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帕金森病的虚拟就诊:一项多中心非对照队列研究。

Virtual visits for Parkinson disease: A multicenter noncontrolled cohort.

作者信息

Korn Ryan E, Wagle Shukla Aparna, Katz Maya, Keenan H Tait, Goldenthal Steven, Auinger Peggy, Zhu William, Dodge Michael, Rizer Kyle, Achey Meredith A, Byrd Erica, Barbano Richard, Richard Irene, Andrzejewski Kelly L, Schwarz Heidi B, Dorsey E Ray, Biglan Kevin M, Kang Gail, Kanchana Sulada, Rodriguez Ramon, Tanner Caroline M, Galifianakis Nicholas B

机构信息

University of Rochester School of Medicine and Dentistry (REK, HTK); Center for Human Experimental Therapeutics (REK, HTK, SG, PA, WZ, MAA, ERD, KMB) and Department of Neurology (PA, RB, IR, KLA, HBS, ERD, KMB, SK), University of Rochester, NY; Center for Movement Disorders and Neurorestoration (AWS, KR), Department of Neurology, University of Florida, Gainesville; Department of Neurology (MK, MD, EB, CMT, NBG), University of California-San Francisco; Parkinson's Disease Research, Education and Clinical Center (MK, MD, EB, CMT, NBG), San Francisco Veterans Affairs Medical Center, CA; University of Michigan Medical School (WZ), Ann Arbor; Department of Neurology (KLA), University at Buffalo, NY; Neurology Private Practice (GK), Berkeley, CA; and Department of Internal Medicine (RR), University of Central Florida College of Medicine, Orlando, FL.

出版信息

Neurol Clin Pract. 2017 Aug;7(4):283-295. doi: 10.1212/CPJ.0000000000000371.

Abstract

BACKGROUND

Previous small-scale studies have demonstrated the feasibility of providing remote specialty care via virtual visits. We assessed the feasibility and benefits of a one-time consultation between a remote Parkinson Disease (PD) specialist and an individual with PD at home on a larger scale.

METHODS

We conducted a multicenter noncontrolled cohort of virtual visits administered over videoconferencing between remote PD specialists and individuals with PD in their home. Specialists performed a patient history and a PD-specific physical examination and provided recommendations to patients and their local physicians. The primary outcome measures were feasibility, as measured by the proportion of visits completed as scheduled, and the 6-month change in quality of life, as measured by the Parkinson's Disease Questionnaire 39. Additional outcomes included satisfaction with visits and interest in future virtual visits.

RESULTS

A total of 277 participants from 5 states enrolled, 258 participants completed virtual visits with 14 different physicians, and 91% of visits were completed as scheduled. No improvement in quality of life was observed at 6 months (0.4-point improvement; 95% confidence interval -1.5 to 0.6; = 0.39). Overall satisfaction with virtual visits was high among physicians (94% satisfied or very satisfied) and patients (94% satisfied or very satisfied), and 74% of participants were interested in receiving future care via virtual visits.

CONCLUSIONS

Providing specialty care remotely into the homes of individuals with PD is feasible, but a one-time visit did not improve quality of life. Satisfaction with the visits was high among physicians and patients, who were interested in receiving such care in the future.

CLASSIFICATION OF EVIDENCE

This study provides Class IV evidence that for patients with PD, remote specialty care is feasible but does not improve quality of life.

CLINICALTRIALSGOV IDENTIFIER

NCT02144220.

摘要

背景

先前的小规模研究已证明通过虚拟就诊提供远程专科护理的可行性。我们在更大规模上评估了远程帕金森病(PD)专科医生与居家的PD患者进行一次性会诊的可行性和益处。

方法

我们开展了一项多中心非对照队列研究,通过视频会议对远程PD专科医生与居家的PD患者进行虚拟就诊。专科医生进行了病史采集和PD特异性体格检查,并向患者及其当地医生提供建议。主要结局指标为可行性,通过按计划完成就诊的比例衡量;以及生活质量的6个月变化,通过帕金森病问卷39衡量。其他结局包括对就诊的满意度以及对未来虚拟就诊的兴趣。

结果

来自5个州的共277名参与者入组,258名参与者与14位不同医生完成了虚拟就诊,91%的就诊按计划完成。6个月时未观察到生活质量改善(改善0.4分;95%置信区间为 -1.5至0.6;P = 0.39)。医生(94%满意或非常满意)和患者(94%满意或非常满意)对虚拟就诊的总体满意度较高,74%的参与者有兴趣通过虚拟就诊接受未来护理。

结论

向居家的PD患者远程提供专科护理是可行的,但一次性就诊并未改善生活质量。医生和患者对就诊的满意度较高,他们有兴趣在未来接受此类护理。

证据分类

本研究提供了IV级证据,即对于PD患者,远程专科护理可行但未改善生活质量。

临床试验注册号

NCT02144220。

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