Parkinson’s disease (PD) affects nearly one million Americans. A significant number do not receive specialized care, which increases risk for further healthcare needs. Penn Medicine neurologists have spearheaded the use of telemedicine for Parkinson’s disease and other movement disorders to improve access to care and patient outcomes.
“In the United States, access to subspecialty healthcare is limited for rural and homebound patients. Telemedicine can be a way to bridge that gap,” says Meredith A. Spindler, MD, associate clinical director of Penn Parkinson's Disease and Movement Disorders Center and associate professor of clinical neurology.
Dr. Spindler has a history of researching and advocating for the use of telemedicine for Parkinson’s disease and movement disorders. She notes in her 2021 Telemedicine and e-Health publication that Penn Neurology was one of the first departments at Penn to adopt telemedicine during the onslaught of COVID-19.
The Immense Need for Accessible, Specialized Parkinson’s Disease Care
The PD population faces all the traditional barriers to healthcare, ranging from geographical location to the availability of providers in the region. According to a 2022 survey, more than one-third of people with PD have difficulty getting to healthcare centers for a variety of reasons. People with PD often face motor and cognitive disabilities that present additional challenges in getting to a clinic.
In her 2011 study published in Neurology, Allison Willis, MD, director of the Penn Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes and chief of the Division of Neurology at the Philadelphia VA Medical Center, found that 42 percent of Medicare beneficiaries with PD do not even have a neurologist. In the same study, she showed that women and minorities with PD had a significantly lower likelihood of seeing a neurologist.
The literature consistently shows that a lack of neurological evaluation, disease diagnosis and treatment leads to dangerous consequences for PD patients, including higher rates of:
- Emergency department visits
- Hip fractures and falls
- Hospitalizations for psychosis
- Infection, such as urinary tract infection
- Mortality
- Placement in a skilled nursing facility
- Traumatic injury
“Improved access to specialized PD care could significantly reduce the risk of these complications, and teleneurology could be the answer for those with geographic or mobility limitations,” Dr. Spindler proposes.
The Role of Teleneurology in Parkinson’s Disease
Increased and consistent use of telemedicine for Parkinson’s disease offers a promising way to extend healthcare’s reach. Providers can complete the main aspects of a patient exam for PD visually, a structure that lends itself toward virtual care.
Dr. Spindler’s findings in Neurology Clinical Practice showed equal clinical outcomes for teleneurology versus in-person visits for the Unified Parkinson’s Disease Rating Scale (UPDRS), Geriatric Depression Scale (GDS) and quality of life measures. A modified version of the UPDRS that omits assessments of rigidity and postural instability, which are more difficult to do remotely, has also proven reliable.
Across the board, research shows PD patients and providers alike report satisfaction with telemedicine for Parkinson’s disease. They also note that online neurology consultations compare to in-person visits overall and in terms of care received or provided, clinical outcomes, comfort and personal connection.
A study by Thomas Francis Tropea, DO, assistant professor of neurology, showed that 93 percent of Penn neurologists thought the physician-patient relationship over telemedicine was good or excellent. Of particular note, 89 percent of movement disorders specialists found the overall experience of virtual visits to be the same or better than in-person visits.
According to a 2018 survey by the Movement Disorders Society, 36 percent of leading neurology departments in the US use telemedicine for movement disorders, up from 22 percent in 2012. This significant proportion (and increase in use), combined with Dr. Tropea’s findings, suggests that telehealth is an especially useful tool for assessing movement disorders like PD.
“In addition to Parkinson’s disease, we have virtual follow-up visits available for every movement disorder,” notes Dr. Spindler. Through the Penn Connected Care telemedicine program, patients have easy access to Parkinson's and Movement Disorders Virtual Visits.
Based on her experience and existing research, Dr. Spindler highlights a few clear patient benefits of teleneurology for PD, including:
- Access to multidisciplinary care without visits to several doctor’s offices
- Decreased discomfort during evaluations that require patients to be “off” medication
- Improved access to much-needed longitudinal care, especially during late-stage PD
- Insight into patients’ abilities in their at-home environment
- No travel time or travel resources required
- Reduced patient costs
Penn’s Virtual Deep Brain Stimulation Evaluation
When the pandemic restricted in-person visits at Penn, the team quickly adapted its Deep Brain Stimulation (DBS) Pre-Operative Evaluation Program to a virtual platform — a format that has continued. Led by Dr. Spindler, the program assesses whether patients will be a good fit for DBS (a successful therapy for PD motor symptoms) and provides in-depth information about the treatment.
Using telemedicine has eased the initial evaluation for patients. Once a patient gets referred to the DBS preoperative clinic, they receive virtual meeting links for the various components of their visit.
“Patients have to start their visit off medication, which is often very uncomfortable,” explains Dr. Spindler. “When we started doing the off evaluation by telemedicine, it became very clear that it was a lot easier for people to do it at home.”
Penn providers complete a private, virtual off exam with each patient before giving a one-hour virtual presentation about DBS and what to expect to all patients and family members present. After answering attendee questions in a group setting, the team again meets with everyone individually for remaining questions and an exam on medications. Patients also complete separate in-person evaluations at the rehabilitation center as part of their preoperative evaluation.
“It’s brain surgery, and it’s complicated,” says Dr. Spindler. “The telehealth visit is chance for us to evaluate patients, but also for patients to evaluate the surgery comprehensively.”
Limitations of Telehealth for Neurology
“While the pandemic made telemedicine more ubiquitous, it unfortunately has not appeared to significantly increase access for rural and underserved communities for reasons that are not entirely clear,” says Dr. Spindler. She proposes a few possibilities, including:
- Hesitation about the quality of telehealth versus in-person care
- Medical license laws that prevent clinicians from reaching more geographical areas
- The digital divide (lack of access to the technology and knowledge necessary to join a virtual visit)
“I want people to know that they don’t have to cross the state of Pennsylvania to access us, get an opinion and find treatment,” says Dr. Spindler.
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