Feasibility of telemedicine for patients with parkinsonism in the Brazilian public health system

Santos, Daniel Teixeira; Camelo, Daniel Monte Freire; Strelow, Matheus Zschornack; Silva, Maysa Tayane Santos; Führ, Paula; Marins, Letícia Winer; Schumacher-Schuh, Artur Francisco

doi:10.1055/s-0042-1755323

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Brasil

Arquivos de Neuro-Psiquiatria

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Original Article • Arq. Neuropsiquiatr. 80 (9) • 2022 • https://doi.org/10.1055/s-0042-1755323 copy

Feasibility of telemedicine for patients with parkinsonism in the Brazilian public health system

Viabilidade da telemedicina para pacientes com parkinsonismo no sistema público de saúde brasileiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Telemedicine for patients with parkinsonism is feasible, cost-effective and satisfactory. However, the feasibility of this modality of care for this subpopulation is not known in real-life scenarios of developing countries like Brazil.

Objective

To evaluate the feasibility of telemedicine for patients with parkinsonism in a developing country.

Methods

A cross-sectional study with patients with parkinsonism treated in the Brazilian public healthcare system. We included 130 patients, who were contacted by telephone; those who could be reached underwent a structured interview for data collection. The primary outcomes were the feasibility of teleconsultations and video consultations, but we also performed a logistic regression regarding the feasibility of a video consultation and associated factors.

Results

Telemedicine was feasible and accepted by 69 (53.08%) patients regarding teleconsultations and by 50 (38.5%) patients regarding video consultations. Tele-consultations were feasible for 80.2%, and video consultations were feasible for 58.1% of the patients reachable through telephone calls. Having a higher family income was positively correlated with the feasibility for a video consultation while a negative association was observed regarding being married or in a stable union and having a low level of schooling.

Conclusions

A significant proportion of patients with parkinsonism in a developing country are unreachable, unwilling, or unable to participate in telemedicine. Among the reachable patients, feasibility is higher but still lower than what is reported in studies in developed countries. Family income, level of schooling, and marital status were associated with the feasibility of video consultations.

Keywords:
Parkinsonian Disorders; Parkinson Disease; Telemedicine; Remote Consultation

Variables
Age, mean ± standard deviation	64.68 ± 11.10
Gender, male	44	63.8%
Marital status, married or stable union	39	56.5%
Ethnicity, white	62	89.9%
Degree of education
Elementary school or lower	17	24.6%
Middle school	14	20.3%
High school	26	37.7%
Bachelor degree or higher	12	17.4%
Family income (monthly minimum wages)
1	15	21.7%
2	30	43.5%
3	15	21.7%
4 or more	9	13.0%
Diagnosis, Parkinson’s disease	63	91.3%
Disease’s duration, mean ± standard deviation	10.94 ± 6.71
Absence of dementia	56	81.2%
Treatment with deep brain stimulation	12	17.4%
Schwab and England scale, dependen¹ 1 Score of 80% or lower in the scale.	54	78.3%

		N	%
Teleconsultation is effective		62	89.9%
Worsened care if only by teleconsultation		29	42.0%
Travel time to the clinic (minutes): mean ± standard deviation		91.30 ± 87.7
Benefits of teleconsultations (open-ended)	No need to mobilize patient for in-person visit	46	66.7%
	Safety in the context of the COVID-19 pandemic	23	33.3%
	No need to pay for travel costs	21	30.4%
	No need to wait in a waiting room	1	1.5%
	Possibility of more consultations	2	2.9%
Has a telephone, tablet or computer with internet access		59	85.5%
Knows how to use technology for video consultations		55	79.7%
Has the interest and means to attend to a video consultation		50	72.5%*
Technology preferred for video consultations (n = 50): smartphone		44	88.0%
Would receive aid from a caretaker in a video consultation (n = 50)		37	74.0%

	Had the means and interest in attending a video consultation (n = 69)		OR (95%CI)	P-value
	No (n=19)	Yes (n =50)	OR (95%CI)	P-value
Age (years)	–	–	1.02 (0.97–1.07)	0.36
Family income (monthly minimum wages)	–	–	2.21 (1.1–4.44)	0.03
Disease duration	–	–	1.04 (0.95–1.13)	0.42
Gender: male	14 (73.7%)	30 (60.0%)	0.54 (0.17–1.72)	0.29
Marital status: married or in a stable union*	15 (79%)	24 (48.0%)	0.25 (0.07–0.85)	0.03
Level of schooling: low**	9 (47.4%)	8 (16.0%)	0.21 (0.07–0.69)	0.01
Diagnosis of Parkinson disease	18 (94.7%)	45 (90.0%)	0.5 (0.05–4.58)	0.54
Absence of dementia	17 (89.5%)	39 (78.0%)	0.42 (0.08–2.09)	0.29
Treatment with deep brain stimulation: yes	1 (5.3%)	11 (22.0%)	5.08 (0.61–42.38)	0.13
Classification in the Schwab and England Activities of Daily Living scale: dependent***	14 (73.7%)	40 (80.0%)	1.43 (0.42–4.91)	0.57

Step 1: initial multivariate model	OR (95%CI)	p-value
Family income (monthly minimum wages)	2.63 (1.09–6.25)	0.03
Marital status: married or in a stable union*	0.2 (0.05–0.81)	0.02
Level of schooling: low**	0.16 (0.04–0.71)	0.02
Treatment with deep brain stimulation: yes	7.69 (0.78–100.0)	0.08

Step 2: final multivariate model	OR (95%CI)	p-value
Family income (monthly minimum wages)	2.78 (1.16–6.67)	0.02
Marital status: married or in a stable union*	0.19 (0.05–0.76)	0.02
Level of schooling low**	0.22 (0.06–0.83)	0.02

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[1] Address for correspondence Artur F. Schumacher Schuh (e-mail: aschuh@hcpa.edu.br).