For Parkinson’s Patients, Better Care Comes in Groups

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Russell Thurston

One-on-one doctor-patient visits are a staple of our health care system, giving patients with chronic disease valuable time with their physicians to ask critical questions and learn more about their condition and, hopefully, improve the outcome of their treatment.

But researchers studying Parkinson’s disease say that group visits, in which patients are pooled together for longer sessions with a doctor, may be just as effective — if not more so — in treating the neurological disorder.

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In a study of 30 patients and 27 of their caregivers, Parkinson’s experts led by Dr. Ray Dorsey at Johns Hopkins University School of Medicine examined two types of doctor’s visits. Half of the patients saw their doctors in traditional half-hour one-on-one visits every three to six months over the course of a year; the other patients all saw their physician together, once every three months, in 90-min. group sessions.

At the end of the study, those in the group reported no difference in their satisfaction with their visit from those who had solo encounters. “Group visits mirror the best aspects of both group therapy and traditional office visits,” says Dorsey. “Support groups provide an avenue for people to learn about their condition from others bearing the same burden, while doctor visits allow them to engage an authority or expert in the disease they’re suffering from.”

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Other studies have shown that group visits also benefit other patients with chronic diseases such as diabetes and heart disease. But Dorsey says group sessions for Parkinson’s may hold additional benefits, since they provide doctors a richer, longer interaction with their patients, and allows them to better observe any improvement or worsening of the condition’s hallmark physical tremors. Being better able to monitor such progress over time may help doctors adjust medication doses as necessary as well.

“The clinic visit over 20 to 30 minutes is a bit of an artificial setting, and you often see patients at their very best,” says Dorsey. “They are on their best behavior, they are showered, and they are attentive for a short period of time. But in the group sessions, which last longer, you’re able to learn a lot more about how the disease affects patients, so both the patient and the physician become more educated.”

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Dorsey himself was reminded of how much he took the disease’s symptoms for granted when he brought the wrong type of cups for the study’s first group session, where he served lemonade during a break. The cups he provided were short, and his patients’ tremors made it impossible for them to keep the beverages from spilling before they could drink them. “The next time, I brought tall glasses and straws,” he says. “Learning more about how the disease affects their daily activity was illuminating.”

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The group sessions also allowed him to observe how much the symptoms of the disease fluctuate, even in the course of an hour and a half. Many patients experience daytime sleepiness, for instance, and if physicians can see how some patients are more affected by this than others, it might help them better treat the symptom.

“We are hoping this is a step in the right direction of improving the way health care is delivered to people with Parkinson’s and other chronic neurological conditions,” Dorsey says. “We don’t think group sessions will replace individual visits. But group educational sessions could be an excellent adjunct to traditional one-on-one encounters.” So when it comes to coping with Parkinson’s, you might be better off in a crowd.