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Swallow DM, Murchie P, Counsell CE. Total Patient Delay: A Comparison of Patient and Clinician/Health System Delays in the Diagnosis of Progressive Supranuclear Palsy and Corticobasal Syndrome. Mov Disord Clin Pract 2024; 11:478-487. [PMID: 38369623 PMCID: PMC11078481 DOI: 10.1002/mdc3.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Early diagnosis in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) is important for clinical care and key to developing successful disease-modifying agents. The patient-dependent phases of decision-making made before contact with a healthcare professional have been inadequately studied. OBJECTIVES To evaluate the patient-dependent phases of decision-making from symptom onset, comparing this to clinician and/or health system delays within the overall diagnostic pathway. METHODS Using the Anderson General Model of Total Patient Delay and a mixed-methods approach in participants with PSP/CBS and their caregivers recruited to the Scottish PSP and CBS cohort, we quantified and evaluated the determinants of "appraisal", "illness," and "behavioral" delay, comparing this to the clinician and/or health system delays ("treatment" delay) within the overall time from symptom onset to diagnosis. RESULTS The time from index symptom onset to diagnosis was 3.26 (interquartile range [IQR] = 2.42, 4.75) years in PSP and 2.58 (IQR = 1.69, 4.08) years in CBS. Patient appraisal delay was 24 (IQR = 6, 60) weeks in PSP and 8 (IQR = 5, 24) weeks in CBS, illness delay 0 (IQR = -14, 0) weeks in PSP and 0 (IQR = -4, 0) weeks in CBS, with little perceived behavioral delay. Determinants of delay included the non-specificity of symptoms, normalization of symptoms within the context of age or normal physiological variability, and the extent of insight into new somatic symptoms. CONCLUSIONS Although patient appraisal delay contributes to overall diagnostic delay in PSP/CBS, the greater proportion of overall diagnostic delay arises after contact with a healthcare professional (treatment delay).
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Affiliation(s)
- Diane M.A. Swallow
- Institute of Applied Health SciencesUniversity of AberdeenAberdeenUnited Kingdom
| | - Peter Murchie
- Institute of Applied Health SciencesUniversity of AberdeenAberdeenUnited Kingdom
| | - Carl E. Counsell
- Institute of Applied Health SciencesUniversity of AberdeenAberdeenUnited Kingdom
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Swallow DMA, Counsell CE. The evolution of diagnosis from symptom onset to death in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) compared to Parkinson’s disease (PD). J Neurol 2023:10.1007/s00415-023-11629-x. [DOI: 10.1007/s00415-023-11629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
Misdiagnosis and delayed diagnosis in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are common. Few studies have systematically evaluated the diagnostic process from symptom onset to death in representative cohorts.
Methods
All PSP/CBD cases (n = 28/2) and age-sex matched Parkinson’s disease (PD) cases (n = 30) were identified from a UK prospective incident Parkinsonism cohort. Medical and research records were reviewed to compare median times from first index symptom to key diagnostic milestones and the nature/timing of secondary care referral and review.
Results
Index symptoms were similar apart from more tremor in PD (p < 0.001) and more impaired balance (p = 0.008) and falls (p = 0.004) in PSP/CBD. PD was diagnosed a median 0.96 years after index symptom. In PSP/CBD the median times from index symptom to identifying parkinsonism and then including PSP/CBD in the differential diagnosis and the final diagnosis were 1.88, 3.41 and 4.03 years, respectively (all p < 0.001). Survival from symptom onset in PSP/CBD and PD was not significantly different (5.98 vs 6.85 years, p = 0.72). More diagnoses (p < 0.001) were considered in PSP/CBD. Prior to diagnosis, PSP/CBD patients had more recurrent emergency attendances (33.3% vs 10.0%, p = 0.01) and were referred to more specialities than PD (median 5 vs 2). Time to any outpatient referral (0.70 vs 0.03 years, p = 0.025) and to specialist movement disorder review (1.96 vs 0.57 years, p = 0.002) was longer in PSP/CBD.
Conclusions
The duration and complexity of the diagnostic journey were greater in PSP/CBD than age-sex matched PD but can be improved. In this older cohort, there was little difference in survival from symptom onset in PSP/CBD and age-sex matched PD.
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Nomoto M, Tsuda H, Yamato K, Arai M. The Assessment of the Diagnostic Delay in Japanese People with Parkinson's Disease Using a Web-based Survey of Patients and Physicians. Intern Med 2023; 62:839-847. [PMID: 36928276 PMCID: PMC10076140 DOI: 10.2169/internalmedicine.8527-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
Objective Although diagnostic criteria of Parkinson's disease (PD) have been established, the details of the process by which patients notice symptoms, visit a physician, and receive a diagnosis of PD is unclear. We therefore explored factors influencing latency in diagnosing PD. Methods We performed an internet-based survey of patients with PD and their families as well as physicians treating patients with PD to identify any diagnostic latency and its determinants. Evaluated factors included motor and non-motor symptoms, the diagnosis history and symptoms, patients' feelings toward PD prior to the diagnosis, and physician-determined reasons for the diagnostic delay. Results Among the 186 eligible patient respondents (including 87 responses from family members of patients), 24% received a PD diagnosis >1 year after the onset of PD-related symptoms, 58.6% had mid- or late-stage PD at the diagnosis, and 29% of patients had initially thought their symptoms were common age-related phenomena. Tremor (42%) was the most frequent symptom that led patients to visit a medical institution, whereas gait disturbance (14%) was the least frequent. More patients diagnosed with early-stage PD than those diagnosed with mid- or late-stage PD consulted a neurologist at their first visit. Among the 331 eligible physicians, patients' misinterpretation of their symptoms as being age-related was deemed one of or the most common cause (s) of a diagnostic delay by 67% and 36%, respectively. Conclusion Patients' insufficient or misinterpreted information about PD may cause delays in accessing healthcare services, leading to diagnostic delay.
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Affiliation(s)
- Masahiro Nomoto
- Saiseikai Imabari Center for Health and Welfare, Japan
- Neurology, Clinical Trial Research Center, Imabari Hospital, Japan
- Department of Neurology and Clinical Pharmacology, School of Medicine, Ehime University, Japan
| | - Hiroshi Tsuda
- Department of Neurology, Faculty of Medicine, Toho University, Japan
- Department of Neurology, Juntendo University School of Medicine, Japan
- Japan Medical Office, Takeda Pharmaceutical, Company Limited, Japan
| | - Kentaro Yamato
- Japan Medical Office, Takeda Pharmaceutical, Company Limited, Japan
| | - Masaki Arai
- Japan Medical Office, Takeda Pharmaceutical, Company Limited, Japan
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Gibbons CH, Freeman R, Bellaire B, Adler CH, Moore D, Levine T. Synuclein-One study: skin biopsy detection of phosphorylated α-synuclein for diagnosis of synucleinopathies. Biomark Med 2022; 16:499-509. [PMID: 35272481 PMCID: PMC9169016 DOI: 10.2217/bmm-2021-0646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
Finding an easily accessible and reliable tool to diagnose the diseases collectively defined as 'synucleinopathies' is an urgent, unmet priority. The synucleinopathies include Parkinson's disease, multiple system atrophy, pure autonomic failure and dementia with Lewy bodies. There are millions of people who have a diagnosis of a synucleinopathy, with more diagnosed every year. With accessibility, ease of implementation, consistently high sensitivity (>80%) and specificity approaching 100%, skin biopsy has great potential as the clinical test of choice for the diagnosis of synucleinopathies. The large, multi-center Synuclein-One study will determine the sensitivity, specificity, accuracy and precision of α-synuclein detection within punch skin biopsies in patients with clinically established synucleinopathies using standardized, robust methods suitable for large-scale analysis. Clinical Trial Registration: NCT04700722 (ClinicalTrials.gov).
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Affiliation(s)
- Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA
| | | | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Dan Moore
- Calico Computing, Livermore, CA 94550, USA
| | - Todd Levine
- Department of Neurology, Honorhealth, Phoenix, AZ 85251, USA
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Sánchez-Guzmán MA, Paz-Rodríguez F, Espinola Nadurille M, Trujillo-De Los Santos Z. Intimate Partner Violence in Persons With Parkinson's Disease. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1732-1748. [PMID: 32779513 DOI: 10.1177/0886260520920862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent studies have reported that older adults with cognitive or physical disabilities are at risk to suffer intimate partner violence. This article investigates the intimate partner violence among caregivers and persons with Parkinson's disease (PD). We used qualitative methods to investigate whether the presence of violence was related to the type of couple relationship before the disease onset. We used a survey, in-depth interviews, and focus groups in 20 dyads of caregivers and patients. Twelve (60%) persons with PD and nine (45%) caregivers reported receiving violence. Considering their relationships previous to disease onset, we describe three typologies of violence in PD: (a) disease and history of violence, (b) disease as a buffer of violence, and (c) the burden of disease as an inductor of violence. Previous relationships and the couple's biographical trajectories influence the types of violence and its nature. This study is relevant as it considers time as a crucial factor in both the violence and suffering of PD and its caregiving.
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Lim ICZY, Saffari SE, Neo S. A cross-sectional study of knowledge and practices in the management of patients with Parkinson’s disease amongst public practice-based general practitioners and geriatricians. BMC Health Serv Res 2022; 22:91. [PMID: 35057812 PMCID: PMC8780393 DOI: 10.1186/s12913-022-07503-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background As most patients are likely to first interface with their community general practitioner (GP) or geriatrician for chronic healthcare conditions, these non-neurologists practitioners are well-placed to diagnose, initiate treatment in symptomatic Parkinson’s disease (PD) patients, and provide regular and timely management of their PD. However, current studies suggest that the role of the GP and geriatrician in providing holistic care for PD patients may be limited by factors such as patient perceptions, and a lack of knowledge base in the quality measures of care. This paper aims to better understand the different management styles between GPs and geriatricians practicing in public institutions in Singapore, qualify the difficulties they face in providing patient-centric care for PD patients, and identify any gaps in quality measures of care. Methods A questionnaire was completed anonymously by GPs (n = 43) and geriatricians (n = 33) based at public institutions, on a voluntary basis before a compulsory didactic teaching on PD. Questions were modelled after quality measures set out by the American Academy of Neurology, specifically eliciting information on falls, non-motor symptoms, exercise regime and medication-related symptoms. “PD management practices and styles” questions were answered by the respondents on a 4-point Likert scale. Results Geriatricians spent more time in consult with PD patients compared with GPs (median [Q1-Q3] = 20 [15–30] vs 10 [10–15] minutes, p < 0.001). Geriatricians were more comfortable initiating PD medications than GPs (OR = 11.8 [95% CI: 3.54–39.3], p < 0.001), independent of gender, years of practice and duration of consult. Comfort in initiating dopamine replacement therapy (OR 1.06 [1.00–1.36], p = 0.07; aOR = 1.14 [1.02–1.26], p = 0.02) also increased with physician’s years of practice. Unfamiliarity with the types and/or doses of the medications was the most cited barrier faced by GPs (76.7%). Geriatricians were more likely than GPs to ask about falls (100% vs 86.0%, p = 0.025), non-motor symptoms (75.8% vs 53.5%, p = 0.049) and the patient’s regular physical activities (72.7% vs 41.9%, p = 0.01). Conclusions This study identified key patterns in the management practices and styles of non-neurologists physicians, and identified gaps in current practice. Our data suggests that interventions directed at education on PD medication prescriptions and provision of patient PD education, creation of best clinical practice guidelines, and accreditation by national bodies may instil greater confidence in practitioners to initiate and continue patient-centric PD care. A longer consultation duration with PD patients should be considered to allow physicians to get a greater scope of the patient’s needs and better manage them. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07503-7.
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Dodel R, Tinelli M, Deuschl G, Petersen G, Oertel W, Ahmerkamp-Böhme J. The economic benefit of timely, adequate, and adherence to Parkinson's disease treatment: the Value of Treatment Project 2. Eur J Neurol 2020; 28:707-716. [PMID: 33048415 DOI: 10.1111/ene.14584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a chronic progressive neurological disorder with a high psychosocial and economic burden. As part of the European Brain Council (EBC)-led Value of Treatment project, this study aimed to capture the economic benefit of timely, adequate, and adherence to PD treatment. METHODS The EBC Value of Treatment Initiative combined different stakeholders to identify unmet needs in the patients' journey according to Rotterdam methodology. The economic evaluation focused on three major topics identified as major gaps: start of treatment; best treatment for advanced disease; and adherence to treatment. Two separate healthcare systems (Germany and the UK) were chosen. Cost-effectiveness was determined by using decision-analytical modelling approaches. Effectiveness was expressed as quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER). RESULTS Treatment intervention in PD was found to be cost-effective regardless of the initial health state of the patient receiving the treatment. Cost savings were between -€1000 and -€5400 with 0.10 QALY gain and -€1800 and -€7600 with 0.10 QALY gain for Germany and the UK, respectively. Treatment remains cost-effective within the National Institute for Health and Care Excellence thresholds. Availability of adequate treatment to more patients was also found to be cost-effective, with an ICER of €15,000-€32,600 across country settings. Achieving the target adherence to treatment would generate cost-savings of €239,000-€576,000 (Germany) and €917,000-€2,980.000 (UK) for every 1,000 patients treated adequately. CONCLUSIONS The analyses confirmed that timely, adequate, and adherence to PD treatment will not only improve care of the patients but is also cost-effective across healthcare systems. Further studies with a distinct identification of gaps in care are necessary to develop better and affordable care.
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Affiliation(s)
- R Dodel
- Department of Geriatric Medicine, University Duisburg-Essen, Essen, Germany
| | - M Tinelli
- Care Policy Evaluation Centre (CPEC), London School of Economics and Political Science (LSE), London, UK
| | - G Deuschl
- Department of Neurology, UKSH, Christian-Albrechts University, Kiel, Germany
| | | | - W Oertel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Plouvier AOA, Olde Hartman TC, de Bont OA, Maandag S, Bloem BR, van Weel C, Lagro-Janssen ALM. The diagnostic pathway of Parkinson's disease: a cross-sectional survey study of factors influencing patient dissatisfaction. BMC FAMILY PRACTICE 2017; 18:83. [PMID: 28841849 PMCID: PMC5574149 DOI: 10.1186/s12875-017-0652-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/09/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The diagnostic pathway of Parkinson's disease (PD) is often complicated. Experiences during this pathway can affect patients' satisfaction and their confidence and trust in healthcare providers. Although healthcare providers cannot influence the impact of the diagnosis, they can influence how patients experience the pathway. This study, therefore, aims to provide insight into PD patients' dissatisfaction with the diagnostic pathway and to describe the factors that influence it. METHODS We carried out a cross-sectional survey study among 902 patient members of the Dutch Parkinson's Disease Association, who were each asked to write an essay about their diagnostic pathway. A coding format was developed to examine the content of these essays. Inter-observer agreement on coding patient dissatisfaction was calculated using Cohen's kappa. The χ2 test and a multivariable logistic regression analysis were performed to assess the relation between dissatisfaction and sex, level of education, duration of the pathway, communication with the general practitioner (GP) and the neurologist, the number of healthcare providers involved, whether or not a second opinion had taken place (including the person who initiated it) and diagnostic delay (taking into consideration who caused the delay according to the patient). A subgroup analysis was performed to gain insight into sex-related differences. RESULTS Of all patients, 16.4% explicitly described they were dissatisfied with the diagnostic pathway, whereas 4.8% were very satisfied. The inter-observer agreement on coding dissatisfaction was κ = 0.82. The chance of dissatisfaction increased with a lower level of education, the involvement of more than one additional healthcare provider, a second opinion initiated by the patient and delay caused by a healthcare provider. When only the GP and the neurologist were involved, women were more likely to be dissatisfied than men. CONCLUSIONS PD patients' dissatisfaction with the diagnostic pathway is related to a lower level of education, a second opinion initiated by the patient and experienced diagnostic delay. GPs can positively influence patients' experiences if they are aware of these risk factors for dissatisfaction and pay extra attention to communication and shared decision making. This will contribute to a trusting therapeutic relationship that is indispensable with progression of the disease.
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Affiliation(s)
- Annette O A Plouvier
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Olga A de Bont
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sjoerd Maandag
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology and Parkinson Center Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Department Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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