Infectious Disease

Socio-economic standing influences telemedicine use by Parkinson’s sufferers throughout COVID-19

January 25, 2021

4 min read

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According to an analysis of more than 1,300 patients published in NJP Parkinson’s, the use of telemedicine among patients with Parkinson’s disease rose from 9.7% before the COVID-19 pandemic to 63.5% during the pandemic.

However, the analysis also found that people with higher socioeconomic status, particularly those related to education and income, were more likely to resort to telemedicine, indicating differences in access to this resource.

“Managing PD symptoms is complex,” James Beck, PhD, senior vice president and chief scientific officer of the Parkinson Foundation, told Healio. “People who live with Parkinson’s disease need regular doctor visits to their neurologists as well as frequent use of other medical services such as physical therapy, occupational therapy, or mental health services. These medical visits, as well as almost all other interactions, came to an abrupt halt when COVID-19 hit. “

The COVID-19 pandemic “has turned our whole lives upside down,” Beck continued. The stress and a “chronic, progressive disease” like PD – and the fact that most patients with PD are older and have a “particularly high risk for negative outcomes” from COVID-19 – prompted Beck and colleagues to conduct an anonymous survey of Parkinson’s patients and their caregivers use the Parkinson Foundation and Columbia University’s Parkinson Disease Center of Excellence mailing lists.

The researchers saw an average response rate of 19.3%. The final analysis included responses from 1,342 patients.

The mean age of the patients with PD who responded to the survey was 71 years (range, 32-93 years), according to study results. Just over half of those with PD were women (50.6%) and more than 90% identified themselves as white, while 2.4% identified more as a race and 2.4% identified themselves as Hispanic Latino. The mean age at onset of Parkinson’s disease was 64 years (range 21-91 years) and the mean disease duration was 7 years (range <1 year to 52 years).

Effects of COVID-19

Only 17 patients with PD (1.3%) said they had been diagnosed with COVID-19 by a health care provider. 5 of these patients had confirmed COVID-19 through tests. The most common symptoms of COVID-19 were fatigue (70.59%), muscle pain (58.82%), body pain (58.82%), cough (62.94%), headache (47.06%), and shortness of breath ( 47.06%). The mean COVID-19 disease duration was 13.5 days.

Beck and colleagues found that most patients with PD (87.9%) correctly answered all COVID-19 knowledge questions. A similar percentage of patients (> 85%) stated that their personal life had changed due to the pandemic. About half of respondents described a negative change in Parkinson’s disease symptoms, including reports of mood disorders in 45% to 66% of patients.

According to the study results, the use of telemedicine in patients with Parkinson’s rose from 9.7% before the pandemic to 63.5% during the pandemic. Researchers observed an association between telemedicine use during the pandemic and household income greater than $ 100,000 per year (OR = 1.54; 95% CI, 1.06-1.76) and post-secondary education (OR = 2 , 05; 95% CI, 1.16) -3.62). The use of telemedicine before the pandemic also correlated with greater use of telemedicine during the pandemic (OR = 2.27; 95% CI, 1.34-3.85).

“Telehealth usage increased from 9.7% to 63.5% in just three months, and respondents were generally satisfied with these telehealth services. About half of the respondents stated that they would like to continue to use telehealth services, ”said Beck. “However, the use of telehealth has been associated with higher income, higher education and earlier use of telehealth.”

The researchers also looked at mood symptoms in the survey, according to Beck, and the responses showed that COVID-19 restrictions “took a toll” on patients with Parkinson’s disease.

“In the 6 weeks prior to the survey, more than half of the respondents had nervousness or anxiety (66.5%), a feeling of dejection or depression (50.9%), less interest or pleasure in activities (53.7%) ) or sleep disorders (66.2%), “Beck said.” All of these symptoms are common in Parkinson’s, but what we saw here was higher than in pre-pandemic studies. We also found differences between gender and income, with Women and respondents with lower incomes reported a higher prevalence of mood symptoms. “

Obstacles to Telehealth

In particular, the study results showed that a woman (OR = 1.81; 95% CI, 1.31-2.5) identified herself as white (OR = 1.82; 95% CI, 1.07-3 , 12) and exercising less (OR = 1.41; 95% CI, 1.03–1.94) correlated with feelings of nervousness, fear or “nervous”. In addition, the researchers associated with being a woman, having a household income of less than $ 50,000 a year, and exercising less, with feelings of uncontrollable worry, depression, or hopelessness and isolation.

“Our data strongly suggests differences in the socioeconomic status of people with Parkinson’s disease during the COVID-19 pandemic, with those on lower incomes being far more vulnerable to financial and professional uncertainties,” Beck said.

The increased use of telemedicine among Parkinson’s patients who were rich and educated is manifold, he continued: “It’s not just that these people had much better access to computers, tablets or phones with cameras. It is likely that they had the resources from friends or family to master the technology. Extending telemedicine to economically disadvantaged populations can help reduce the disparities. “

More research is needed to understand the barriers to using telehealth in rural and non-white communities, Beck said.

“While telehealth is a great option for people in rural areas, we could benefit from a better understanding of the potential motivators and barriers to care, especially the mental health and related health services that are often unavailable to people with Parkinson’s disease in rural communities. “he said.” We could also benefit from understanding the potential motivators and barriers to telehealth in non-white communities in order to improve care uptake. “

The Parkinson’s Foundation has created a blog post designed to help patients with Parkinson’s prepare for telemedicine visits, Beck added. This blog post can be accessed here: https://www.parkinson.org/blog/tips/Telemedicine.

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