ASSESSING DIGITAL READINESS AND REMOTE CLINICAL CARE IN PARKINSON’S DISEASE

BACKGROUND: TELEMEDICINE IS BECOMING INCREASINGLY RELEVANT IN THE MANAGEMENT OF PARKINSON’S DISEASE (PD), YET ITS EFFECTIVE IMPLEMENTATION DEPENDS ON USERS’ LEVEL OF DIGITAL INCLUSION. DESPITE GROWING INTEREST, DIGITAL READINESS REMAINS UNEVEN AND NO SPECIFIC TOOLS EXIST TO SYSTEMATICALLY ASSESS IT IN CLINICAL SETTINGS. AT THE SAME TIME, COMPARATIVE EVIDENCE BETWEEN REMOTE AND IN-PERSON VISITS IN TERMS OF COST-EFFECTIVENESS IS PROMISING BUT STILL LIMITED. OBJECTIVES: THIS THESIS ADDRESSES TWO COMPLEMENTARY DIMENSIONS OF REMOTE CARE IN PD: THE ROLE OF DIGITAL INCLUSION AS A PREREQUISITE FOR TELEMEDICINE ENGAGEMENT, AND THE COST-EFFECTIVENESS OF REMOTE VISITS COMPARED WITH STANDARD IN-PERSON CARE. SPECIFICALLY, THE RESEARCH PROJECT AIMS WERE TO: (1) DEVELOP AND PSYCHOMETRICALLY VALIDATE A TOOL DESIGNED TO QUANTIFY DIGITAL INCLUSION IN CLINICAL POPULATIONS [(E.G., THE DIGITAL INCLUSION QUESTIONNAIRE (DIQUEST)]; (2) ASSESS DISEASE-SPECIFIC DETERMINANTS OF DIGITAL EXCLUSION IN PEOPLE WITH PD (PWPD); AND (3) EVALUATE THE COST- EFFECTIVENESS OF A PILOT TELEMEDICINE SERVICE FOR PD AS COMPARED TO THE STANDARD OF CARE. METHODS: THE DIQUEST WAS DEVELOPED THROUGH AN ITERATIVE PROCESS THAT INCLUDED ITEM SELECTION AND REFINEMENT, FOLLOWED BY A STRUCTURED PSYCHOMETRIC EVALUATION ENCOMPASSING RELIABILITY AND BOTH CONVERGENT AND PREDICTIVE VALIDITY, USING DATA FROM 30 PWPD. TO ASSESS DISEASE-SPECIFIC FEATURES MODULATING THE LEVEL OF DIGITAL INCLUSION, THE DIQUEST WAS ADMINISTERED TO A LARGE SAMPLE OF 490 PWPD THROUGH A MULTICENTER CASE–CONTROL STUDY. FINALLY, A COMPARATIVE STUDY WAS IMPLEMENTED TO COMPARE CLINICAL AND ECONOMICAL OUTCOMES —INCLUDING BOTH DIRECT AND INDIRECT COSTS TO PATIENTS AND THE HEALTHCARE SYSTEM— BETWEEN A TELEMEDICINE CARE MODEL AND THE STANDARD OF CARE (E.G. IN PERSON VISITS) OVER ONE YEAR. RESULTS: THE DIQUEST SHOWED GOOD RELIABILITY AND PSYCHOMETRIC ROBUSTNESS. IN THE MULTICENTER STUDY, PWPD HAD A SIGNIFICANTLY LOWER LEVEL OF DIGITAL INCLUSION THAN HEALTHY CONTROLS, INCREASING WITH HIGHER MOTOR BURDEN AS WELL AS WITH THE PRESENCE OF COGNITIVE DYSFUNCTION. THE PRELIMINARY DATA FROM THE PROSPECTIVE COMPARATIVE STUDY BETWEEN THE MODELS OF CARE SUPPORT THE FEASIBILITY AND PATIENT ACCEPTABILITY OF REMOTE FOLLOW-UP IN SELECTED PATIENTS, THAT IS WITH A GOOD LEVEL OF DIGITAL INCLUSION. CONCLUSIONS: DIGITAL INCLUSION IS A CRITICAL PREREQUISITE FOR EQUITABLE TELEMEDICINE IN PD. DIQUEST PROVIDES A PRACTICAL TOOL TO ASSESS DIGITAL READINESS, AND EMERGING EVIDENCE SUPPORTS INTEGRATING REMOTE VISITS INTO PD MANAGEMENT, REDUCING COSTS FOR BOTH PATIENTS AND THE HEALTHCARE SYSTEM AND IMPROVING THE QUALITY OF CARE FOR THIS CONDITION.