1
|
Lithander FE, Tenison E, Ypinga J, Halteren A, Smith MD, Lloyd K, Richfield EW, Brazier DE, Breasail MÓ, Smink AJ, Metcalfe C, Hollingworth W, Bloem B, Munneke M, Ben-Shlomo Y, Darweesh SKL, Henderson EJ. Proactive and Integrated Management and Empowerment in Parkinson's Disease protocol for a randomised controlled trial (PRIME-UK) to evaluate a new model of care. Trials 2023; 24:147. [PMID: 36849987 PMCID: PMC9969590 DOI: 10.1186/s13063-023-07084-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND People living with Parkinson's disease experience progressive motor and non-motor symptoms, which negatively impact on health-related quality of life and can lead to an increased risk of hospitalisation. It is increasingly recognised that the current care models are not suitable for the needs of people with parkinsonism whose care needs evolve and change as the disease progresses. This trial aims to evaluate whether a complex and innovative model of integrated care will increase an individual's ability to achieve their personal goals, have a positive impact on health and symptom burden and be more cost-effective when compared with usual care. METHODS This is a single-centre, randomised controlled trial where people with parkinsonism and their informal caregivers are randomised into one of two groups: either PRIME Parkinson multi-component model of care or usual care. Adults ≥18 years with a diagnosis of parkinsonism, able to provide informed consent or the availability of a close friend or relative to act as a personal consultee if capacity to do so is absent and living in the trial geographical area are eligible. Up to three caregivers per patient can also take part, must be ≥18 years, provide informal, unpaid care and able to give informed consent. The primary outcome measure is goal attainment, as measured using the Bangor Goal Setting Interview. The duration of enrolment is 24 months. The total recruitment target is n=214, and the main analyses will be intention to treat. DISCUSSION This trial tests whether a novel model of care improves health and disease-related metrics including goal attainment and decreases hospitalisations whilst being more cost-effective than the current usual care. Subject to successful implementation of this intervention within one centre, the PRIME Parkinson model of care could then be evaluated within a cluster-randomised trial at multiple centres.
Collapse
Affiliation(s)
- Fiona E. Lithander
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, 1142 New Zealand ,grid.9654.e0000 0004 0372 3343Department of Nutrition and Dietetics, University of Auckland, Auckland, 1142 New Zealand
| | - Emma Tenison
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Jan Ypinga
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Angelika Halteren
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Matthew D. Smith
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Katherine Lloyd
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Edward W. Richfield
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB UK
| | - Danielle E. Brazier
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Mícheál Ó. Breasail
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Agnes J. Smink
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Chris Metcalfe
- grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - William Hollingworth
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - Bas Bloem
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marten Munneke
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Sirwan K. L. Darweesh
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Emily J. Henderson
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.413029.d0000 0004 0374 2907Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG UK
| |
Collapse
|
2
|
Ibrahim H, Cavanagh A, Richfield EW. 64 Evaluating the Acute use of Rotigotine Patch for Dopaminergic Replacement in An Inpatient Population. Age Ageing 2020. [DOI: 10.1093/ageing/afz187.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Rotigotine, a trans-dermal dopamine agonist (DA), can be used acutely for inpatient populations and is an option in end of life (EoL) care for people with Parkinson’s disease (PD) where enteral (oral or naso-gastric) routes are no longer available or appropriate. Concerns regarding acute use of DAs in hospital include: i) difficulty achieving dopaminergic equivalence; ii) promotion of delirium; and iii) promotion of terminal agitation at EoL.
Methods
We retrospectively evaluated acute inpatient Rotigotine use in a UK teaching hospital. Prescriptions between January-June 2018 were identified from the pharmacy database and relevant inpatient records were analysed. The OPTIMAL calculator was used as a gold standard for dopaminergic conversion.
Results
33 eligible inpatients were identified. 13 (39%) patients were prescribed the recommended dose of Rotigotine; 7 (21%) higher and 13 (39%) lower than recommended dose. Of 22 (66%) patients with delirium, 18 (82%) inappropriately received the higher dose. 12 (36%) patients developed new or worsening delirium; and 6 (18%) developed new or worsening hallucinations. 19 (58%) patients were dead at time of evaluation with median survival of 22 days (range 1-207). For patients prescribed Rotigotine for EoL (n=13), median survival was 15 days (range 1-62); for patients not prescribed Rotigotine for EoL (n=20), median survival was 81 days (range 6-207). Of 13 (39%) patients prescribed Rotigotine for EoL, 9 (69%) had evidence of terminal agitation.
Conclusions
Acute conversion to Rotigotine remains problematic, despite availability of validated tools. Inappropriate dosing may precipitate or worsen delirium. Acute prescription of Rotigotine appears to act as a proxy marker for poor prognosis and could be a red flag for triggering advanced care planning. Little is published regarding use of Rotigotine at EoL, this data raises concerns regarding risk of terminal agitation and is an important area for further study.
Collapse
Affiliation(s)
- H Ibrahim
- Southmead Hospital, North Bristol NHS Foundation Trust
| | - A Cavanagh
- Southmead Hospital, North Bristol NHS Foundation Trust
| | - E W Richfield
- Southmead Hospital, North Bristol NHS Foundation Trust
| |
Collapse
|
5
|
Abstract
BACKGROUND Parkinson's disease is a common, life-limiting, neurodegenerative condition. Despite calls for improved access to palliative care for people with Parkinson's disease, services have been slow in developing. Obstacles include poor understanding and recognition of palliative care needs, the role for specialist palliative care services and an agreed structure for sustainable palliative care provision. AIM To summarise the evidence base for palliative care in Parkinson's disease, linking current understanding with implications for clinical practice and identifying areas for future research. WHAT IS KNOWN Convention recognises a final 'palliative phase' in Parkinson's disease, while qualitative studies suggest the presence of palliative care need in Parkinson's disease from diagnosis. Clinical tools to quantify palliative symptom burden exist and have helped to identify targets for intervention. Dementia is highly prevalent and influences many aspects of palliative care in Parkinson's disease, with particular implications for end-of-life care and advance care planning. IMPLICATIONS FOR CLINICAL PRACTICE The 'palliative phase' represents a poor entry point for consideration of palliative care need in Parkinson's disease. An alternative, integrated model of care, promoting collaboration between specialist palliative and neurological services, is discussed, along with some specific palliative interventions. WHAT IS UNKNOWN: Limited evidence exists regarding timing of palliative interventions, triggers for specialist referral and management of terminal care. IMPLICATIONS FOR FUTURE RESEARCH Research examining access to palliative care and management of terminal symptoms will assist development of sustainable, integrated palliative care services for Parkinson's disease.
Collapse
Affiliation(s)
- Edward W Richfield
- Supportive Care, Early Diagnosis and Advanced disease research group, University of Hull, Hull York Medical School, Hull, UK
| | | | | |
Collapse
|