Socioeconomic status impacts telehealth use in Parkinson’s disease during COVID-19
The use of telehealth among patients with Parkinson’s disease increased from 9.7% before the COVID-19 pandemic to 63.5% during the pandemic, according to an analysis of more than 1,300 patients published in NJP Parkinson’s Disease.
However, the analysis also found that individuals of higher socioeconomic status, specifically regarding education and income, increased their use of telehealth more often, indicating disparities in access to this resource.
“The management of PD symptoms is complex,” James Beck, PhD, senior vice president and chief scientific officer of the Parkinson’s Foundation, told Healio. “People living with PD require regular doctor visits with their neurologists, as well as frequent use of other medical services like physical or occupational therapy or mental health services. Those medical visits, as well as almost all other interactions, came to an abrupt halt as COVID-19 hit.”
The COVID-19 pandemic “upturned all of our lives,” Beck continued. The stress of that plus a “chronic, progressive disease” such as PD — and the fact that most patients with PD are elderly and “at particularly grave risk for negative outcomes” from COVID-19 — led Beck and colleagues to conduct an anonymous survey of patients with PD and their caregivers using mailing lists from the Parkinson’s Foundation and the Columbia University Parkinson’s Disease Center of Excellence.
The researchers saw an average response rate of 19.3%. The final analysis included responses from 1,342 patients.
The mean age of patients with PD who responded to the survey was 71 years (range, 32-93 years), according to the study results. Slightly more than half of the respondents with PD were women (50.6%) and more than 90% self-identified as white, while 2.4% reported more than one race and 2.4% self-identified as Hispanic Latino. Mean age at PD onset was 64 years (range, 21-91 years) and average disease duration was 7 years (range, <1 year to 52 years).
Impact of COVID-19
Only 17 patients with PD (1.3%) reported having been diagnosed with COVID-19 by a health care provider; 5 of these patients had COVID-19 confirmed through testing. The most frequent symptoms of COVID-19 included fatigue (70.59%), muscle pain (58.82%), body aches (58.82%), cough (62.94%), headache (47.06%) and shortness of breath (47.06%). Mean COVID-19 disease duration was 13.5 days.
Beck and colleagues found that most patients with PD (87.9%) responded to all COVID-19 knowledge questions correctly. A similar percentage of patients (>85%) reported that their personal lives had changed because of the pandemic. Approximately half of respondents described a negative change in the symptoms of PD they were experiencing, including reports of mood disturbances in 45% to 66% of patients.
Telehealth use in patients with PD increased from 9.7% before the pandemic to 63.5% during the pandemic, according to the study results. The researchers observed a link between use of telehealth during the pandemic and a household income of more than $100,000 per year (OR = 1.54; 95% CI, 1.06-1.76) as well as postsecondary education (OR = 2.05; 95% CI, 1.16-3.62). Use of telehealth before the pandemic also correlated with greater use of telehealth during the pandemic (OR = 2.27; 95% CI, 1.34-3.85).
“In just 3 months, telehealth use jumped from 9.7% to 63.5%, and survey respondents were generally satisfied with these telehealth services. About half of those surveyed said they wanted to continue using telehealth services,” Beck said. “However, telehealth use was associated with higher income, higher education and prior telehealth use.”
The researchers also examined mood symptoms in the survey, according to Beck, and the responses demonstrated that COVID-19 restrictions were “taking a toll” on patients with PD.
“More than half of respondents experienced nervousness or anxiety (66.5%), feeling down or depressed (50.9%), reduced interest or pleasure in doing things (53.7%) or sleep disturbances (66.2%) in the 6 weeks prior to the survey,” Beck said. “All of these symptoms are common in PD, but what we saw here was higher than seen in pre-pandemic studies. We also found gender and income differences, with women and lower-income respondents reporting a higher prevalence of mood symptoms.”
Barriers to telehealth
Specifically, the study findings demonstrated that being a woman (OR = 1.81; 95% CI, 1.31-2.5), self-identifying as white (OR = 1.82; 95% CI, 1.07-3.12) and decreased exercise (OR = 1.41; 95% CI, 1.03–1.94) correlated with feelings of nervousness, anxiousness or being “on edge.” In addition, the researchers linked being a woman, having a household income of less than $50,000 per year and decreased exercise with feelings of uncontrollable worry, depression or hopelessness and isolation.
“Our data strongly suggest disparities across socioeconomic status in people with PD during the COVID-19 pandemic, with those of lower income far more affected by nancial and job uncertainties,” Beck said.
The increased use of telemedicine among patients with PD who were wealthy and educated is multi-faceted, he continued: “It is not simply that these people had significantly greater access to computers, tablets or phones with cameras; it is likely that they had the resources of friends or family to help them master the technology. Extending telemedicine services to economically disadvantaged populations may help reduce disparities.”
More research is needed to understand the barriers to telehealth use in rural and non-white communities, according to Beck.
“Although telehealth provides a great option for people living in rural areas, we could benefit from a better understanding of the potential motivators and barriers to care, particularly for the mental and allied health services that are often not available in rural communities to people with PD,” he said. “We could also benefit from understanding the potential motivators and barriers to telehealth are among non-white communities to improve care utilization.”
The Parkinson’s Foundation produced a blog post designed to help patients with PD prepare for telehealth visits, Beck added. That blog post can be accessed here: https://www.parkinson.org/blog/tips/Telemedicine.