WebMD Medical News
Laura J. Martin, MD
April 27, 2011 -- Group doctor visits may be a preferred form of care for some people with Parkinson’s disease, a study shows.
The new research appears online in Neurology.
Parkinson’s is a progressive movement disorder affecting nearly 1 million people in the U.S.
Group doctor visits have been shown to enhance quality of life for people with other chronic health conditions, including diabetes and heart disease. But this is the first time that this approach has been studied among people with Parkinson’s disease.
In the study, group sessions lasted 90 minutes and were held every three months. They consisted of a brief introduction, followed by 10 minutes of patient updates, 40-minute education sessions on a topic chosen by the group, and 20 minutes of questions and answers followed by a brief 10-minute one-on-one meeting with the doctor.
The greatest number of participants in any of the sessions was 13 -- seven patients and six caregivers.
After one year, there was no difference in quality of life seen among people who took part in the group sessions vs. those who had individual half-hour visits with their doctors every three to six months. There were no confidentiality issues expressed by people in the group sessions.
All participants in the study had mild to moderate Parkinson's disease. The findings may not apply to people with advanced Parkinson’s disease.
Researchers set out to determine how willing people with Parkinson’s disease and their caregivers would be to take part in such group sessions. After the study, eight of 14 people who received group care said they preferred it. Five wanted to go back to traditional care and one person was indifferent. Among those in the traditional care group, five of 14 said they wanted group care, six preferred their usual care, and three were undecided.
The best way to provide care for people with Parkinson’s disease is a work in progress, says study researcher Ray Dorsey, MD, a neurologist at Johns Hopkins University School of Medicine in Baltimore.
As it stands, many people with Parkinson’s disease remain in the waiting room for at least 20 minutes before they see their doctor. And they have limited time with their doctor. As a result, they aren’t satisfied with the level of care that they receive.
“There is insufficient time to engage and discuss issues that are important,” Dorsey says.
The group visits “try to marry the best of support group and one-on-one doctor encounters to deliver health care for people with chronic conditions,” he says.
“Patients don’t know other individuals who have similar burdens, and there are also geographic barriers to Parkinson’s specialists,” he says.
Are group visits a cure-all for Parkinson’s disease?
Likely not, Dorsey says, but “this is a step in the right direction for changing the way that health care is given to people with Parkinson’s, disease.”
There may also be a role for telemedicine in treating people with Parkinson’s, he says.
Telemedicine allows for virtual visits with your doctor via a computer. “This can remove geographical barriers to care for people with Parkinson disease who are in nursing homes,” he says.
Stephen G. Reich, MD, co-director of the Parkinson's disease and Movement Disorders Center at the University of Maryland School of Medicine in Baltimore, co-authored an editorial accompanying the new study with William J. Weiner, MD, chair of neurology at the University of Maryland School of Medicine.
Group visits are “one potential part of care, not a solution,” he says. “It is challenging to meet the needs of people with Parkinson’s disease and group visits are not a substitute for one-on-one visits, but may be an adjunct.”
In these group sessions, “patients may have more time with the physician and there could be mutual support from other patients and caregivers,” he says.
Parkinson’s is more than just a movement disorder. Besides tremor, stiffness, slowness, and imbalance, people with Parkinson’s disease also are prone to depression and anxiety, cognitive impairment including hallucination, sleep disorders, swallowing difficulty, bladder and bowel problems, pain, numbness and tingling, he says. Caregiver issues are also paramount, Reich says.
“How could you really cover all of those things in the usual half-an-hour visit?”
"The idea is fascinating," says Michele Tagliati, MD, director of the movement disorders program at Cedars-Sinai Medical Center in Los Angeles.
But "people with Parkinson's disease are all fairly different in terms of their needs and how they present, so for this to work a great amount of time would be needed to put people with similar features, questions, and stages of the disease together in a group," he says.
"It does seem to have a support group function including disease education and the idea of sharing strategies to cope with Parkinson's, which could be a complement to medical care as we currently practice it," says Blair Ford, MD, a professor of clinical neurology at Columbia University Medical Center in New York City and a scientific advisor for the Parkinson's Disease Foundation.
"Most of the patients [in the study] had relatively mild disease and were highly motivated and educated, yet it took researchers a long time to recruit such a small number of patients, so there are some obstacles," he says.
"It may be that there is an unmet need for support groups," Ford says.
SOURCES:Dorsey, E.R. Neurology, 2011; vol 76: pp 1542-1547.Reich, S.G. Weiner, W.J. Neurology, 2011; vol 76: pp 1538-1539.Stephen G. Reich, MD, co-director, Maryland Parkinson's Disease and Movement Disorders Center, Baltimore.Ray Dorsey, MD, neurologist, Johns Hopkins University School of Medicine, Baltimore.Parkinson’s Disease Foundation.Michele Tagliati, MD, director, movement disorders program, Cedars-Sinai Medical Center, Los Angeles.Blair Ford, MD, professor, clinical neurology, Columbia University Medical Center, New York City.
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