Using telemedicine and wearable technology to establish a virtual clinic for people with Parkinson’s disease

Abstract

BackgroundTo develop an effective, patient-centred and sustainable service, we set up a virtual clinic (VC) for patients with Parkinson’s disease, combining phone consultations and reports from wearable technology. The Parkinson’s Kinetigraph (PKG) is a wrist-worn device providing objective motor assessment, generating a report used by clinicians to optimise medication regimens.InterventionsA pilot study of VC was designed using quality improvement methodology. For a VC appointment, patients were phoned by a clinician. After discussing symptoms and reviewing the PKG report, the clinician could decide on any medication changes or other interventions and relay this to the patient’s general practitioner in a clinic letter. Patient feedback was gathered via questionnaires and data collected on the outcomes and timings of the consultations.ResultsOver 12 clinics, 61 patients had VC appointments. Of questionnaire respondents, 89% were satisfied with VC (n=41). At VC, the clinician was able to make a treatment decision comparable to a face-to-face clinic in 79% of cases (n=48). Reasons appointments were deemed unsuccessful included issues with the PKG, speech or hearing problems and complex phase of disease. VC appointments, including administration time, last on average 22 min. This compares to 20 min face-to-face appointments but these do not include administration time.ConclusionsWe have demonstrated a safe and effective VC template. Most VC appointments are equivalent to face-to-face clinic in terms of treatment outcome. Success could be further improved by appropriate patient selection. Using VC is time saving and can result in releasing face-to-face appointment slots for those in urgent need or newly referred patients. Further cost analysis is required; the cost of the PKG alone is more expensive than a face-to-face appointment, but this does not take into account other value added, such as patient convenience and satisfaction, and reduced need for ambulance transport.

The state of telemedicine for persons with Parkinson's disease

“…Incorporating telemonitoring into regular clinical practice faces similar challenges. Recent work indicates that it is feasible and informative to employ telemonitoring tools such as wrist-worn sensors and smartphone applications in clinical practice [ 43 , 44 , 45 ▪ , 46 , 47 ▪ ]. However, conclusive evidence of their actual impact on clinical outcomes is lacking.…”

“…Pilot studies show positive experiences of clinicians who used such tools in clinical practice. Specifically, the information on symptom severity and medication intake displayed in these dashboards was in line with in-clinic assessments [ 43 ], enabled a clinician to make treatment decisions that were comparable to in-person evaluations in most cases [ 47 ▪ ], and resulted in more medication adjustments and higher medication doses [ 45 ▪ ]. Despite these encouraging initial findings, we lack large-scale randomized controlled trials (RCTs) assessing the effect of such dashboards on clinically relevant outcomes.…”

Feasibility of a continuous, multi-sensor remote health monitoring approach in persons living with neurodegenerative disease

“…Remote monitoring is particularly valuable for recording behaviors that occur sporadically and thus may not manifest during clinical appointments, behaviors that vary over time, and those symptoms that present differently in clinic versus at home [ 4 , 9 , 10 ]. Wearable technology, when paired with telemedicine as a virtual care tool, has also demonstrated clinical utility in the context of the COVID-19 pandemic [ 11 – 13 ]. Further, extended sensor wear in the home environment can reveal patterns in health-linked behaviors that can be captured with greater ecological validity and fidelity than point-in-time assessments or symptom diaries [ 14 , 15 ].…”

Promoting Self-Care in Nursing Encounters with Persons Affected by Long-Term Conditions—A Proposed Model to Guide Clinical Care

“…In recent years, technological advances have provided new opportunities in clinical care [ 18 ]. Technical devices are now used for symptom monitoring, initiation and titration of treatments for and provision of therapies for example cognitive behavioural therapy in Parkinson’s disease [ 19 , 20 ]. In the coming years technology will also be more integrated in the way self-management support is carried out.…”