologist Ray Dorsey, M.D., M.B.A., senior author of the study which appears today in the journal Neurology: Clinical Practice. “This study demonstrates that, by employing essentially the same technology that grandparents use to talk to their grandchildren, we can expand access to the specialized care that we know will improve patient’s quality of life and health.”
More than 40 percent of people with Parkinson’s disease do not see a neurologist, placing these individuals at greater risk for poor health outcomes. For example, people with the disease who do not see a specialist are 20 percent more likely to fall and fracture a hip, 20 percent more likely to end up in a skilled nursing facility, and 20 percent more likely to die.
Geography is often a determining factor in whether a person with Parkinson’s sees a specialist. Neurologists with training in movement disorders like Parkinson’s disease tend to be concentrated in major academic medical centers. Additionally, the nature of the disease – particularly the impact on movement, balance, and coordination – can make a long trip to the doctor’s office unfeasible.
“We have an ample supply of neurologists in the country to take care of people with Parkinson’s, but because of distance, disability, and the distribution of doctors, many patients have a difficult time seeing a specialist,” said Dorsey.
Working with the patient networking website PatientsLikeMe, the study invited individuals with Parkinson’s who lived in the five states where Dorsey is licensed to practice medicine – California, Delaware, Florida, Maryland, and New York – to receive one free telemedicine consultation in the comfort of their own home.
The participants downloaded secure web-based video conferencing software developed by California-based Vidyo. The technology, which is akin to Skype, only requires an internet connected computer and a webcam.
Using this system, Dorsey saw more than 50 people with Parkinson disease, ranging from individuals who were getting a third opinion to those that were seeing a neurologist for the very first time. Virtually all of the visits resulted in treatment recommendations, including increasing exercise (86 percent), changes in current medications (63 percent), the addition on new medications (53 percent), and discussions about potential surgical options (10 percent). Patient satisfaction with the telemedicine care exceeded 90 percent.
Parkinson’ disease particularly lends itself to telemedicine because many aspects of the diagnosis and treatment of the disease are “visual” – meaning that the interaction with the doctor primarily consists of observing the patient perform certain tasks such as holding their hands out and walking and listening to the patient’s history.
“James Parkinson wrote the seminal description of the condition in 1817 by watching people walk in the park,” said Dorsey. “This is just a 21st century application of that principal of observation.”
The authors contend that this approach could also be applied to a number of other chronic conditions, from autism to Alzheimer disease, from diabetes to congestive heart failure. Collectively, chronic conditions affect over 140 million Americans and are responsible for 84 percent of health care expenditures.
While demonstrably effective, one of the key barriers to the wider adoption of this approach is the fact that Medicare does not pay for telemedicine care provided to people in their homes. Also, out-of-state physicians are barred from providing remote care to patients in many states.
These barriers prevent the potential savings – both in terms of cost and time – that can be realized by care delivered via telemedicine. A previous URMC study showed that not only did telemedicine visits cost less than providing care in a traditional setting such as a clinic or a hospital, but the virtual house calls saved patients an average of more than three hours and 100 miles of travel per visit when factoring in travel to and from the doctor’s office.
Dorsey and his colleagues are now extending the program with the support of the National Parkinson’s Foundation and support from the Patient Centered Outcomes Research Institute. The new study, called Connect.Parkinson, plans to enroll approximately 200 individuals with Parkinson’s disease beginning next year. Participants will either receive their usual care from a physician in their community or additional remotely-delivered care from a Parkinson’s disease center of excellence in their state.
“This research demonstrates that we can reach
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A telemedicina traz Cuidados de Parkinson como "Qualquer pessoa , em qualquer lugar "
5 de dezembro de 2013
Tradutor Google.
Um novo estudo mostra que um neurologista em um escritório a milhares de quilômetros de distância pode oferecer atendimento especializado eficaz para as pessoas com doença de Parkinson. Para os indivíduos com a doença - muitos dos quais nunca vi um especialista - essas " chamadas de casa virtual" poderia permitir-lhes viver de forma independente durante a gerir eficazmente os sintomas da doença.
"A idéia de que podemos fornecer o cuidado de indivíduos com doença de Parkinson , independentemente de onde eles vivem é tanto um conceito simples e revolucionário ", disse University of Rochester Medical Center ( URMC ) neurologista Ray Dorsey , MD , MBA, autor sênior do estudo, que aparece hoje na revista Neurology : Prática Clínica. " Este estudo demonstra que , ao empregar , essencialmente, a mesma tecnologia que os avós usam para falar com seus netos , podemos expandir o acesso ao atendimento especializado que sabemos que irá melhorar a qualidade de vida e saúde do paciente. "
Mais de 40 por cento das pessoas com doença de Parkinson não vejo um neurologista , colocando essas pessoas em maior risco de resultados de saúde pobres. Por exemplo , as pessoas com a doença que não consultar um especialista são 20 por cento mais propensos a cair e fraturar o quadril , 20 por cento mais probabilidade de acabar em serviços especializados de enfermagem , e 20 por cento mais probabilidades de morrer .
Geografia é muitas vezes um fator determinante para saber se uma pessoa com Parkinson vê um especialista. Neurologistas com formação em distúrbios do movimento , como a doença de Parkinson tendem a se concentrar nos grandes centros médicos acadêmicos . Além disso, a natureza da doença - em particular o impacto sobre o movimento , equilíbrio e coordenação - pode fazer uma longa viagem para o consultório médico inviável.
"Temos uma ampla oferta de neurologistas do país para cuidar de pessoas com Parkinson , mas por causa da distância , deficiência, ea distribuição de médicos , muitos pacientes têm dificuldade de ver um especialista ", disse Dorsey .http://www.redorbit.com/news/health/1113021049/telemedicine-brings-parkinsons-care-to-anyone-anywhere-2/
Trabalhando com o site de rede paciente PatientsLikeMe , o estudo convidou pessoas com Parkinson , que viveu nos cinco estados onde Dorsey é licenciado para praticar medicina - Califórnia , Delaware , Flórida, Maryland e Nova York - para receber uma consulta de telemedicina livre no conforto da sua própria casa.
Os participantes baixado software seguro videoconferência baseado na web desenvolvido pela Vidyo com sede na Califórnia . A tecnologia, que é semelhante ao Skype, requer apenas um computador conectado à Internet e uma webcam.
Usando este sistema, Dorsey viu mais de 50 pessoas com a doença de Parkinson , que vão desde indivíduos que estavam recebendo uma terceira opinião àqueles que estavam vendo um neurologista pela primeira vez. Praticamente todas as visitas resultou em recomendações de tratamento , incluindo o exercício aumentando (86 por cento ) , alterações na medicamentos atuais (63 por cento) , a adição de novos medicamentos ( 53 por cento) , e as discussões sobre possíveis opções cirúrgicas ( 10 por cento) . A satisfação do paciente com o cuidado de telemedicina ultrapassou 90 por cento.
Doença de Parkinson presta-se particularmente a telemedicina porque muitos aspectos do diagnóstico e tratamento da doença são "visual" - o que significa que a interação com o médico consiste principalmente em observar o paciente realizar determinadas tarefas, como segurando suas mãos e caminhar e ouvir a história do paciente .
" James Parkinson escreveu a descrição seminal do estado em 1817 , observando as pessoas caminham no parque ", disse Dorsey . " Esta é apenas uma aplicação desse princípio de observação do século 21. "
Os autores afirmam que esta abordagem também pode ser aplicada a uma série de outras doenças crónicas , a partir do autismo a doença de Alzheimer , a diabetes de insuficiência cardíaca congestiva . Coletivamente , as condições crônicas afetam mais de 140 milhões de americanos e são responsáveis por 84 por cento das despesas de saúde.
Embora comprovadamente eficaz , uma das principais barreiras para a adoção mais ampla dessa abordagem é o fato de que o Medicare não pagar por cuidados telemedicina prestados às pessoas em suas casas. Além disso, out-of -state médicos estão impedidos de prestar assistência remota a pacientes em muitos estados.
Estas barreiras evitar o potencial de poupança - tanto em termos de custo e tempo - que podem ser realizados pelo atendimento prestado via telemedicina. Um estudo anterior mostrou que URMC não só visitas de telemedicina custam menos do que a prestação de cuidados em um ambiente tradicional , como uma clínica ou um hospital, mas as chamadas casas virtuais salva pacientes uma média de mais de três horas e 100 quilômetros de viagem por visita , quando factoring em viagem de e para o consultório médico .
Dorsey e seus colegas estão agora a extensão do programa com o apoio da Fundação Nacional de Parkinson e apoio do Paciente Centrado Outcomes Research Institute . O novo estudo, chamado Connect.Parkinson , planeja matricular cerca de 200 indivíduos com doença de Parkinson começam no próximo ano. Os participantes irão receber ou seu tratamento usual de um médico em sua comunidade ou cuidado remotamente entregue adicional de um centro de doença de Parkinson de excelência em seu estado.
"Esta pesquisa demonstra que podemos chegar
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