In the May issue of Neurology, Dorsey and colleagues from the Parkinson's Foundation Center of Excellence in Rochester, NY, asked an interesting question: can group visits for Parkinson's disease (PD) care provide a feasible alternative to regular doctor visits? The idea of group visits is not new for other chronic diseases but had not been previously studied in PD. Dorsey and colleagues randomly divided patients into two groups: the first would have 12 months of group visits and the second would continue regular "one on one" style care. Four group visits were administered over the course of a year, with each lasting an hour-and-a-half. Because of the small size of the study, the investigators were primarily interested in whether the care model for PD was feasible (could they recruit and would the patients complete the study). The investigators were also interested in whether there would be an added benefit in quality of life measures.
Ultimately, 30 patients and 27 caregivers participated. Quality of life was not discovered to be different between the groups randomized to group versus one on one care. The investigators concluded that group care was feasible, but that it did not offer any enhancement to the quality of life. There were many weaknesses in the study. The readers were not told how many people had to be screened to ultimately reach the goal of 30 patients. It would have been useful to know who declined participation, as this information may have enhanced the understanding of who will be the captive audience for the future of PD care groups. We would suspect that patients with shorter disease duration and those with less severe disease would potentially opt for group care, but this data remains unknown. Also, more patients will need to be included in the future, and more documentation provided on the economic and non-economic benefits to the healthcare system.
There is something very attractive about group visits for many PD patients. First, they receive a solid hour and a half with the physician. Next, they get a rare opportunity at 40 minutes of education on a PD topic of the group's choice. Finally, patients and caregivers get 20 minutes of discussion and questions, followed by the option of a quick 10-minute personal visit with the doctor. The group visit therefore offers opportunities for socializing, and for fostering the idea that one is not alone with their PD.
Despite the potential benefits of group visits, many patients who travel to see their PD doctor may have serious motor, non-motor and quality of life issues. Many patient problems could be private, and may be most appropriately addressed behind closed doors. Patients may need more than 10 minutes to review medications and to update prescriptions. Group visits may struggle in addressing the need for interdisciplinary services such as physical therapy, occupational therapy, speech therapy, and social work.
What shape will the future of group care visits for PD take over the next two decades? Group visits may be better suited to different arenas such as exercise therapy, dance therapy and psychological counseling—and these arenas may provide an easier argument for insurance-based reimbursement. Group visits may have a future in helping select patients and families with their PD issues; however, which types of patients and services should be thoughtfully addressed. Finally, it will be important to better define the economic and non-economic benefits to the health care system of a group approach—it is definitely feasible, but as a society we should ask when and where it will have its greatest impact.
Dorsey ER, Deuel LM, Beck CA, Gardiner IF, Scoglio NJ, Scott JC, Marshall FJ, Biglan KM. Group patient visits for Parkinson disease: A randomized feasibility trial. Neurology. 2011 May 3;76(18):1542-7. Epub 2011 Apr 27. PubMed PMID: 21525426.