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.

Background

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.

Woman on phone

Aims

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.

Challenges

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.

Outcomes

“So much easier – no time off work, no bus journey or fight to find a parking place.”

Anonymous patient

“If given the choice I would prefer face to face contact, this aids the doctor’s assessment.”

Anonymous patient

Next steps

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