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Fukasawa T, Nakanishi E, Shimoda H, Shinoda K, Ito S, Asada S, Yoshida S, Tanaka-Mizuno S, Mizuno K, Takahashi R, Kawakami K. Adherence to istradefylline in patients with Parkinson's disease: A group-based trajectory analysis. J Neurol Sci 2024; 462:123092. [PMID: 38925070 DOI: 10.1016/j.jns.2024.123092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Understanding the different patterns of adherence to istradefylline treatment is essential to identifying Parkinson's disease (PD) patients who might benefit from targeted interventions. OBJECTIVES This descriptive study aimed to identify longitudinal istradefylline adherence patterns and to characterize factors associated with them. METHODS We identified PD patients aged 21-99 years who initiated istradefylline treatment in a Japanese hospital administrative database. Group-based trajectory modeling was used to model the monthly proportion of days covered over time to identify distinct 360-day adherence patterns. Factors associated with each adherence pattern were assessed using univariable multinomial logistic regression models. RESULTS Of 2088 eligible PD patients, 4 distinct adherence groups were identified: consistently high adherence (56.8%); rapidly declining adherence (25.8%); gradually declining adherence (8.5%); and gradually declining and then recovering adherence (9.0%). Compared to the consistently high adherence group, the other groups had the following characteristics associated with a likelihood of lower adherence: the rapidly declining adherence group received fewer dopamine agonists (63.8% vs. 69.4%), monoamine oxidase B (MAO-B) inhibitors (26.8% vs. 31.6%), and catechol-O-methyl transferase inhibitors (31.6% vs. 37.0%) and had a higher prevalence of anxiety/mood disorders (29.9% vs. 24.6%); the gradually declining adherence group received fewer MAO-B inhibitors (22.5% vs. 31.6%) and amantadine (8.4% vs. 16.1%) and had a higher prevalence of mild cognitive impairment/dementia (27.0% vs. 18.8%); and the declining and then recovering adherence group had a higher prevalence of anxiety/mood disorders (34.2% vs. 24.6%). CONCLUSIONS Clinicians should be aware of the heterogeneous patterns of adherence to istradefylline.
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Affiliation(s)
- Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Etsuro Nakanishi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroo Shimoda
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Katsumi Shinoda
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Satoru Ito
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan; Pharmacovigilance Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Shinji Asada
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
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Schröter N, Sajonz BEA, Jost WH, Rijntjes M, Coenen VA, Groppa S. Advanced therapies in Parkinson's disease: an individualized approach to their indication. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02773-3. [PMID: 38613674 DOI: 10.1007/s00702-024-02773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
Device aided therapies (DAT) comprising the intrajejunal administration of levodopa/carbidopa intestinal gel (LCIG) and levodopa/carbidopa/entacapone intestinal gel (LECIG), the continuous subcutaneous application of foslevodopa/foscarbidopa or apomorphine infusion (CSAI) and deep brain stimulation (DBS) are used to treat Parkinson's disease with insufficient symptom alleviation under intensified pharmacotherapy. These DAT significantly differ in their efficacy profiles, indication, invasiveness, contraindications, and potential side effects. Usually, the evaluation of all these procedures is conducted simultaneously at the same point in time. However, as disease progression and symptom burden is extremely heterogeneous, clinical experience shows that patients reach the individual milestones for a certain therapy at different points in their disease course. Therefore, advocating for an individualized therapy evaluation for each DAT, requiring an ongoing evaluation. This necessitates that, during each consultation, the current symptomatology should be analyzed, and the potential suitability for a DAT be assessed. This work represents a critical interdisciplinary appraisal of these therapies in terms of their individual profiles and compares these DAT regarding contraindications, periprocedural considerations as well as their efficacy regarding motor- and non-motor deficits, supporting a personalized approach.
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Affiliation(s)
- Nils Schröter
- Department of Neurology and Clinical Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center of Deep Brain Stimulation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Lei S, Liu Q, Leong I, Fan J, Tsang Y, Liu X, Xu X, Zhuang L. Acupuncture therapy for Parkinson's disease: a case report demonstrating symptomatic improvement without medication. Front Neurol 2024; 14:1330054. [PMID: 38348115 PMCID: PMC10859393 DOI: 10.3389/fneur.2023.1330054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/27/2023] [Indexed: 02/15/2024] Open
Abstract
Background Parkinson's disease (PD) often necessitates immediate medical intervention following diagnosis. In recent years, there has been a noticeable increase in clinical investigations assessing the efficacy of acupuncture in PD, with many studies reporting positive outcomes. Ethical guidelines commonly endorse pharmaceutical therapies for PD, leading ongoing research to combine acupuncture with standard drug-based treatments. At present, there is a conspicuous absence of dedicated clinical research exclusively examining the independent impact of acupuncture on PD treatment. Case In a clinical observation, we documented a case involving a 75-year-old male displaying progressive, characteristic PD symptoms, including evident limb tremors, rigidity, bradykinesia, fatigue, and additional non-motor symptoms. The patient received a confirmed diagnosis of PD. Due to the refusal of the patient to take medication, we exclusively administered acupuncture therapy. The outcomes indicated a noteworthy enhancement in the clinical symptoms of the patient solely through acupuncture intervention. Conclusion This case affirms that using acupuncture in isolation significantly improved both the motor and non-motor symptoms in the patient. Acupuncture could potentially serve as an alternative therapy for patients who decline or are intolerant to anti-Parkinson drugs. However, further studies are needed to assess its long-term efficacy. This case report obtained approval from the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (Ethics number: K-2023-127).
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Affiliation(s)
- Suying Lei
- The First Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing Liu
- The First Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - IanI Leong
- The First Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingqi Fan
- School of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - YauKeung Tsang
- School of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Liu
- The First Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Xu
- The First Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixing Zhuang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Levodopa-carbidopa intestinal gel in advanced Parkinson's disease: long-term results from COSMOS. J Neurol 2023; 270:2765-2775. [PMID: 36802031 PMCID: PMC10130122 DOI: 10.1007/s00415-023-11615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND While immediate benefits of levodopa-carbidopa intestinal gel (LCIG) are evident in patients with Parkinson's disease (PD), long-term LCIG effects require further study. OBJECTIVES We explored long-term LCIG on motor symptoms, nonmotor symptoms (NMS), and LCIG treatment settings in patients with advanced PD (APD). METHODS Data were obtained (medical records and patient visit) from COSMOS, a multinational, retrospective, cross-sectional post-marketing observational study in patients with APD. Patients were stratified into 5 groups based on LCIG treatment duration at the patient visit, from 1-2 to > 5 years LCIG. Between-group differences were assessed for changes from baseline in LCIG settings, motor symptoms, NMS, add-on medications, and safety. RESULTS Out of 387 patients, the number of patients per LCIG group was: > 1- ≤ 2 years LCIG (n = 156); > 2- ≤ 3 years LCIG (n = 80); > 3- ≤ 4 years LCIG (n = 61); > 4- ≤ 5 years LCIG (n = 30); > 5 years LCIG (n = 60). Baseline values were similar; data reported are changes from the baseline. There were reductions in "off" time, dyskinesia duration, and severity across LCIG groups. Prevalence, severity, and frequency of many individual motor symptoms and some NMS were reduced amongst all LCIG groups, with few differences between groups. Doses for LCIG, LEDD and LEDD for add-on medications were similar across groups both at LCIG initiation and patient visit. Adverse events were similar across all LCIG groups and consistent with the established safety profile of LCIG. CONCLUSIONS LCIG may provide sustained, long-term symptom control, while potentially avoiding increases in add-on medication dosages. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03362879. Number and date: P16-831, November 30, 2017.
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Santos García D, de Deus Fonticoba T, Cores C, Suárez Castro E, Hernández Vara J, Jesús S, Mir P, Cosgaya M, José Martí M, Pastor P, Cabo I, Seijo M, Legarda I, Vives B, Caballol N, Rúiz Martínez J, Croitoru I, Cubo E, Miranda J, Alonso Losada MG, Labandeira C, López Ariztegui N, Morales-Casado M, González Aramburu I, Infante J, Escalante S, Bernardo N, Blázquez Estrada M, Menéndez González M, García Caldentey J, Borrué C, Vela L, Catalán MJ, Gómez Mayordomo V, Kurtis M, Prieto C, Ordás C, Nogueira V, López Manzanares L, Ávila Rivera MA, Puente V, García Moreno JM, Solano Vila B, Álvarez Sauco M, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Gastón I, Kulisevsky J, Valero C, de Fábregues O, González Ardura J, López Díaz LM, Martinez-Martin P. Falls Predict Acute Hospitalization in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:105-124. [PMID: 33843696 PMCID: PMC9912731 DOI: 10.3233/jpd-212539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a need for identifying risk factors for hospitalization in Parkinson's disease (PD) and also interventions to reduce acute hospital admission. OBJECTIVE To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort. METHODS PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson's DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit. RESULTS Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065-5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319-6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757-8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124-4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080-8.322; p = 0.035) was an independent predictor of AH. CONCLUSION Falls is an independent predictor of AH in PD patients.
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Affiliation(s)
- Diego Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain,Correspondence to: Dr. Diego Santos García, Department of Neurology, Hospital Universitario de A Coruña (HUAC), Complejo Hospitalario Universitario de A Coruña (CHUAC), C/ As Xubias 84, 15006, A Coruña, Spain. Tel.: +34 646173341; E-mail:
| | | | - Carlos Cores
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Jorge Hernández Vara
- Neurology Department and Neurodegenerative Diseases Research. Vall D’Hebron Universitary Campus, Barcelona, Spain
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain,CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain,CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
| | | | | | - Pau Pastor
- Movement disorders Unit, University Hospital Mutua de Terrassa, Barcelona, Spain
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | - Inés Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Bárbara Vives
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Javier Miranda
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | - Carmen Labandeira
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | | | - Jon Infante
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Noemí Bernardo
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | | | | | | | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Berta Solano Vila
- Institut d’Assistència Sanitària (IAS) - Institut Català de la Salut. Girona, Spain
| | | | | | | | | | | | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain,Hospital de Sant Pau, Barcelona, Spain
| | | | - Oriol de Fábregues
- Neurology Department and Neurodegenerative Diseases Research. Vall D’Hebron Universitary Campus, Barcelona, Spain
| | | | | | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Spain
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Frazer M, Arcona S, Le L, Sasane R. Dopamine agonist monotherapy utilization in patients with Parkinson's disease. Clin Park Relat Disord 2022; 8:100173. [PMID: 36660109 PMCID: PMC9842678 DOI: 10.1016/j.prdoa.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives To characterize patients with Parkinson's disease (PD) who initiated dopamine agonist (DA) monotherapy, describe medication utilization and provider types, and estimate medication adherence and discontinuation rates. Methods Retrospective study identified patients with PD in the Optum Research Database and included those with ≥1 claim for DA or levodopa between 09/01/2012 and 12/31/2018, ≥2 PD diagnoses, commercial or Medicare Advantage Part D (MAPD) insurance, ≥40 years old, and continuous medical and pharmacy coverage ≥12 months before and after index date. A subset of patients receiving DA monotherapy was selected for this analysis. Variables were analyzed descriptively. Adherence was measured with medication possession ratio (MPR) and proportion of days covered (PDC); defined as ≥0.80. Results Patients (N = 642) had mean (SD) age of 70.2 (9.9) years, 70.6 % had MAPD coverage, and 61.7 % were male. Neurologists prescribed 64.6 % of DA monotherapy, and 56.9 % of patients had ≥2 PD diagnoses before or on the index date. Index therapy was discontinued by 44.1 % of patients, and 55.9 % persisted for 12 months without change. Mean (SD) time to discontinuation was 102 (79) days. Mean (SD) MPR for patients (n = 562) with ≥2 fills was 0.84 (0.2); 70.3 % were MPR adherent. Mean (SD) PDC for all 642 patients was 0.66 (0.3); 50.5 % were PDC adherent. Conclusion Adherence and continuation of therapy were suboptimal, which could translate into poor patient outcomes. Future studies could provide insights on the impact of low adherence and persistence with DA monotherapy.
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Affiliation(s)
| | | | - Lisa Le
- Optum HEOR, USA,Corresponding author at: Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN 55344, USA.
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Metta V, Ibrahim H, Loney T, Benamer HTS, Alhawai A, Almuhairi D, Al Shamsi A, Mohan S, Rodriguez K, Mohan J, O’Sullivan M, Muralidharan N, Al Mazrooei S, Dar Mousa K, Chung-Faye G, Mrudula R, Falup-Pecurariu C, Rodriguez Bilazquez C, Matar M, Borgohain R, Chaudhuri KR. First Two-Year Observational Exploratory Real Life Clinical Phenotyping, and Societal Impact Study of Parkinson’s Disease in Emiratis and Expatriate Population of United Arab Emirates 2019–2021: The EmPark Study. J Pers Med 2022; 12:jpm12081300. [PMID: 36013249 PMCID: PMC9410099 DOI: 10.3390/jpm12081300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Phenotypic differences in Parkinson’s Disease (PD) among locals (Emiratis) and Expatriates (Expats) living in United Arab Emirates have not been described and could be important to unravel local aspects of clinical heterogenicity of PD pointing towards genetic and epigenetic variations. Objective: To investigate the range and nature of motor and nonmotor clinical presentations of PD and its impact on time to diagnosis, local service provisions, and quality of life in Emiratis and Expats in UAE, as well as address the presence of current unmet needs on relation to care and etiopathogenesis of PD related to possible genetic and epigenetic factors. Methods: a cross-sectional one point in time prospective, observational real-life study of 171 patients recruited from PD and Neurology clinics across United Arab Emirates from 2019–2021. Primary outcomes were sociodemographic data, motor and nonmotor symptoms (NMS), including cognition and sleep, and quality of life (QOL) assessments, Results: A total of 171 PD patients (52 Emiratis 119 Expats) were included with mean age (Emiratis 48.5 (13.1) Expats 64.15 (13.1)) and mean disease duration (Emiratis 4.8 (3.2) Expats 6.1 (2.9)). In the Emiratis, there was a significant mean delay in initiating treatment after diagnosis (Emiratis 1.2 (0.9) Expats 1.6 (1.1)), while from a clinical phenotyping aspect, there is a high percentage of akinesia 25 (48.1) or tremor dominant (22 (42.3)) phenotypes as opposed to mixed subtype 67 (56.3) in Expat cohorts; double tremor dominant, especially Emirati females (25%), had a predominant lower limb onset PD. Both Emirati (27.9 (24.0)) and Expat 29.4 (15.6) showed moderate NMS burden and the NMS profile is dominated by Sleep, Fatigue, Mood, Emotional well-being 3.0 (1.1) and Social Stigma 3.5 (0.9) aspects of PDQ8 SI measurements are predicted worse QOL in Emiratis, while lack of social support 2.3 (1.3) impaired QOL in Expat population. Awareness for advanced therapies was low and only 25% of Emiratis were aware of deep brain surgery (DBS), compared to 69% Expats. Only 2% of Emiratis, compared to 32% of Expats, heard of Apomorphine infusion (CSAI), and no (0%) Emiratis were aware of intrajejunal levodopa infusion (IJLI), compared to 13% of expats. Conclusion: Our pilot data suggest clinical phenotypic differences in presentation of PD in Emiratis population of UAE compared to expats. Worryingly, the data also show delayed treatment initiation, as well as widespread lack of knowledge of advanced therapies in the Emirati population.
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Affiliation(s)
- Vinod Metta
- Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King’s College London, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
- Kings College Hospital London, Dubai, United Arab Emirates
- Correspondence:
| | | | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hani T. S. Benamer
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ali Alhawai
- Higher Colleges of Technology, Dubai, United Arab Emirates
| | | | | | - Sneha Mohan
- Kings College Hospital London, Dubai, United Arab Emirates
| | | | - Judith Mohan
- Kings College Hospital London, Dubai, United Arab Emirates
| | | | | | | | - Khadeeja Dar Mousa
- Dubai Statistics Centre, Dubai, United Arab Emirates
- People of Determination Council (POD) Council of Dubai Police, Dubai, United Arab Emirates
| | - Guy Chung-Faye
- Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King’s College London, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
- Kings College Hospital London, Dubai, United Arab Emirates
| | - Rukmini Mrudula
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | | | - Maryam Matar
- Genetic Disease Association, Dubai, United Arab Emirates
| | - Rupam Borgohain
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K. Ray Chaudhuri
- Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King’s College London, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
- Kings College Hospital London, Dubai, United Arab Emirates
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Tosin MHS, Goetz CG, Bispo DPCF, Ferraz HB, Leite MAA, Hall DA, Stebbins GT, Oliveira BGRB. Parkinson's Disease Medication Adherence Scale: Conceptualization, Scale Development, and Clinimetric Testing Plan. Front Aging Neurosci 2022; 14:900029. [PMID: 35645779 PMCID: PMC9136049 DOI: 10.3389/fnagi.2022.900029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Medication adherence is a crucial component in the management of patients with chronic diseases needing a long-term pharmacotherapy. Parkinson's disease (PD) is a chronic, degenerative disease with complex drug treatment that poses challenging barriers to patient adherence. The adoption of best practices of scale development can contribute to generate solid concepts and, in the long run, a more stable knowledge base on the underlying constructs of medication adherence in PD measured by the items of the first scale to be created for this purpose. Purpose To present the development process and clinimetric testing plan of the Parkinson's Disease Medication Adherence Scale (PD-MAS). Method We adopted a hybrid approach plan based on the United States Food and Drug Administration and Benson and Clark Guide that will create a patient-reported outcome instrument. We presented an overview of consecutive and interrelated steps, containing a concise description of each one. International research centers from Brazil and United States were initially involved in the planning and implementation of the methodological steps of this study. Results We developed a four-phase multimethod approach for the conceptualization and the clinimetric testing plan of the PD-MAS. First, we describe the development process of the conceptual framework of the PD-MAS underpinning the scale construct; second, we formalized the development process of the first version of the PD-MAS from the generation of item pools to the content validation and pre-testing; third, we established the steps for the first pilot testing and revision; fourth, we describe the steps plan for the first pilot testing and revision, to finally describe its clinimetric testing plan and validation. Conclusion The overview presentation of the development phases and the clinimetric testing plan of the PD-MAS demonstrate the feasibility of creating an instrument to measure the multidimensional and multifactorial components of the medication adherence process in people with PD.
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Affiliation(s)
- Michelle H. S. Tosin
- Department of Nursing, Fluminense Federal University, Niteroi, Brazil
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Christopher G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Dharah P. C. F. Bispo
- Department of Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
| | - Henrique B. Ferraz
- Department of Neurology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Deborah A. Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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Soileau MJ, Pagan F, Fasano A, Rodriguez-Cruz R, Wang L, Kandukuri PL, Yan CH, Alobaidi A, Bao Y, Kukreja P, Oh M, Siddiqui MS. Comparative Effectiveness of Carbidopa-Levodopa Enteral Suspension and Deep Brain Stimulation on Parkinson's Disease-Related Pill Burden Reduction in Advanced Parkinson's Disease: A Retrospective Real-World Cohort Study. Neurol Ther 2022; 11:851-861. [PMID: 35441973 PMCID: PMC9095798 DOI: 10.1007/s40120-022-00351-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction In advanced Parkinson’s disease (PD), a high pill burden is associated with poor compliance, reduced control of symptoms, and decreased quality of life. We assessed the impact of carbidopa–levodopa enteral suspension (CLES) and deep brain stimulation (DBS) on PD-related pill burden. Methods A retrospective cohort analysis was conducted in the IBM MarketScan and Medicare Supplemental databases. Patients with advanced PD, taking only PD medications, and initiating CLES or DBS between 9 January 2015 and 31 July 2019 were identified. CLES patients were matched to DBS patients in a 1:3 ratio based on a propensity score to balance patient characteristics. Pill burden was measured as a 30-day average number of PD-related pills per day and was captured monthly. Pill-free status was evaluated as the percentage of patients receiving CLES or DBS monotherapy. Descriptive statistics were used to compare pill counts and assess the proportion of patients on monotherapy at 6 and 12 months after initiating CLES or DBS. Results The cohorts included 34 CLES patients matched to 97 DBS patients. A significant reduction in PD-related pill burden was observed at 6 months after initiation of CLES or DBS (∆CLES: −5.62, p < 0.0001; ∆DBS: −1.48, p = 0.0022). PD-related pill burden reduction in CLES patients was significantly greater than in matched DBS patients at 6 months (∆: −4.14, p < 0.0001), which was sustained at 12 months after initiation. At 12 months, nearly three times more CLES patients were pill free than DBS patients (29.41% and 10.31%, respectively, p = 0.0123). Conclusions Device-aided therapies such as CLES and DBS are effective in significantly reducing PD-related pill burden. Patients treated with CLES were more likely to achieve pill-free status than patients receiving DBS.
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Affiliation(s)
- Michael J Soileau
- Texas Movement Disorder Specialists, 204 S. Interstate 35, Suite 103, Georgetown, TX, 78628, USA.
| | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington DC, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada
| | | | - Lin Wang
- Johns Hopkins School of Public Health, Baltimore, MD, USA.,AbbVie Inc., North Chicago, USA
| | | | - Connie H Yan
- AbbVie Inc., North Chicago, USA.,Department of Pharmacy Systems, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Alobaidi
- AbbVie Inc., North Chicago, USA.,Department of Pharmacy Systems, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Mok Oh
- AbbVie Inc., North Chicago, USA.,College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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10
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Oonk NGM, Movig KLL, van der Palen J, Nibourg SAF, Koehorst-Ter Huurne K, Nijmeijer HW, van Kesteren ME, Dorresteijn LDA. The Effect of a Structured Medication Review on Quality of Life in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1295-1306. [PMID: 35253776 DOI: 10.3233/jpd-213021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Drug therapy is important for controlling symptoms in Parkinson's disease (PD). However, it often results in complex medication regimens and could easily lead to drug related problems (DRP), suboptimal adherence and reduced treatment efficacy. A structured medication review (SMR) could address these issues and optimize therapy, although little is known about clinical effects in PD patients. OBJECTIVE To analyze whether an SMR improves quality of life (QoL) in PD. METHODS In this multicenter randomized controlled trial, half of the 202 PD patients with polypharmacy received a community pharmacist-led SMR. The control group received usual care. Assessments at baseline, and after three and six months comprised six validated questionnaires. Primary outcome was PD specific QoL [(PDQ-39; range 0 (best QoL) - 100 (worst QoL)]. Secondary outcomes were disability score, non-motor symptoms, general health status, and personal care giver's QoL. Furthermore, DRPs, proposed interventions, and implemented modifications in medication schedules were analyzed. RESULTS No improvement in QoL was seen six months after an SMR, with a non-significant treatment effect difference of 2.09 (-0.63;4.80) in favor of the control group. No differences were found in secondary outcomes. In total, 260 potential DRPs were identified (2.6 (±1.8) per patient), of which 62% led to drug therapy optimization. CONCLUSION In the current setting, a community pharmacist-led SMR did not improve QoL in PD patients, nor improved other pre-specified outcomes.
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Affiliation(s)
- Nicol G M Oonk
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
- Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
| | - Kris L L Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands
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11
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Advanced Parkinson's Disease Treatment Simplification and Long-Term Outcomes with Levodopa Carbidopa Intestinal Gel: COSMOS Romanian Subanalysis. Brain Sci 2021; 11:brainsci11121566. [PMID: 34942868 PMCID: PMC8699449 DOI: 10.3390/brainsci11121566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
The aim of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS) was to assess the use of levodopa/carbidopa intestinal gel (LCIG) as monotherapy in patients with advanced Parkinson’s disease (APD) in routine clinical practice. COSMOS was an international observational study with one cross-sectional visit and retrospective data collection. In Romania, 95 adult patients with APD on LCIG treatment for at least 12 months were enrolled and stratified according to their LCIG therapy after 12 months: monotherapy (without any add-on PD medication), monotherapy with night PD medication and LCIG + add-on medication. Compared to the moment of LCIG initiation, the percentage of patients on monotherapy increased at three months after LCIG initiation and remained constant up to 12 months, when 30.5% of the patients were on LCIG monotherapy and 11.6% were on monotherapy with night medication. “Off” time and “On” time with dyskinesia decreased from LCIG initiation to patient visit in all groups. LCIG monotherapy with or without night medication may provide a simplified treatment option for selected APD patients, with long-term efficacy similar to that of LCIG plus add-on medication.
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12
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Adherence to treatment in Parkinson's disease: A multicenter exploratory study with patients from six Latin American countries. Parkinsonism Relat Disord 2021; 93:1-7. [PMID: 34741998 DOI: 10.1016/j.parkreldis.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adherence to treatment in Parkinson's disease (PD) is compromised due to the need for multiple therapies, comorbidities related to aging, and the complexity of therapeutic schemes. In the present study, we aimed to explore adherence to treatment in groups of PD patients from six Latin-American (LA) countries and identify its associated demographic and clinical parameters. METHODS A multicenter, cross-sectional, exploratory study was conducted from September 2016 to March 2017. Treatment adherence was assessed using the simplified medication adherence questionnaire (SMAQ), applied to patients and caregivers. Sociodemographic and clinical variables (MDS-UPDRS Part III-IV, MMSE, Beck Depression Inventory-II (BDI-II)) were recorded. RESULTS Eight hundred patients from six LA countries were evaluated. Nonadherence was reported in 58.25% of the population, according to patients. The most frequent issues were forgetfulness and correct timing of doses. A high level of agreement in adherence prevalence and most SMAQ items were observed between patients and their caregivers. The nonadherent population had a significantly higher proportion of unemployment, free access to medication, troublesome dyskinesias and off-periods, lesser years of education, and worse motor, cognitive, and mood scores. In multiple logistic and linear regression analyses, MDS-UPDRS Part III, BDI-II, gender, free access to medication, treatment with dopamine agonists alone, years of education, excessive concerns about adverse effects, and beliefs about being well-treated remained significant contributors to adherence measures. CONCLUSION Educational strategies, greater involvement of PD patients in decision-making, and consideration of their beliefs and values might be of great need to improve medication adherence in this PD population.
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13
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Aggarwal S, Paul G, Paul BS, Mahendru D, Goyal S. Factors Affecting Adherence to Pharmacotherapy in Parkinson's Disease. Ann Indian Acad Neurol 2021; 24:879-884. [PMID: 35359534 PMCID: PMC8965915 DOI: 10.4103/aian.aian_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/07/2021] [Accepted: 03/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The goal of dopaminergic replacement therapy to achieve good clinical outcome in Parkinson's disease (PD) patients largely depends on the pattern of adherence to the pharmacological treatment. This study aims to find the factors affecting medication adherence in patients with PD keeping in mind the cultural, economic, and social diversities so that preventive steps can be taken to fill these gaps. Methods: Demographic data, disease parameters, treatment-related factors, family characteristics, educational, and employment status were assessed for relationship with the medication adherence pattern in a cohort of non-demented PD patients. Medication adherence was measured by MMAS-8; depression, and socioeconomic status were assessed by GDS-SF and Kuppuswamy scales respectively. Results: From 134 PD subjects, high adherence was observed in 43.2%, 18.2% had moderate, and 38.6% reported low adherence level to their pharmacotherapy. The sub-optimal level of adherence was significantly correlated to compliance of follow up with the physician (p 0.03), presence of adverse events related to drugs (p 0.03), and depressive symptoms (p < 0.0001). Also, there was significant negative co-relationship between poor adherence and depression on Spearman's rank coefficient (0.702). There was no effect of demographic factors, living conditions, family type, educational qualification, associated comorbid conditions, and socioeconomic status on adherence to dopaminergic treatment in patients with PD. Conclusion: Poor adherence to prescribed medication is a menace that is more than just oversimplification of forgetfulness which should be evaluated at each visit to improve efficacy of the prescribed regimen to achieve better treatment result and thus quality of life of PD patients.
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Affiliation(s)
| | - Gunchan Paul
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Birinder S Paul
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Diksha Mahendru
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Shriya Goyal
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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14
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Standaert DG, Aldred J, Anca-Herschkovitsch M, Bourgeois P, Cubo E, Davis TL, Iansek R, Kovács N, Pontieri FE, Siddiqui MS, Simu M, Bergmann L, Kukreja P, Robieson WZ, Chaudhuri KR. DUOGLOBE: One-Year Outcomes in a Real-World Study of Levodopa Carbidopa Intestinal Gel for Parkinson's Disease. Mov Disord Clin Pract 2021; 8:1061-1074. [PMID: 34631942 PMCID: PMC8485588 DOI: 10.1002/mdc3.13239] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 11/09/2022] Open
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) is an established treatment for improving motor and some non-motor symptoms (NMS) in patients with advanced Parkinson's disease (PD). Prospective long-term data in routine clinical practice are limited. Objective Assess LCIG effectiveness and safety in patients with advanced PD after 12 months during real-world routine clinical practice. Methods Duodopa/Duopa in patients with advanced Parkinson's disease-a global observational study evaluating long-term effectiveness (DUOGLOBE) (NCT02611713) is an ongoing, prospective, multinational, observational study of LCIG-naïve patients treated as part of routine clinical practice; 3 years of follow-up are planned. The primary outcome is the change in patient-reported off time. Other assessments include the Unified Dyskinesia Rating Scale (UDysRS), Non-Motor Symptoms Scale (NMSS), Parkinson's Disease Sleep scale (PDSS-2), Epworth Sleepiness Scale (ESS), health-related quality of life (HR-QoL), caregiver burden, and serious adverse events (SAEs). Outcomes from baseline to month (M) 12 are presented. Results In this 12-month follow-up, patients (N = 195) had baseline characteristics similar to other LCIG studies. Significant improvements (mean change to M12) were observed in off time (-3.9 ± 3.6 hr/day, P < 0.001), dyskinesia assessed using the UDysRS (-9.6 ± 22.5, P < 0.001), NMSS (-23.1 ± 41.4, P < 0.001), sleep and sleepiness symptoms on the PDSS-2 (-6.5 ± 12.2, P < 0.001) and ESS (-1.0 ± 5.7, P < 0.05), HR-QoL (-9.0 ± 21.6, P < 0.001), and caregiver burden (-1.9 ± 6.7, P = 0.008). Overall, 40.5% (n = 79) of patients experienced SAEs; fall (n = 6; 3.1%) and urinary tract infection (n = 6; 3.1%) were SAEs reported in ≥3% of patients. Conclusions These 12-month outcome data show sustained, long-term improvements and support the real-world effectiveness of LCIG in patients with advanced PD. Safety was consistent with previous studies.
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Affiliation(s)
| | | | | | | | - Esther Cubo
- Neurology Department Hospital Universitario Burgos Burgos Spain
| | - Thomas L Davis
- Vanderbilt University Medical Center Nashville Tennessee USA
| | - Robert Iansek
- Kingston Centre, Monash Health Melbourne Victoria Australia
| | | | | | | | - Mihaela Simu
- Victor Babes University of Medicine and Pharmacy Timisoara Romania
| | | | | | | | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital, and King's College Institute of Psychiatry, Psychology & Neuroscience London United Kingdom
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15
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Johnsrud M, Richards K, Arcona S, Sasané R, Leoni M. An assessment of Parkinson's disease medication treatment patterns in the Medicaid population. Clin Park Relat Disord 2021; 5:100109. [PMID: 34693271 PMCID: PMC8512608 DOI: 10.1016/j.prdoa.2021.100109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Most Parkinson's disease (PD) medication adherence studies have focused on patients with commercial or Medicare health insurance coverage. However, less is known regarding medication treatment patterns within the Medicaid population. METHODS This retrospective cohort study utilized 2011-2019 administrative healthcare claims from 7 state Medicaid programs. We compared newly diagnosed patients with PD started on either levodopa or a dopamine agonist (DA). Baseline comorbidities were compared. Outcomes were assessed during a 12-month post-index observation period, and included total medication days, proportion of days covered (PDC), adherence status, persistence to initiating PD medication, and time to non-persistence of initiating PD medication. RESULTS Our study sample of 805 Medicaid patients had an average age of 54.1 years, with 52.0% being female. Levodopa was the predominant PD medication at initiation (75.4%). Roughly half of patients had a baseline depressive disorder and nearly 40% had an anxiety disorder. Levodopa patients had a significantly higher PDC compared to DA patients (0.621 vs. 0.546, p = 0.007). An adjusted logistic regression model showed no significant difference in the number of adherent patients between the two groups (p = 0.058). An adjusted Cox proportional hazards model controlling for demographic and baseline variables showed a 26% lower risk of non-persistence for levodopa patients versus DA patients (HR 0.740, CI 0.597-0.917, p = 0.006). CONCLUSIONS Adherence and persistence rates were suboptimal following initiation of either levodopa or DA medication for patients with PD in Medicaid programs, though rates were better for those initiated on levodopa.
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Affiliation(s)
- Michael Johnsrud
- TxCORE (Texas Center for Health Outcomes Research and Education), The University of Texas at Austin, 2409 University Avenue, Austin, TX 78712, USA
| | - Kristin Richards
- TxCORE (Texas Center for Health Outcomes Research and Education), The University of Texas at Austin, 2409 University Avenue, Austin, TX 78712, USA
| | - Steve Arcona
- Cerevel Therapeutics, 222 Jacobs Street, Suite 200, Cambridge, MA 02141, USA
| | - Rahul Sasané
- Cerevel Therapeutics, 222 Jacobs Street, Suite 200, Cambridge, MA 02141, USA
| | - Matthew Leoni
- Cerevel Therapeutics, 222 Jacobs Street, Suite 200, Cambridge, MA 02141, USA
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16
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A qualitative exploration of the healthcare challenges and pharmaceutical care needs of people with Parkinson's and their caregivers. Int J Clin Pharm 2021; 44:53-63. [PMID: 34318400 PMCID: PMC8866252 DOI: 10.1007/s11096-021-01312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/23/2021] [Indexed: 11/06/2022]
Abstract
Background People with Parkinson’s are at higher risk of healthcare and pharmaceutical care issues. Objective To determine the healthcare challenges, pharmaceutical care needs, and perceived need of a pharmacist-run clinic by people with Parkinson’s and their caregivers. Setting Malaysian Parkinson’s Disease Association. Method A focus group discussion adopting a descriptive qualitative approach was conducted involving people with Parkinson’s and their caregivers. A semi-structured interview guide was used to determine the challenges they faced with their medications and healthcare system, their pharmaceutical care needs, and their views on a pharmacist-run clinic. Data was thematically analysed. Main outcome measure: Healthcare challenges faced by people with Parkinson’s and caregivers along with their pharmaceutical care needs and perceived need of a pharmacist-run clinic. Results Nine people with Parkinson’s and four caregivers participated. Six themes were developed: (1) “It’s very personalised”: the need for self-experimentation, (2) “Managing it is quite difficult”: challenges with medication, (3) “The doctor has no time for you”: challenges with healthcare providers, (4) “Nobody can do it except me”: challenges faced by caregivers, (5) “It becomes a burden”: impact on quality of life, and (6) “Lack of consistency could be counterproductive”: views on pharmacist-run clinic. Conclusion The provision of pharmaceutical care services by pharmacists could help overcome issues people with Parkinson’s face, however there is a need for them to first see pharmacists in their expanded roles and change their limited perception of pharmacists. This can be achieved through integration of pharmacists within multidisciplinary teams in specialist clinics which they frequent.
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17
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Espiritu AI, Anna C Brillantes MM, G Layog AV, G Jamora RD. Reasons for hospitalization and factors of mortality in patients with Parkinson's disease in the Philippines. Neurodegener Dis Manag 2021; 11:229-238. [PMID: 33966488 DOI: 10.2217/nmt-2020-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We aimed to determine the reasons for hospitalizations and factors of mortality of Filipino Parkinson's disease (PD) patients in a tertiary hospital. Methods: We conducted a retrospective review of medical records of PD patients admitted to our institution between 2016 and 2018. Demographic and clinical data were analyzed. Results: We included 166 PD patients. The most common cause of admission was infectious (pneumonia, urinary tract, and skin-soft tissue infections) (n = 65, 39.2%). The most common cause of mortality was sepsis (n = 9, 5.4%). Renal comorbidity was a significant factor of mortality (OR: 3.67, 95% CI: 1.11-12.12; p = 0.033). Conclusion: Interventions designed to reduce the risk of complications in PD patients should be prioritized to potentially decrease the probability of eventual hospitalization.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine & Philippine General Hospital, University of The Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of The Philippines Manila, Manila, Philippines
| | | | - Allister Vincent G Layog
- Department of Internal Medicine, Section of Neurology, Cardinal Santos Medical Center, San Juan City, Philippines.,Department of Clinical Neurosciences, University of The East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine & Philippine General Hospital, University of The Philippines Manila, Manila, Philippines.,Department of Internal Medicine, Section of Neurology, Cardinal Santos Medical Center, San Juan City, Philippines.,Movement Disorders Service & Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City & Global City, Philippines
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Fasano A, Gurevich T, Jech R, Kovács N, Svenningsson P, Szász J, Parra JC, Bergmann L, Johnson A, Sanchez-Soliño O, Tang Z, Vela-Desojo L. Concomitant Medication Usage with Levodopa-Carbidopa Intestinal Gel: Results from the COSMOS Study. Mov Disord 2021; 36:1853-1862. [PMID: 33908647 PMCID: PMC8453961 DOI: 10.1002/mds.28596] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background Levodopa‐carbidopa intestinal gel (LCIG) is administered directly to the small intestine of patients with advanced Parkinson's disease (APD) to help maintain stable plasma levodopa levels. Objective The objective of this study was to investigate the effect of LCIG in reducing polypharmacy for the treatment of APD. Methods The COmedication Study assessing Mono‐ and cOmbination therapy with levodopa‐carbidopa inteStinal gel (COSMOS) is a large, real‐world, multinational observational study investigating comedication use with LCIG. All enrolled patients had used LCIG for ≥12 months and data were collected cross‐sectionally (study visit) and retrospectively. The primary endpoint was the percentage of patients using LCIG as monotherapy (without add‐on PD medications) at initiation and at 3, 6, 9, and 12 months thereafter. Results Overall, 409 patients were enrolled from 14 countries and were treated with LCIG for a mean of 35.8 ± 23.2 months. A total of 15.2% of patients initiated LCIG as monotherapy and 31.7% were receiving monotherapy at 12 months after initiation. The mean duration of LCIG monotherapy was 39.3 ± 25.6 months. Use of add‐on medications decreased over time with all LCIG regimens. From LCIG initiation to the patient visit, mean off time decreased by 3.8, 4.6, and 3.9 hours/day for LCIG monotherapy, LCIG daytime monotherapy, and LCIG polytherapy groups, respectively, while duration of dyskinesia decreased by 1.7, 2.0, and 1.9 hours/day, respectively. Adverse events likely related to study treatment occurred in 112 patients (27.4%) during LCIG treatment. Conclusions LCIG is an effective long‐term monotherapy option with a positive risk–benefit profile and contributes to reduced polypharmacy for patients with APD. © 2021 The AbbVie Inc. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Alfonso Fasano
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, and Tel Aviv University, Tel Aviv, Israel
| | - Robert Jech
- Department of Neurology and Center of Clinical Neurosciences, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | | | - Per Svenningsson
- Department of Clinical Neuroscience, Section for Neurology, Karolinska Institutet, Stockholm, Sweden
| | - József Szász
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mureș, Emergency Clinical County Hospital Tîrgu Mureș, Târgu Mureș, Romania
| | | | | | | | | | | | - Lydia Vela-Desojo
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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19
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Dahodwala N, Jahnke J, Pettit AR, Li P, Ladage VP, Kandukuri PL, Bao Y, Zamudio J, Jalundhwala YJ, Doshi JA. Low Sustainment of High-Dose Oral Medication Regimens for Advanced Parkinson's Disease in Medicare Beneficiaries. JOURNAL OF PARKINSONS DISEASE 2021; 11:675-684. [PMID: 33386811 DOI: 10.3233/jpd-202147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasing doses of oral antiparkinson medications are indicated in advanced Parkinson's disease (PD), but little is known about sustainment of high-dose regimens. OBJECTIVE To investigate sustainment of high-dose oral medication regimens in Medicare beneficiaries with incident advanced PD. METHODS This retrospective cohort study utilized 100%fee-for-service Medicare claims from 2011-2013. We identified advanced PD using a pharmacy claims-based proxy and selected patients who initiated a new high-dose oral medication regimen (daily levodopa equivalent dose [LED] >1000 mg/day for ≥30 days) in 2012. In the following 12 months, we examined: 1) annual proportion of days covered (PDC)≥0.80 and 2) presence of a ≥ 90 day continuous gap at varying dosage thresholds: the initial >1000 mg/day, >800 mg/day, >500 mg/day, or >0 mg/day. RESULTS We identified 9,405 patients with advanced PD (mean age 77.4 [SD 6.8] years; 53%men). Only 5%maintained a regimen of >1000 mg/day at PDC ≥0.80; 75% had a ≥ 90-day gap in that dosage level. At a dosage threshold of >800 mg/day, 20% had a PDC ≥0.80 and 53% had a ≥ 90-day gap; at >500 mg/day, 56% had a PDC ≥0.80 and 19%had a ≥ 90-day gap; and at >0 mg/day (any dose), 76% had a PDC ≥0.80 and only 10%had a≥90-day gap. CONCLUSION Few patients with advanced PD sustained a high-dose oral medication regimen in the year following initiation, but most sustained a substantially lower-dose regimen. Strategies to improve advanced PD treatment are needed.
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Affiliation(s)
- Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan Jahnke
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy R Pettit
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | - Pengxiang Li
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vrushabh P Ladage
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Jalpa A Doshi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Franke GH, Nentzl J, Jagla-Franke M, Prell T. Medication Adherence and Coping with Disease in Patients from a Neurological Clinic: An Observational Study. Patient Prefer Adherence 2021; 15:1439-1449. [PMID: 34234417 PMCID: PMC8253891 DOI: 10.2147/ppa.s311946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/05/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Medication non-adherence is a huge concern for the medical community. For chronic, especially neurological diseases, taking medication is a central pillar of treatment. To improve adherence to these oftentimes complex medication regimens, the construct needs to be understood in more depth. The aim of this study was to investigate associations between adherence with sociodemographics, clinical variables, and coping in neurological patients. PATIENTS AND METHODS The sample consisted of 545 patients from a German neurological clinic. Adherence was assessed with the Stendal Adherence to Medication Score (SAMS). Patients were grouped as completely adherent (SAMS = 0), non-adherent (upper 25% of the sample), and moderately adherent. Associations with coping were assessed using the Essen Coping Questionnaire. RESULTS Medication adherence was low compared to other non-neurological patient samples. Differences between adherence groups were found regarding gender and facets of coping, namely "trivialisation, wishful thinking and defence" and "finding of inner stability". CONCLUSION Interventions to improve medication adherence should focus on facets of coping with disease, increasing acceptance of disease, willpower, and confidence in treatment.
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Affiliation(s)
- Gabriele Helga Franke
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Stendal, Germany
| | - Julia Nentzl
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Stendal, Germany
| | - Melanie Jagla-Franke
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Stendal, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany
- Correspondence: Tino Prell Department of Neurology, Jena University Hospital, Jena, Germany Email
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21
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Dahodwala N, Li P, Jahnke J, Ladage VP, Pettit AR, Kandukuri PL, Bao Y, Zamudio J, Jalundhwala YJ, Doshi JA. Burden of Parkinson's Disease by Severity: Health Care Costs in the U.S. Medicare Population. Mov Disord 2020; 36:133-142. [PMID: 33031604 DOI: 10.1002/mds.28265] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Current understanding of the health care costs of Parkinson's disease (PD) and the incremental burden of advanced disease is incomplete. OBJECTIVES The aim of this study was to assess the direct economic burden associated with advanced versus mild/moderate PD in a prevalent national sample of elderly U.S. Medicare beneficiaries with a PD diagnosis. METHODS Analyzing 100% fee-for-service Medicare claims from 2013, we defined advanced PD with a medication-based algorithm and calculated all-cause and PD-related costs for the overall sample and by disease severity. We measured primary PD-related costs (based on claims with a primary diagnosis of PD) and any PD-related costs (based on claims with PD in any diagnostic field). Generalized linear models were used to estimate risk-adjusted mean cost differences between the advanced and mild/moderate PD groups for the calendar year. RESULTS The final sample (N = 144,703) had mean observed all-cause, primary PD-related, and any PD-related costs of $23,041 (SD, $34,045), $3429 (SD, $7431), and $9924 (SD, $22,140), respectively. Twenty percent of patients were classified as advanced PD. Costs varied substantially; any PD-related mean costs were $483 for the lowest patient decile (which included 1% of the advanced group) and $48,145 for the highest decile (which included 15% of the advanced group). Incremental risk-adjusted costs of advanced PD were $5818 (95% confidence interval [CI]: $5411-$6225) for all-cause costs, $3644 (95% CI: $3484-$3806) for primary PD-related costs, and $6088 (95% CI: $5779-$6398) for any PD-related costs. CONCLUSIONS Elderly Medicare beneficiaries with PD had substantial variation in PD-related costs. Advanced PD was associated with a larger economic burden than mild/moderate PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pengxiang Li
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jordan Jahnke
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vrushabh P Ladage
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy R Pettit
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Yanjun Bao
- AbbVie Inc., North Chicago, Illinois, USA
| | | | | | - Jalpa A Doshi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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Impaired error awareness in healthy older adults: an age group comparison study. Neurobiol Aging 2020; 96:58-67. [PMID: 32949902 DOI: 10.1016/j.neurobiolaging.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 11/22/2022]
Abstract
Aging is associated with reduced conscious error detection but the brain regions mediating these changes have yet to be clarified. The present study examined the neural correlates of error awareness in healthy older adults. Sixteen older participants (mean age = 75.5 years) and sixteen younger controls (mean age = 27.9 years) were administered the error awareness task, a go/no-go response inhibition paradigm, in which participants were required to signal commission errors. Compared with young adults, older adults were significantly poorer at consciously detecting performance errors, despite both groups being matched for overall accuracy. This age-related behavioral effect was associated with differences in error-related dorsal anterior cingulate cortex and insula activation, with younger adults showing significant differences between errors made with versus without awareness compared with older adults. By contrast, an age-specific modulation in right inferior parietal lobule activation emerged, with increased right inferior parietal lobule activity occurring in older adults during errors made with awareness compared with younger adults. These findings are consistent with theories of age-related deterioration in error processing mechanisms.
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23
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Tosin MHS, Stebbins GT, Goetz CG, Santana RF, Leite MAA, Oliveira BGRB. Measuring Medication Adherence in Parkinson's Disease: A Systematic Review of Contributing Components in Rating Scales. Mov Disord Clin Pract 2020; 7:607-615. [PMID: 32775505 DOI: 10.1002/mdc3.13006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/21/2022] Open
Abstract
Background Poor medication adherence in chronic illnesses such as Parkinson's disease (PD) is a significant but potentially addressable issue if core components are systematically measured. Objective To assess whether rating scales used in PD adequately cover essential components of medication adherence. Methods We accessed 5 databases targeting articles published before October 2019 and using rating scales to measure medication adherence in PD. The ABC Taxonomy from the European Ascertaining Barriers to Compliance Consortium and World Health Organization recommendations were used as the evaluation standard of 5 essential adherence dimensions (patient-based, health system-based, social-based, therapy-based, and health condition-based), 3 phases (initiation, implementation, and discontinuation), and 2 factors (intentional and nonintentional). Results We screened 192 and selected 16 studies, collectively using 5 medication adherence rating scales. No scale covered all essential components of medication adherence (dimensions, phases, factors). The Morisky Medication Adherence Scales were the most frequently used (11 studies), but they measure only 2 dimensions and phases. The Stendal Adherence to Medication Score (used in 1 study) measured all phases but only 2 dimensions, and the Brief Medication Questionnaire (used in 3 studies) measured 3 dimensions and 2 phases. Distinctions between intentional and nonintentional factors were not completely considered in any scale. Conclusions Although multiple studies target medication adherence in PD, the used scales did not measure all recommended components, highlighting the need to develop a sensitive, specific, and comprehensive tool for measuring medication adherence among patients with PD.
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Affiliation(s)
- Michelle H S Tosin
- Department of Nursing Fluminense Federal University Niterói Rio de Janeiro Brazil.,Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Glenn T Stebbins
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Christopher G Goetz
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Rosimere F Santana
- Department of Nursing Fluminense Federal University Niterói Rio de Janeiro Brazil
| | - Marco A A Leite
- Department of Nursing Fluminense Federal University Niterói Rio de Janeiro Brazil.,Department of Clinical Medicine Fluminense Federal University Niterói Rio de Janeiro Brazil
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Self-Reported Nonadherence Predicts Changes of Medication after Discharge from Hospital in People with Parkinson's Disease. PARKINSONS DISEASE 2020; 2020:4315489. [PMID: 32714503 PMCID: PMC7355339 DOI: 10.1155/2020/4315489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/13/2020] [Indexed: 12/26/2022]
Abstract
Background Medication is often changed after hospital discharge in people with Parkinson's disease (PD). Objective This observational study aimed to describe changes in PD medication after discharge and explore their association with self-reported adherence and clinical parameters. Methods During hospitalisation sociodemographic characteristics, the Movement Disorder Society-sponsored revision of the Unified PD Rating Scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Beck Depression Inventory II (BDI-II) score, Montreal Cognitive Assessment (MoCA) score, nonmotor symptoms questionnaire (NMSQ), and Stendal Adherence to Medication Score (SAMS) were collected in 125 people with PD. A semistructured interview was conducted 1 month after discharge to determine the extent and reasons for medication changes. Results Thirty-eight patients (30.4%) changed their PD medication after discharge. Most changes (20.8%) were performed by physicians while 9.6% of patients changed their medication by themselves due to side effects, missing effect of the medication, missing knowledge about the indication, running out of medication, or nonspecific reason. This led to decreased doses while changes by physicians resulted in both increase and decrease of doses as well as new drug prescription. Patients without changes, patients with changes performed by them, and patients with changes performed by physicians did not differ in age, disease duration, MDS-UPDRS III, LEDD, NMSQ, MoCA, BDI-II, gender, marital status, or education. However, patients who themselves made the changes were more likely to be nonadherent according to baseline SAMS. Patients who made changes after discharge had higher SAMS modification and forgetting subscores than patients without changes or with changes made by physicians. Conclusion Both intended and unintended nonadherence occur in patients who change medication after discharge. The use of an adherence questionnaire during inpatient treatment may help detect patients with higher risk of changing medication after discharge.
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25
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Poewe W, Bergmann L, Kukreja P, Robieson WZ, Antonini A. Levodopa-Carbidopa Intestinal Gel Monotherapy: GLORIA Registry Demographics, Efficacy, and Safety. JOURNAL OF PARKINSONS DISEASE 2020; 9:531-541. [PMID: 31282424 PMCID: PMC6700622 DOI: 10.3233/jpd-191605] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Continuous delivery of levodopa-carbidopa intestinal gel (LCIG) provides stable plasma levodopa concentrations and reduces motor fluctuations in advanced Parkinson’s disease (PD) patients. Objective: To compare the effectiveness and safety of LCIG monotherapy vs polytherapy in patients in the GLORIA registry. Methods: This was a post hoc analysis of a 24-month, multinational observational registry where advanced PD patients with persistent motor complications received LCIG (with adjunctive PD treatment, as necessary). Patients were categorized retrospectively into three stable treatment groups: LCIG monotherapy, LCIG in combination with oral levodopa only (“levodopa monotherapy” [including nighttime oral levodopa]), or LCIG in combination with any other antiparkinsonian medication (“LCIG polytherapy”). Results: Of 356 patients, 208 were on stable regimens (LCIG monotherapy n = 80; levodopa monotherapy n = 47; LCIG polytherapy n = 81). Baseline characteristics were similar across groups. LCIG monotherapy showed significant improvements until month 18 in activities of daily living and quality of life, and until month 24 for Unified Parkinson’s Disease Rating Scale (UPDRS) motor examination (p < 0.05), “Off” time (p < 0.001), “On” time with dyskinesia (p < 0.01), and non-motor symptoms (p < 0.01). More patients in the levodopa monotherapy and LCIG polytherapy groups experienced treatment-related adverse drug reactions (ADRs) including dyskinesias and serious ADRs than did patients in the LCIG monotherapy group. There were few polyneuropathy-related ADRs, of which one case of polyneuropathy led to discontinuation from the Levodopa monotherapy group. Conclusions: These data demonstrate that LCIG monotherapy is an effective treatment option in appropriate advanced PD patients; however, definitive baseline clinical predictors identifying patients who can discontinue concomitant oral therapy have not yet been defined.
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Affiliation(s)
- Werner Poewe
- Department of Neurology, Innsbruck Medical University, Austria
| | | | | | | | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
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26
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Boyd JT, Zadikoff C, Benesh JA, Zamudio J, Robieson WZ, Kukreja P, Yokoyama M, Siddiqui MS. A post hoc comparison of levodopa-carbidopa intestinal gel daytime monotherapy vs polytherapy safety and efficacy in patients with advanced Parkinson's disease: Results from 6 phase 3/3b open-label studies. Clin Park Relat Disord 2019; 2:25-34. [PMID: 34316616 PMCID: PMC8302193 DOI: 10.1016/j.prdoa.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/25/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction As Parkinson's disease (PD) progresses, the number/frequency of PD medications tend to increase, which is correlated with decreased patient compliance and suboptimal control of PD symptoms. We investigated efficacy and safety of levodopa-carbidopa intestinal gel (LCIG) daytime monotherapy (with or without nighttime oral levodopa-carbidopa) compared with polytherapy (LCIG with ≥1 adjunctive PD therapy) in advanced PD patients. Methods This post hoc descriptive study compared LCIG stable daytime monotherapy with LCIG stable polytherapy in all six phase 3/3b open-label studies from both US and international sites; because of study design variability, pooling data for comparison was not appropriate. Efficacy assessments included PD diary data (mean change from baseline in “Off” time and “On” time with or without troublesome dyskinesia), mean Unified PD Rating Scale scores (Parts II and III), and 39-item Parkinson's Disease Questionnaire (PDQ-39) summary index. Adverse events were also assessed. Results Overall, LCIG daytime monotherapy and polytherapy demonstrated similar efficacy/safety profiles in advanced PD patients, regardless of treatment duration or population. LCIG monotherapy vs. polytherapy groups experienced similar mean decreases in “Off” time (4.6 vs. 4.1 h/day) and similar increases in “On” time without troublesome dyskinesia (4.6 vs. 4.1 h/day). In most studies, PDQ-39 summary index scores were reduced from baseline by ≥5 points, regardless of patient population or study duration. Adverse events not related to the procedure/device were similar in both groups. Conclusion Our data suggest that, for appropriate patients, LCIG monotherapy can provide a more simplified treatment option with similar efficacy and safety. Advanced Parkinson's disease (PD) often requires a large number of medications Levodopa-carbidopa intestinal gel (LCIG) is administered continuously LCIG monotherapy vs. polytherapy was assessed in six phase 3/3b studies LCIG monotherapy and polytherapy had similar efficacy and safety profiles LCIG monotherapy may provide a more simplified treatment option for advanced PD
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Affiliation(s)
- James T. Boyd
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, 1 South Prospect Street, UHC – Arnold 2, Burlington, VT 05401, USA
- Corresponding author at: Department of Neurological Sciences, University of Vermont, Larner College of Medicine, 1 South Prospect Street, UHC – Arnold 2, Burlington, VT 05401, USA.
| | - Cindy Zadikoff
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | | | - Jorge Zamudio
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | | | - Pavnit Kukreja
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | | | - Mustafa S. Siddiqui
- Department of Neurology, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
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27
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A meta-analytic review of prospection deficits in Parkinson's disease. Neurosci Biobehav Rev 2019; 108:34-47. [PMID: 31682884 DOI: 10.1016/j.neubiorev.2019.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/21/2022]
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative disorders, and is associated with prominent motor deficits. However, neurocognitive impairment is also a common clinical feature that can contribute greatly to the overall disease burden. In the current study, a meta-analysis was conducted to gain a clearer understanding of how PD affects one of the most functionally important domains of cognition: prospection. The results indicate that, relative to controls, PD is associated with a large deficit in the capacity to engage in planning (g = -0.81, K = 25) and a moderate-sized deficit in prospective memory (g = -0.57, K = 16). Sub-analyses indicated that these deficits are evident for both time and event-based prospective memory, as well as for prospective memory tasks that have relatively limited ecological validity. Significant impairment was also evident for both medicated and non-medicated PD sub-groups, but for planning, these deficits were substantially greater in the unmedicated sub-group. The theoretical and practical implications of these findings are discussed.
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28
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Bloem BR, Ypinga JHL, Willis A, Canning CG, Barker RA, Munneke M, De Vries NM. Using Medical Claims Analyses to Understand Interventions for Parkinson Patients. JOURNAL OF PARKINSONS DISEASE 2019; 8:45-58. [PMID: 29254108 PMCID: PMC5836412 DOI: 10.3233/jpd-171277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The scientific evidence to support the value of a range of non-pharmacological interventions for people with Parkinson’s disease (PD) is increasing. However, showing unequivocally that specific interventions are better than usual care is not straightforward because of generic drawbacks of clinical trials. Here, we address these challenges, specifically related to the context of evaluating complex non-pharmacological interventions for people with PD. Moreover, we discuss the potential merits of undertaking “real world” analyses using medical claims data. We illustrate this approach by discussing an interesting recent publication in The Lancet Neurology, which used such an approach to demonstrate the value of specialized physiotherapy for PD patients, over and above usual care physiotherapy.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Jan H L Ypinga
- Department Care Purchasing, CZ Groep, Goes, The Netherlands
| | - Allison Willis
- Departments of Neurology and of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, UK
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Nienke M De Vries
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
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Peter I, Dubinsky M, Bressman S, Park A, Lu C, Chen N, Wang A. Anti-Tumor Necrosis Factor Therapy and Incidence of Parkinson Disease Among Patients With Inflammatory Bowel Disease. JAMA Neurol 2019; 75:939-946. [PMID: 29710331 DOI: 10.1001/jamaneurol.2018.0605] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Despite established genetic and pathophysiologic links between inflammatory bowel disease (IBD) and Parkinson disease (PD), clinical data supporting this association remain scarce. Although systemic inflammation is considered a potential biological mechanism shared between the 2 diseases, the role of reduced systemic inflammation through IBD-directed anti-tumor necrosis factor (anti-TNF) therapy in PD risk is largely unknown. Objective To compare the incidence of PD among individuals with or without IBD and to assess whether PD risk among patients with IBD is altered by anti-TNF therapy. Design, Setting, and Participants This is a retrospective cohort study analyzing information in the Truven Health MarketScan administrative claims database and the Medicare Supplemental Database between January 1, 2000, and March 31, 2016. Individuals were selected who had at least 2 claims for IBD diagnoses, at least 6 months of follow-up, and no prior diagnosis of PD on or before the IBD index date. Exposure to Anti-TNF therapy was measured from the anti-TNF index date to the last date of anti-TNF coverage or the end of enrollment or PD index date, whichever was earliest. Incidence rates per 1000 person-years were calculated, and crude and adjusted incidence rate ratios were estimated by Poisson regression models and presented with 95% CIs. Main Outcomes and Measures Incidence of PD among patients with IBD with or without exposure to anti-TNF therapy. Results In total, 144 018 individuals with IBD were matched on age, sex, and year of index date with 720 090 unaffected controls. Of them, 1796 individuals had at least 2 PD diagnoses and at least 1 filled PD-related prescription. The mean (SD) age of individuals with IBD was 51 (17) years, and 44% were men. The incidence of PD among patients with IBD was 28% higher than that among unaffected matched controls (adjusted incidence rate ratio, 1.28; 95% CI, 1.14-1.44; P < .001). A 78% reduction in the incidence rate of PD was detected among patients with IBD who were exposed to anti-TNF therapy compared with those who were not exposed (adjusted incidence rate ratio, 0.22; 95% CI, 0.05-0.88; P = .03). Conclusions and Relevance A higher incidence of PD was observed among patients with IBD than among individuals without IBD. Early exposure to antiinflammatory anti-TNF therapy was associated with substantially reduced PD incidence. These findings support a role of systemic inflammation in the pathogenesis of both diseases. Further studies are required to determine whether anti-TNF treatment administered to high-risk individuals may mitigate PD risk.
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Affiliation(s)
- Inga Peter
- Department of Genetics and Genomic Sciences, ISMMS (Icahn School of Medicine at Mount Sinai), New York, New York
| | - Marla Dubinsky
- Division of Gastroenterology, Department of Medicine, ISMMS, New York, New York
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30
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Hannink K, Ter Brake L, Oonk NGM, Wertenbroek AA, Piek M, Vree-Egberts L, Faber MJ, van der Palen J, Dorresteijn LD. A randomized controlled efficacy study of the Medido medication dispenser in Parkinson's disease. BMC Geriatr 2019; 19:273. [PMID: 31619184 PMCID: PMC6796399 DOI: 10.1186/s12877-019-1292-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Complex medication schedules in Parkinson’s disease (PD) result in lower therapy adherence, which contributes to suboptimal therapy and clinical deterioration. Medication reminder systems might improve therapy adherence and subsequently improve symptoms of PD. This randomized controlled study assessed the effect of the electronic medication dispenser Medido on physical disability in PD, as a proxy for changes in therapy adherence.x Methods Eighty-seven patients were randomized into the Medido group or control group. The primary outcome of physical disability was measured by the AMC Linear Disability Scale (ALDS). Secondary outcomes were quality of life (QoL) (PDQ-39), health status (EQ5D-5L, VAS), non-motor symptoms (NMS-Quest), and QoL of the caregiver (PDQ-carer). Measurements were performed at baseline, and after 3 and 6 months follow-up. Results When using the Medido, a non-significant improvement of 3.0 points (95% CI -5.6;11.6) was seen in ALDS. The exploratory subgroup Hoehn & Yahr classification (H&Y) > 2.5 improved significantly on ALDS with 14.7 points (95% CI -28.5;-0.9, p = 0.029 for group x time interaction). QoL deteriorated with 1.0 point in PDQ-39 (p = 0.01 for group x time interaction) in favor of the control group. Non-significant differences were observed for VAS (0.4 points, p = 0.057) and NMS-Quest (1.3 points, p = 0.095) in favor of the Medido group. No changes over time were observed in EQ5D-5L and PDQ-carer. Conclusions Based on these data, no firm conclusion can be drawn, but use of the Medido medication dispenser may result in a clinical improvement of physical disability and seems particularly appropriate for more severe patients. Trial registration NTR3917. Registered 19 March 2013.
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Affiliation(s)
- K Hannink
- Department of Neurology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - L Ter Brake
- Department of Neurology, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - N G M Oonk
- Department of Neurology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - A A Wertenbroek
- Department of Neurology, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - M Piek
- Department of Neurology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - L Vree-Egberts
- Department of Neurology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - M J Faber
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands
| | - L D Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands.
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31
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Wang AS, Gunzler SA. Systematic review of the pharmacoeconomics of Parkinson disease medications. Expert Opin Pharmacother 2019; 20:1659-1670. [DOI: 10.1080/14656566.2019.1622091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alexander S. Wang
- Neurological Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Steven A. Gunzler
- Neurological Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
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32
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Oonk N, Movig K, Munster E, Koehorst-Ter Huurne K, van der Palen J, Dorresteijn L. The effect of a structured medication review on quality of life in Parkinson's disease: The study protocol. Contemp Clin Trials Commun 2019; 13:100308. [PMID: 30582067 PMCID: PMC6298904 DOI: 10.1016/j.conctc.2018.100308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/17/2018] [Accepted: 11/27/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Treatment of Parkinson's disease (PD) is symptomatic and frequently consists of complicated medication regimes. This negatively influences therapy adherence, resulting in lower benefit of treatment, drug related problems and decreased quality of life (QoL). A potential effective intervention strategy is a structured medication review, executed by community pharmacists. However, little is known about the effects on clinical endpoints like QoL, as well as on feasibility and cost-effectiveness in PD patients. OBJECTIVES To assess the effect of a structured medication review on QoL in PD patients. Secondary objectives are measurements of physical disability, activities in daily life, non-motor symptoms, health state, personal carers' QoL and cost-effectiveness. Furthermore, a better insight in the process of performing medication reviews will be obtained from the perspective of community pharmacists. METHODS In this multicenter randomized controlled trial we aim to enroll 200 PD patients from the outpatient clinic of three Dutch hospitals. Community pharmacists will perform a structured medication review in half of the assigned patients; the other half will receive usual care. Data obtained by use of six validated questionnaires will be collected at baseline and after 3 and 6 months of follow-up. Semi-structured interviews with community pharmacists will be conducted till data saturation has been reached. DISCUSSION This trial targets a high-risk patient group for whom optimizing therapy by a structured medication review might be of added value. If effectiveness is proven, this could further promote the implementation of pharmaceutical care in a primary care setting.
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Affiliation(s)
- N.G.M. Oonk
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - K.L.L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - E.M. Munster
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - K. Koehorst-Ter Huurne
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Pharmacy De Hofbraak, Haaksbergen, the Netherlands
| | - J. van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands
- Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands
| | - L.D.A. Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
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Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open 2018; 8:e016982. [PMID: 29358417 PMCID: PMC5780689 DOI: 10.1136/bmjopen-2017-016982] [Citation(s) in RCA: 464] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To determine the economic impact of medication non-adherence across multiple disease groups. DESIGN Systematic review. EVIDENCE REVIEW A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. RESULTS Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to 'all causes' non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. CONCLUSION Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required. PROSPERO REGISTRATION NUMBER CRD42015027338.
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Affiliation(s)
- Rachelle Louise Cutler
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy Faculty of Pharmacy, Research Institute for Medicines (iMed.ULisboa), University of Lisbon, Lisbon, Portugal
| | - Michael Frommer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Charlie Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Fleisher JE, Dahodwala NA, Xie SX, Mayo M, Weintraub D, Chodosh J, Shea JA. Development and Validation of the Parkinson's Disease Medication Beliefs Scale (PD-Rx). JOURNAL OF PARKINSONS DISEASE 2017; 6:383-92. [PMID: 27061070 DOI: 10.3233/jpd-150765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medication non-adherence is common in Parkinson's disease (PD) and is associated with increased disability and healthcare costs. Individuals' beliefs regarding their medical conditions and treatments impact medication adherence. While instruments exist to measure patients' beliefs about medications in general, no such tool exists for PD. OBJECTIVES Create an instrument eliciting medication beliefs of persons with PD; identify demographic and clinical characteristics associated with beliefs; and examine whether beliefs are associated with dopaminergic therapy adherence. METHODS We developed the Parkinson's Disease Medication Beliefs Scale (PD-Rx) in four phases: focus groups of patients and caregivers to generate items, scale development, expert and patient revision of items, and a cross-sectional validation sample (n = 75). Adherence was calculated using two approaches incorporating self-reported medication lists. RESULTS The PD-Rx consists of 11 items covering benefits and risks of PD pharmacotherapies. The scale covers motor improvement, current adverse effects, and future concerns. Higher scores indicate more positive beliefs. Internal consistency was acceptable (Cronbach's alpha = 0.67). Test-retest reliability was 0.47. Quality of life was associated with PD-Rx scores, and lower scores were associated with non-adherence. CONCLUSIONS Negative beliefs about PD treatments are associated with lower quality of life and may be related to medication non-adherence. Further study of any causal relationship between beliefs and medication non-adherence in PD will inform the design of future patient-centered interventions to improve adherence.
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Affiliation(s)
- Jori E Fleisher
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, Departments of Neurology and Population Health, New York, NY, USA
| | - Nabila A Dahodwala
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Sharon X Xie
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics and Epidemiology., Philadelphia, PA, USA
| | - Mark Mayo
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Daniel Weintraub
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Joshua Chodosh
- New York University School of Medicine, Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY, USA
| | - Judy A Shea
- University of Pennsylvania Perelman School of Medicine, Department of Medicine, Philadelphia, PA, USA
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Schwartz JK, Grogan KA, Mutch MJ, Nowicki EB, Seidel EA, Woelfel SA, Smith RO. Intervention to Improve Medication Management: Qualitative Outcomes From a Phase I Randomized Controlled Trial. Am J Occup Ther 2017; 71:7106240010p1-7106240010p10. [PMID: 29135431 DOI: 10.5014/ajot.2017.021691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We sought to define an occupational therapy intervention to promote medication management and to evaluate the acceptability and effectiveness of the intervention. METHOD Nineteen adults with chronic health conditions and poor medication adherence participated in a two-group, blinded, randomized study. They received either an occupational therapy or a standard care intervention. We used a qualitative method to measure participants' changes in medication management through an interview regarding participants' perceptions and behaviors. RESULTS The occupational therapy intervention group reported greater improvements in medication management and implemented twice as many new adaptive strategies as the standard care group. Participants indicated that interventions related to advocacy, education, assistive technology, environmental modifications, self-monitoring, and good rapport were the active ingredients of the intervention. CONCLUSIONS Occupational therapy is an acceptable intervention for medication management, and it can lead to self-perceived improvements and the adoption of new medication management behaviors. Further research is warranted.
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Affiliation(s)
- Jaclyn K Schwartz
- Jaclyn K. Schwartz, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami;
| | - Kimberly A Grogan
- Kimberly A. Grogan, MS, OTR/L, is Occupational Therapist, Hawthorn School District and MemoryCare Corp, Chicago, IL
| | - Melissa J Mutch
- Melissa J. Mutch, MS, OTR/L, is Occupational Therapist, University of Wisconsin Health, University Hospital, Madison
| | - Emily B Nowicki
- Emily B. Nowicki, MS, OTR/L, is Occupational Therapist, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Elizabeth A Seidel
- Elizabeth A. Seidel, MS, OTR/L, is Occupational Therapist, Rehabilitation Hospital of Wisconsin, Waukesha
| | | | - Roger O Smith
- Roger O. Smith, PhD, OT, FAOTA, RESNA Fellow, is Professor, Department of Occupational Science and Technology, College of Health Sciences, and Director, Rehabilitation Research Design and Disability Center, University of Wisconsin-Milwaukee
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Objective Assessment of Bradykinesia Estimated from the Wrist Extension in Older Adults and Patients with Parkinson's Disease. Ann Biomed Eng 2017; 45:2614-2625. [PMID: 28852889 DOI: 10.1007/s10439-017-1908-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022]
Abstract
Parkinson's disease (PD) presents several motor signs, including tremor and bradykinesia. However, these signs can also be found in other motor disorders and in neurologically healthy older adults. The incidence of bradykinesia in PD is relatively high in all stages of the disorder, even when compared to tremor. Thus, this research proposes an objective assessment of bradykinesia in patients with PD (G PD: 15 older adults with Parkinson's disease, 65.3 ± 9.1 years) and older adults (G HV: 12 healthy older adults, 60.1 ± 6.1 years). The severity of bradykinesia in the participants of G PD was assessed using the Unified Parkinson's Disease Rating Scale. Movement and muscular activity were detected by means of inertial (accelerometer, gyroscope, magnetometer) and electromyographic sensors while the participants performed wrist extension against gravity with the forearm on pronation. Mean and standard error of inertial and electromyographic signal parameters could discriminate PD patients from healthy older adults (p value <0.05). In discriminating patients with PD from healthy older adults, the mean sensitivity and specificity were respectively 86.67 and 83.33%. The discrimination between the groups, based on the objective evaluation of bradykinesia, may contribute to the accurate diagnosis of PD and to the monitoring of therapies to control parkinsonian bradykinesia, and opens the possibility for further comparative studies considering individuals suffering from other motor disorders.
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Schwartz JK, Smith RO. Intervention Promoting Medication Adherence: A Randomized, Phase I, Small-N Study. Am J Occup Ther 2016; 70:7006240010p1-7006240010p11. [DOI: 10.5014/ajot.2016.021006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. Many people with chronic health conditions fail to take their medications as prescribed, resulting in declines in health and function. The purpose of this study was to perform a Phase I feasibility study to understand whether an integrated occupational therapy intervention could help people with chronic health conditions improve their adherence to medications.
METHOD. Using a small-N design, we report single-subject analyses of the medication adherence of 11 participants before and after either an occupational therapy intervention or a standard care intervention. We used a multiple baseline approach with intersubject replication and blinding.
RESULTS. The occupational therapy intervention was found to decrease performance variability and to increase medication adherence rates in some people with chronic conditions.
CONCLUSION. These findings suggest that an occupational therapy intervention can improve medication adherence in people with chronic health conditions. The intervention tested in this study is feasible and would benefit from further research.
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Affiliation(s)
- Jaclyn K. Schwartz
- Jaclyn K. Schwartz, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami;
| | - Roger O. Smith
- Roger O. Smith, PhD, OT, FAOTA, RESNA Fellow, is Professor, Department of Occupational Science and Technology, College of Health Sciences, and Director, Rehabilitation Research Design and Disability Center, University of Wisconsin–Milwaukee
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Schwartz JK. Pillbox use, satisfaction, and effectiveness among persons with chronic health conditions. Assist Technol 2016; 29:181-187. [PMID: 27689861 DOI: 10.1080/10400435.2016.1219884] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to understand how persons with chronic health conditions use pillboxes, their satisfaction with current devices, and the impact of pillbox use on medication adherence. We used convergent parallel mixed methods approach to explore the experiences of 13 regular, 3 occasional, and 5 non-pillbox users. Medication consumers completed the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0), an interview about their medication routines, and a medication adherence diary to describe their experiences with their pillboxes. Results demonstrated most participants use pillboxes to help manage their medications, and pillbox users tended to have better medication adherence than nonusers. Participants used a variety of pillboxes differing in size, shape, and color. Users reported selecting pillboxes based on their needs in addition to the demands of their habits and medication regimens. Users were generally satisfied with their pillboxes with an average QUEST score of 4.33. However, participants also identified areas for an improved design of pillboxes. Pillboxes can be an effective strategy to improve medication adherence. Improvements in device prescription, training, research, and design are needed to understand the mechanisms and size of effects of this intervention.
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Affiliation(s)
- Jaclyn K Schwartz
- a Department of Occupational Therapy, Nicole Wertheim College of Nursing & Health Sciences , Florida International University , Miami , Florida , USA
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Foppa AA, Chemello C, Vargas-Peláez CM, Farias MR. Medication Therapy Management Service for Patients with Parkinson's Disease: A Before-and-After Study. Neurol Ther 2016; 5:85-99. [PMID: 27271736 PMCID: PMC4919135 DOI: 10.1007/s40120-016-0046-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor manifestations, autonomic and neurological disorders and sensorial symptoms. Medication therapy management (MTM) consists of a service undertaken by pharmacists to optimize pharmacological therapy results. This way, the pharmacist monitors the treatment prescribed by the doctor and formulates a healthcare plan to guarantee the treatment’s effectiveness, safety and convenience, thereby improving the patient’s quality of life (QoL). Objective To analyze the effect of MTM upon medicine-related problems, motor symptoms, autonomic disorders and QoL of patients with Parkinson’s disease, and describe the pharmaceutical interventions. Methods Quasi-experimental uncontrolled before-and-after study carried out between September 2012 and March 2013 in a community pharmacy. Pharmacotherapy data were collected from medical prescriptions, patient diaries, medical charts and all the medicines (over-the-counter and prescription) brought by the patients to the appointment with the pharmacist. The medicine-related problems were classified as indication, effectiveness, safety and adherence. Adherence was measured through clinical interviews and the Morisky questionnaire. PD symptoms were assessed according to the patients’ and/or caregivers’ perceptions about the On/Off state of the motor symptoms and relief of the nonmotor symptoms. QoL was assessed using the PDQ-39 scores. The interventions were targeted to patients/caregivers and/or doctors, with pharmacological and non-pharmacological measures. Results Seventy patients were followed up, showing a decrease in medicine-related problems (1.67 ± 1.34 to 0.8 ± 0.9 (p < 0.001), positive impact on adherence (from 37 to 10 non-adherent patients, p < 0.001), QoL improvement related to emotional wellbeing (p = 0.012) and autonomic disorder. Most interventions were performed directly with the patients (73.8%), including non-pharmacological guidance (28.5%), pharmacological guidance (24.3%) and rescheduling (13.6%). Conclusions To carry out MTM with PD patients, the pharmacist’s expertise needs to transcend the technical knowledge about the PD pharmacological treatment. The study showed a positive effect with a decrease in the medicine-related problems after the interventions, especially improving adherence and patients’ QoL.
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Affiliation(s)
- Aline Aparecida Foppa
- Farmácia Escola UFSC/PMF, Post-Graduate Program in Pharmaceutical Assistance, UFSC, Florianópolis, SC, Brazil.
| | - Clarice Chemello
- Department of Social Pharmacy, Faculty of Pharmacy, UFMG, Belo Horizonte, MG, Brazil
| | | | - Mareni Rocha Farias
- Department of Pharmaceutical Sciences, Health and Science Center, UFSC, Florianópolis, SC, Brazil
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Evans C, Marrie RA, Zhu F, Leung S, Lu X, Melesse DY, Kingwell E, Zhao Y, Tremlett H. Adherence and persistence to drug therapies for multiple sclerosis: A population-based study. Mult Scler Relat Disord 2016; 8:78-85. [PMID: 27456879 DOI: 10.1016/j.msard.2016.05.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/01/2016] [Accepted: 05/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to estimate the prevalence and predictors of optimal adherence and persistence to the disease-modifying therapies (DMT) for multiple sclerosis (MS) in 3 Canadian provinces. METHODS We used population-based administrative databases in British Columbia (BC), Saskatchewan, and Manitoba. All individuals receiving DMT (interferon-B-1b, interferon-B-1a, and glatiramer acetate) between 1-January-1996 and 31-December-2011 (BC), 31-March-2014 (Saskatchewan), or 31-March-2012 (Manitoba) were included. One-year adherence was estimated using the proportion of days covered (PDC). Persistence was defined as time to DMT discontinuation. Regression models were used to assess predictors of adherence and persistence; results were pooled using random effects meta-analysis. RESULTS 4830 individuals were included. When results were combined, an estimated 76.4% (95% CI: 69.1-82.4%) of subjects exhibited optimal adherence (PDC ≥80%). Median time to discontinuation of the initial DMT was 1.9 years (95% CI: 1.6-2.1) in Manitoba, 2.8 years (95% CI: 2.5-3.0) in BC, and 4.0 years (95% CI: 3.5-4.6) in Saskatchewan. Age, sex and socioeconomic status were not associated with adherence or persistence. Individuals who had ≥4 physician visits during the year prior to the first DMT dispensation were more likely to exhibit optimal adherence compared to those with fewer (0-3) physician visits. CONCLUSIONS We observed adherence that is higher than what has been reported for other chronic diseases, and other non-population-based MS cohorts. Closer examination as to why adherence appears to be relatively better in MS and how adherence influences disease outcomes could contribute to our understanding of MS, and prove useful in the management of other chronic diseases.
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Affiliation(s)
- Charity Evans
- College of Pharmacy & Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 5E5, Canada.
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
| | - Feng Zhu
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| | - Stella Leung
- Department of Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
| | - Xinya Lu
- Saskatchewan Health Quality Council, 241-111 Research Drive, Saskatoon, SK, Canada S7N 3R2.
| | - Dessalegn Y Melesse
- Department of Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
| | - Elaine Kingwell
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| | - Yinshan Zhao
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| | - Helen Tremlett
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
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A systematic review of interventions to reduce hospitalisation in Parkinson's disease. Parkinsonism Relat Disord 2016; 24:3-7. [DOI: 10.1016/j.parkreldis.2016.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 11/22/2022]
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Broen MPG, Leentjens AFG, Köhler S, Kuijf ML, McDonald WM, Richard IH. Trajectories of recovery in depressed Parkinson's disease patients treated with paroxetine or venlafaxine. Parkinsonism Relat Disord 2015; 23:80-5. [PMID: 26739248 DOI: 10.1016/j.parkreldis.2015.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/08/2015] [Accepted: 12/19/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Depression is considered a syndrome with a constellation of symptoms that are frequently categorized into 3 domains including affective, somatic and cognitive. There has been limited research into the domain specific magnitude or relative timing of treatment response in patients with Parkinson's disease (PD). In addition, antidepressant trials involving patients with PD have demonstrated a similar robust placebo response to that seen in other populations. However, the timing of the placebo response has not been carefully studied. METHODS We studied differential responses to antidepressant treatment in affective, somatic and cognitive domains of depression. Patients were treated for twelve weeks with placebo, venlafaxine or paroxetine as part of the Study of Antidepressants in Parkinson's Disease (SAD-PD) randomized controlled trial. Depressive symptoms were evaluated with three commonly used rating scales. RESULTS All symptom domains improved during the study period, There was a significant placebo effect, especially in the first two weeks that had diminished by week 12. Compared to placebo, the affective symptoms significantly improved during treatment as early as week 4, followed by the somatic symptoms of depression in week 6 and cognitive symptoms in week 8. The largest response was seen in the affective domain. CONCLUSION In depressed PD patients treated with venlafaxine or paroxetine, affective symptoms improved first, followed by somatic symptoms and cognitive symptoms. These findings could guide patient counselling and increase patient compliance by informing about the expected treatment responses. The substantial placebo effect underlines the importance of a sufficiently long study period in future studies.
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Affiliation(s)
- M P G Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - A F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - S Köhler
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - M L Kuijf
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - W M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - I H Richard
- Department of Neurology and Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Tucker CS, Behoora I, Nembhard HB, Lewis M, Sterling NW, Huang X. Machine learning classification of medication adherence in patients with movement disorders using non-wearable sensors. Comput Biol Med 2015; 66:120-34. [PMID: 26406881 PMCID: PMC5729888 DOI: 10.1016/j.compbiomed.2015.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 11/24/2022]
Abstract
Medication non-adherence is a major concern in the healthcare industry and has led to increases in health risks and medical costs. For many neurological diseases, adherence to medication regimens can be assessed by observing movement patterns. However, physician observations are typically assessed based on visual inspection of movement and are limited to clinical testing procedures. Consequently, medication adherence is difficult to measure when patients are away from the clinical setting. The authors propose a data mining driven methodology that uses low cost, non-wearable multimodal sensors to model and predict patients' adherence to medication protocols, based on variations in their gait. The authors conduct a study involving Parkinson's disease patients that are "on" and "off" their medication in order to determine the statistical validity of the methodology. The data acquired can then be used to quantify patients' adherence while away from the clinic. Accordingly, this data-driven system may allow for early warnings regarding patient safety. Using whole-body movement data readings from the patients, the authors were able to discriminate between PD patients on and off medication, with accuracies greater than 97% for some patients using an individually customized model and accuracies of 78% for a generalized model containing multiple patient gait data. The proposed methodology and study demonstrate the potential and effectiveness of using low cost, non-wearable hardware and data mining models to monitor medication adherence outside of the traditional healthcare facility. These innovations may allow for cost effective, remote monitoring of treatment of neurological diseases.
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Affiliation(s)
- Conrad S Tucker
- Industrial and Manufacturing Engineering, Engineering Design, The Pennsylvania State University, University Park, PA 16802, USA; Computer Science and Engineering, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Ishan Behoora
- Computer Science and Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Harriet Black Nembhard
- Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Mechelle Lewis
- Department of Neurology, Penn State, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Nicholas W Sterling
- Department of Neurology, Penn State, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Xuemei Huang
- Department of Neurology, Penn State, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Rodríguez-Blázquez C, Forjaz MJ, Lizán L, Paz S, Martínez-Martín P. Estimating the direct and indirect costs associated with Parkinson’s disease. Expert Rev Pharmacoecon Outcomes Res 2015; 15:889-911. [DOI: 10.1586/14737167.2015.1103184] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bazán-Rodríguez L, Cervantes-Arriaga A, Llorens-Arenas R, Calderón-Fajardo H, Rodríguez-Violante M. No Difference on Adherence Between Immediate-Release Versus Extended-Release Dopamine Agonists in Uninsured Subjects with Parkinson's Disease. Mov Disord Clin Pract 2015; 3:68-72. [PMID: 30363523 DOI: 10.1002/mdc3.12226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 11/05/2022] Open
Abstract
Background Pharmacological management of subjects with Parkinson's disease (PD) is complex. Regardless of drug selection, adherence is one of the main concerns. Nonadherence is associated with poor symptomatic control and low quality of life. In general, adherence to once-a-day formulations is thought to be better in comparison to 3-times-daily dosing. Methods A cross-sectional study was carried out. Consecutive uninsured subjects diagnosed with PD were treated either with an immediate- or extended-release dopamine agonist formulation. Clinical and demographic data were collected. Subjects were assessed using the International Parkinson and Movement Disorder Society UPDRS. Adherence was evaluated using the Morisky-Green test (MGT). Results A total of 314 (175 males and 139 females) subjects with PD were included. In regard to treatment, 188 (59.9%) were on an immediate-release dopamine agonist and 126 (40.1%) on an extended-release dopamine agonist. According to the MGT, 21 (6.7%) subjects were classified as nonadherent, 273 (86.9%) with a low adherence, and only 20 (6.4%) were considered with high adherence. Dopamine agonist levodopa equivalent daily dose was higher in the extended-release group (296.6 ± 112.4 vs. 231.3 ± 133.4; P = 0.011); also, these subjects had more years of formal education (12.3 ± 5.2 vs. 9.5 ± 5.2; P = 0.630). No difference in adherence levels was found (P = 0.802) between subjects treated with an immediate-release dopamine agonist and those receiving an extended-release formulation. Conclusions Overall adherence in subjects with PD is low. Use of an extended-release over an immediate-release dopamine agonist formulation in this study population is not associated with a better adherence.
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Affiliation(s)
- Lisette Bazán-Rodríguez
- Neurodegenerative Disease Clinical Research Unit National Institute of Neurology and Neurosurgery Mexico City Mexico
| | - Amin Cervantes-Arriaga
- Neurodegenerative Disease Clinical Research Unit National Institute of Neurology and Neurosurgery Mexico City Mexico
| | - Rodrigo Llorens-Arenas
- Neurodegenerative Disease Clinical Research Unit National Institute of Neurology and Neurosurgery Mexico City Mexico.,Movement Disorder Clinic National Institute of Neurology and Neurosurgery Mexico City Mexico
| | - Humberto Calderón-Fajardo
- Neurodegenerative Disease Clinical Research Unit National Institute of Neurology and Neurosurgery Mexico City Mexico.,Movement Disorder Clinic National Institute of Neurology and Neurosurgery Mexico City Mexico
| | - Mayela Rodríguez-Violante
- Neurodegenerative Disease Clinical Research Unit National Institute of Neurology and Neurosurgery Mexico City Mexico.,Movement Disorder Clinic National Institute of Neurology and Neurosurgery Mexico City Mexico
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Shin JY, Habermann B. Initiation of medications for Parkinson's disease: a qualitative description. J Clin Nurs 2015; 25:127-33. [DOI: 10.1111/jocn.13009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ju Young Shin
- School of Nursing; College of Health Sciences; University of Delaware; Newark DE USA
| | - Barbara Habermann
- School of Nursing; College of Health Sciences; University of Delaware; Newark DE USA
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Challenges and strategies of medication adherence in Parkinson's disease: A qualitative study. Geriatr Nurs 2015; 36:192-6. [DOI: 10.1016/j.gerinurse.2015.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/18/2015] [Accepted: 01/26/2015] [Indexed: 01/18/2023]
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder, after Alzheimer's disease, affecting the elderly worldwide. Current therapy for PD is largely based on prescription of drugs that act as either dopamine precursors, dopamine agonists or agents that inhibit key enzymes in the dopamine catabolic pathways. Most of these drugs are administered in tablet or capsule form and can involve multiple daily doses in complex dosing regimens, which contributes to sub-optimal compliance amongst patients. There is evidence to suggest that non-compliance with medications results in perceived poor response to therapy and may ultimately increase direct and indirect health care costs. Medication compliance in PD assumes a particularly important role, given that PD is a progressive, debilitating condition, and once medication is instituted for ameliorating the symptoms of PD, it is lifelong. We included nine research studies in our review of the medical literature, which report the prevalence of significant medication non-compliance in PD, using standard definitions, varies between 10 and 67%. This variation partly reflects differences in defining what clinically significant medication adherence is, the methods used to estimate the scale of the problem and the underlying population heterogeneity. Nevertheless, medication adherence is related to health costs and to the quality of life of patients affected by PD and, indirectly, their carers. Educating patients and their carers is one method of improving patient adherence to therapy. Simplifying drug regimens can also aid in this effort.
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Wei YJ, Palumbo FB, Simoni-Wastila L, Shulman LM, Stuart B, Beardsley R, Brown C. Relationships between antiparkinson medication nonadherence, regimen modifications, and healthcare utilization and expenditures. Parkinsonism Relat Disord 2014; 21:36-41. [PMID: 25465748 DOI: 10.1016/j.parkreldis.2014.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/13/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine 1) the effect of prior antiparkinson drug (APD) nonadherence on subsequent APD regimen modifications; and 2) the influence of modifications on healthcare utilization and costs by patients with Parkinson's disease (PD). METHODS This retrospective cohort study included 7052 PD patients with ≥2 APD prescriptions who initiated a modification of APD regimens in 2007. Modification was assessed as changing from one APD to another and/or adding a new APD to an existing regimen. Nonadherence was measured using Medication Possession Ratio <0.8. Discrete-time survival analyses were used to estimate the effect of prior nonadherent behavior on initiating APD modifications. Generalized linear models were used to estimate the effect of initiating medication modifications on subsequent 3-month medical use and costs. RESULTS Initiation of APD modifications in any given month was higher among patients who were nonadherent to APDs in the preceding month (adjusted hazard ratio [HR] = 1.23), compared to their adherent counterparts. Modifications significantly predicted higher risk of all-cause and PD-related hospitalizations (adjusted relative risk [RR] = 1.22 and 1.83, respectively), home health agency utilization (RR = 1.18 and 1.52), and use of physician services (RR = 1.14 and 1.41), as well as higher total all-cause healthcare expenditures (mean = $1064) in any given 3-month interval. CONCLUSIONS Prior nonadherence to APDs might influence initiation of APD modification. APD modifications were associated with increased health care utilization and expenditures, with the caveats that indications of modifications and disease severity may still play roles. Prescribers should consider patients' medication adherence when changing APD regimens to lower the costs of medical services.
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Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Francis B Palumbo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Bruce Stuart
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Robert Beardsley
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Clayton Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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