National randomized controlled trial of virtual house calls for Parkinson disease
National randomized controlled trial of virtual house calls for Parkinson disease
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DOI：
10.1212/wnl.0000000000004357
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发表时间：
2017-09-12
期刊：
影响因子：
9.9
通讯作者：
Zhu, William
中科院分区：
文献类型：
--
作者：
Beck, Christopher A.;Beran, Denise B.;Zhu, William
目的：为了确定是否提供远程神经系统护理到帕金森病（PD）的人的家是可行的，有益的，和valued.Methods：在一个为期1年的随机对照试验，我们比较了通常的护理，通常的护理补充4虚拟访问通过视频会议从远程专家到患者的家。主要结果指标是可行性，通过完成至少一次虚拟访问的比例和按时完成虚拟访问的比例来衡量;和疗效，通过帕金森病问卷-39（生活质量量表）的变化来衡量。次要结果包括护理质量，照顾者的负担，时间和旅行savings.Results：共有927人表示感兴趣，210人参加，195人随机。参与者最近看过专科医生（73%），大部分受过大学教育（73%）和白色（96%）。95人（干预组的98%）完成了至少一次虚拟访问，388次虚拟访问中有91%完成。接受虚拟出诊的患者的生活质量没有改善（在100分量表上差0.3分; 95%置信区间[CI] 22.0至2.7分; p = 0.78），护理质量或护理人员负担也没有改善。每次虚拟出诊为患者节省了88分钟（95%CI 70-120; p < 0.0001）和38英里（95%CI 36-56; p < 0.0001）的中位数。结论：直接向PD患者的家中提供远程神经病学护理是可行的，并且与常规的亲自护理相比既不更有效也不更有效。虚拟出诊引起了极大的兴趣，并提供了极大的便利。ClinicalTrials.gov标识符：NCT 02038959。证据分类：这项研究提供了III类证据，证明对于PD患者，神经科医生的虚拟出诊是可行的，与亲自就诊相比，不会显著改变生活质量。该研究被评定为III类，因为无法将患者掩蔽为访视类型。
Objective: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable.Methods: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings.Results: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] 22.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70-120; p < 0.0001) and 38 miles per visit (95% CI 36-56; p < 0.0001).Conclusions: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience. ClinicalTrials.gov identifier: NCT02038959. Classification of evidence: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.