In most parts of this country there simply aren’t enough neurologists. Twenty states have, in fact, been identified as neurology deserts, according to data presented this year (2017) at the Alzheimer’s Association International Conference.
Jaime M. Hatcher-Martin, MD, PhD, a neurologist in Atlanta, says that out of the 159 counties in Georgia, there are only 37 that have a neurologist. Of those neurologists, only four, including herself, are movement disorders specialists. She says that many of her patients live hours away, and that is a big problem, especially for those with cognitive impairment and mobility issues.
Seeing this issue, she has created a virtual tele-movement clinic, allowing her to see patients with movement disorders like Parkinson and Huntington diseases via her computer one morning a week. This arrangement offers more than just convenience. “You get to see the patients at home. You get to see why they are falling—maybe there are papers all over the floor, or a cat weaving in and out of their feet,” she says. “Not only do you learn more about the environment they live in, the patient is also more comfortable being in their own environment.”
Martin gave a live demonstration of a tele-movement visit at the 2017 meeting of the American Academy of Neurology in Boston. Projecting her laptop onto a screen, she could share her head-to-toe view of a patient standing in her living room. Martin asked her patient to perform various tasks like walking, finger taps, and finger-to-nose.
“You may have to change the order of the exam,” says Martin, to accommodate the video set up. She observes her patient’s gait and arm swing as she speeds up. She looks for bradykinesia and tremor and then at posture. She checks her turns. “You can sometimes have a family member help out if you are worried about falls,” she says. “You can ask them to come closer to the screen for eye tests as well.”
Because you can’t do hands-on tests for things like rigidity, spasticity, and abnormal reflexes, Martin requires all telemedicine patients to have their initial evaluations done in person. But, “Many of the tests work nearly as well under video” and the advantages far outweigh the limitations. For many, she says, it is the reason they are seeing a neurologist at all.
A 2017 study of virtual house calls for Parkinson disease, published in Neurology, confirms the benefits and feasibility of these visits. In a randomized controlled trial, researchers looked at 195 patients, comparing usual care to usual care plus four video home conference visits. They quantified the feasibility of the virtual house calls by how often patients showed up and if they were on time. They determined the benefits of these visits using a quality of life survey (Parkinson Disease Questionnaire 39) as well as by looking for time and travel savings.
In this study, 90 percent of the virtual house calls were completed, a much higher attendance rate than you’ll see at a typical clinic. Quality of life changes were comparable to in-person visits, and “Each virtual house call saved patients a median of 88 minutes and 38 miles per visit.”
At the conference, Martin’s patient is clearly enthusiastic about this new kind of neurology visit and tells her, “Being able to talk to you from home is very convenient because your office is an hour from home, and J… can’t always take me.”
Patients want this service, and many already have the technology in their homes to take part in it. In a Neurology Times article, Martin explains how easy it was to get started doing virtual visits with her patients. All she started with was an internet connection, a laptop and a basic webcam. She is not alone, practices all across the US are implementing telemedicine into their practices and getting reimbursed for it too. You can learn more from the American Telemedicine Association. “Get involved,” says Martin. Patients need this.