A Virtual Clinic for people with Parkinson’s Disease
Lauren Evans, Specialty Registrar in Geriatric Medicine
Industry partner: Global Kinetics Corporation
Cardiff and Vale University Health Board
This Bevan Exemplar project set up a virtual clinic for people with Parkinson’s disease using wearable technology.
The geriatrician led Movement Disorder service in Cardiff & Vale cares for over 1500 people with Parkinson’s Disease (PD) and related disorders. Features of PD known as motor symptoms include slowed movement (bradykinesia) and tremor. NICE recommends offering regular follow up appointments to people with PD, so that the medications used to improve motor symptoms can be optimised.
The Parkinson’s Kinetigraph (PKG) is a wrist worn device that captures data on these motor symptoms. An online report is generated and this facilitates clinical decision making. Our service has over 18 months experience using the PKG system.
We proposed an innovative approach using telemedicine and wearable technology to meet increasing demand on services and provide quality care delivered to patients at home. Our aim was to set up a virtual clinic, where instead of travelling in to hospital, patients are phoned at home by their Parkinson’s doctor at a prearranged appointment time. The PKG report is a valuable surrogate for clinical examination part of the consultation. Patients can discuss any concerns with the doctor, and if any medication changes are indicated, these can be instigated by sending a GP letter. The phone clinic does not replace face-to-face clinics completely; we planned to alternate between virtual and face-to-face clinics every 6 months.
Our main challenge was ensuring the virtual clinics would be cost-effective. There is cost saving from not requiring nursing support or ambulance transport, but the cost of the PKG itself, even with substantial discounts from GKC, has proved to be a barrier.
- Over a pilot of 12 clinics, 61 patients had phone clinic appointments. Mean age was 70.
- 77% of appointments were successful in that a clinical decision could be made in the same way as face-to-face clinic.
- We received 47 returned patient feedback questionnaires. Of those respondents 87% agreed or strongly agreed that they we satisfied with phone clinic. However the free text comments showed a trend for finding the concept acceptable but would have a preference for a face-to-face appointment.
A more detailed cost analysis is ongoing, but initial estimates suggest that our virtual clinics were cost-neutral at best. As patient feedback indicates a preference towards face-to-face clinic, at this stage the virtual clinic is not feasible unless the cost of the PKG becomes substantially cheaper. We are considering the use of Skype as an alternative. We have written up our results for publication, so that our ground work in setting up this type clinic can be implemented in other areas of healthcare where the cost of technology may not be a limiting factor. The Bevan Commission Exemplar experience has been inspiring and although the results of the pilot were not as positive as expected, the process has helped equip the skills to take this project forward despite the setbacks.
Part of cohort Bevan Exemplar Projects 2018-19