For people living with the autoimmune disease multiple sclerosis (MS), there can be many impediments to traveling to the neurologist’s office for regular visits, including personal mobility limitations, pain, or vision impairments. And those are just the physical challenges of MS. For those who live in medically underserved areas, the barriers become even greater, as University of California, Riverside professor and MS expert Dr. Elizabeth Morrison-Banks has learned from her experience.
“So many people across the US don’t have optimal access to specialty MS care because they have difficulty in transportation, they may live far away from a neurology clinic, have an inability to pay, language barriers or the they don’t have someone around to help them,” Morrison-Banks told MobiHealthNews in an interview.
But she also learned that telemedicine could help close this care gap. Backed by a $100,000 grant from Genentech, Morrison-Banks is launching a pilot for her Southern California patients to assess if video visits are a viable stand-in for in-person consultations with neurologists.
“We’ve learned that the ones who need it the most have the hardest time getting into the office, so let’s bring the care into their homes,” Morrison-Banks said.
As an autoimmune, progressive disease affecting the brain and spinal cord, MS is the leading cause of non-traumatic disability among young adults in the United States and impacts some 2.3 million people worldwide. It affects everyone differently, is difficult to treat due to its unpredictability, and is impossible to cure, but early disease-modifying therapy as been show to at least slow progression of the condition and lessen long-term disability. But the variation in disability level, compounded by socioeconomic or geographic factors, means not everyone has access to that kind of care.
“Our goal is to provide all the visits they need, and that can be different for each person at different times in the course of their particular case,” said Morrison-Banks. “If we can do that through telemedicine, we could make care more accessible so people can get disease modification therapy as often as possible.”
Based at UCR – which opened its doors recently and will graduate its first class of medical students this year– the home-based pilot aims to enroll 100 people, with half receiving in-office visits and the other half getting the virtual visits. The based pilot will be conducted by a small team: just Morrison-Banks, clinical assistant professor Kristyn Pellechia and a nurse practitioner.
Using videoconferencing tools from Polycom RealPresence or Vidyo, the nurse practitioner will go directly to the patient’s house and remotely connect with Morrison-Banks, who will perform a neurological assessment. This will involve an intake visit, a review of the patient’s history, discussion of lab results and neuro-imaging and treatment plans. They will compare the telemedicine intervention group with the standard visits on a number of variables including pain and fatigue levels, visual impairment, bladder and bowel control, plus mental health, sexual satisfaction and overall quality of life.
“What we are looking for is if telemedicine can serve as a substitute for an physical visit. We’re not looking at remote monitoring or completely patient-directed telemedicine visits right now, but that is something we are definitely interested in down the line,” said Morrison-Banks. “Right now, it’s just to see if the format of the visit is acceptable to people, is it sufficient, do they have the full range of communication they would otherwise have in person?”
While there are a number of other telemedicine interventions for neurological conditions out there, such as those using the technologies to improve stroke or concussion treatment, MS is new territory. With the pilot, which is called CONNECT-MS, neurologists as well as Genentech will get more insights on how to blend therapies and technologies.
“It’s a difficult condition, especially for places that have general neurology services but don’t have MS-specific centers,” said Morrison-Banks. “And bringing in services and technologies in their offices poses challenges because they don’t always have the economies of scale they would if they were treating just one condition.”
Morrison-Banks developed the pilot based on lessons learned from a previous project (also funded by Genentech) she did in Ventura County in 2015, where they used video conferencing at a clinic to help teenagers with MS. That pilot was different in that it was conducted in-clinic and primarily functioned to help the physicians, but it provided valuable preliminary insights.
“Just like that earlier study, we’ll use this one to develop more tools,” said Morrison-Banks. “Maybe this won’t be effective, but if it is, we will look to scale up with other digital therapies available, like physical therapy apps or assessment tools. It would be great to look at those options in more pilots to see what does and doesn’t work for people, and adapt to those kinds of modalities.”