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Yi Z, Mao Y, He C, Zhang Y, Zhou J, Feng XL. Medication adherence and costs of medical care among patients with Parkinson's disease: an observational study using electronic medical records. BMC Public Health 2024; 24:1202. [PMID: 38689223 PMCID: PMC11061997 DOI: 10.1186/s12889-024-18431-y] [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: 10/10/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Adherence to antiparkinsonian drugs (APDs) is critical for patients with Parkinson's disease (PD), for which medication is the main therapeutic strategy. Previous studies have focused on specific disorders in a single system when assessing clinical factors affecting adherence to PD treatment, and no international comparative data are available on the medical costs for Chinese patients with PD. The present study aimed to evaluate medication adherence and its associated factors among Chinese patients with PD using a systematic approach and to explore the impact of adequate medication adherence on direct medical costs. METHODS A retrospective analysis was conducted using the electronic medical records of patients with PD from a medical center in China. Patients with a minimum of two APD prescriptions from January 1, 2016 to August 15, 2018 were included. Medication possession ratio (MPR) and proportion of days covered were used to measure APD adherence. Multiple linear regression analysis was used to identify factors affecting APD adherence. Gamma regression analysis was used to explore the impact of APD adherence on direct medical costs. RESULTS In total, 1,712 patients were included in the study, and the mean MPR was 0.68 (± 0.25). Increased number of APDs and all medications, and higher daily levodopa-equivalent doses resulted in higher MPR (mean difference [MD] = 0.04 [0.03-0.05]; MD = 0.02 [0.01-0.03]; MD = 0.03 [0.01-0.04], respectively); combined digestive system diseases, epilepsy, or older age resulted in lower MPR (MD = -0.06 [-0.09 to -0.03]; MD = -0.07 [-0.14 to -0.01]; MD = -0.02 [-0.03 to -0.01], respectively). Higher APD adherence resulted in higher direct medical costs, including APD and other outpatient costs. For a 0.3 increase in MPR, the two costs increased by $34.42 ($25.43-$43.41) and $14.63 ($4.86-$24.39) per year, respectively. CONCLUSIONS APD adherence rate among Chinese patients with PD was moderate and related primarily to age, comorbidities, and healthcare costs. The factors should be considered when prescribing APDs.
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Affiliation(s)
- Zhanmiao Yi
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China.
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.
| | - Yudan Mao
- Department of Pharmacy, Hospital of Renmin University of China, Renmin University of China, Beijing, China
| | - Chenxuan He
- Institute of Statistics and Big Data, Renmin University of China, Beijing, China
| | - Yantao Zhang
- State Grid Digital Technology Holding Co., LTD, Beijing, China
| | - Junwen Zhou
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xing Lin Feng
- School of Public Health, Peking University, Haidian District, 100191, Beijing, China.
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Kruse C, Lipinski A, Verheyen M, Balzer-Geldsetzer M, Wittenberg M, Lorenzl S, Richinger C, Schmotz C, Tönges L, Woitalla D, Klebe S, Bloem BR, Hommel A, Meissner WG, Laurens B, Boraud T, Foubert-Samier A, Vergnet S, Tison F, Costa N, Odin P, Rosqvist K, Norlin JM, Hjalte F, Schrag A, Dodel R. Care of Late-Stage Parkinsonism: Resource Utilization of the Disease in Five European Countries. Mov Disord 2024; 39:571-584. [PMID: 38425158 DOI: 10.1002/mds.29718] [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: 05/10/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease that leads to progressive disability. Cost studies have mainly explored the early stages of the disease, whereas late-stage patients are underrepresented. OBJECTIVE The aim is to evaluate the resource utilization and costs of PD management in people with late-stage disease. METHODS The Care of Late-Stage Parkinsonism (CLaSP) study collected economic data from patients with late-stage PD and their caregivers in five European countries (France, Germany, the Netherlands, UK, Sweden) in a range of different settings. Patients were eligible to be included if they were in Hoehn and Yahr stage >3 in the on state or Schwab and England stage at 50% or less. In total, 592 patients met the inclusion criteria and provided information on their resource utilization. Costs were calculated from a societal perspective for a 3-month period. A least absolute shrinkage and selection operator approach was utilized to identify the most influential independent variables for explaining and predicting costs. RESULTS During the 3-month period, the costs were €20,573 (France), €19,959 (Germany), €18,319 (the Netherlands), €25,649 (Sweden), and €12,156 (UK). The main contributors across sites were formal care, hospitalization, and informal care. Gender, age, duration of the disease, Unified Parkinson's Disease Rating Scale 2, the EQ-5D-3L, and the Schwab and England Scale were identified as predictors of costs. CONCLUSION Costs in this cohort of individuals with late-stage PD were substantially higher compared to previously published data on individuals living in earlier stages of the disease. Resource utilization in the individual sites differed in part considerably among these three parameters mentioned. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Anna Lipinski
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Malte Verheyen
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Monika Balzer-Geldsetzer
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Michael Wittenberg
- Coordination Center for Clinical Trials of the Philipps-University Marburg, Marburg, Germany
| | - Stefan Lorenzl
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Carmen Richinger
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Christian Schmotz
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Krankenhaus Kupferdreh, Essen, Germany
| | - Stephan Klebe
- Department of Neurology, Essen University Hospital, Essen, Germany
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Adrianus Hommel
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Wassilios G Meissner
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Brice Laurens
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Thomas Boraud
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Alexandra Foubert-Samier
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Sylvain Vergnet
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - François Tison
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Nadège Costa
- Health Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Frida Hjalte
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - Richard Dodel
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Zarotti N, Deane KHO, Ford CEL, Simpson J. Perceived control as a predictor of medication adherence in people with Parkinson's: a large-scale cross-sectional study. Disabil Rehabil 2024; 46:478-488. [PMID: 36824021 DOI: 10.1080/09638288.2023.2181409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Medication adherence is a multi-faceted construct associated with several positive consequences in people with chronic conditions. However, non-adherence currently represents a major issue in Parkinson's, potentially due to low perceptions of control. This study investigated the predictive ability of several aspects of perceived control on adherence in people with Parkinson's, while accounting for previously established predictors such as depression and medication variables. MATERIALS AND METHODS An online cross-sectional survey was carried out with 1210 adults with Parkinson's from 15 English-speaking countries. Demographic and clinical questions, as well as measures of depression, aspects of perceived control, and medication adherence were included. Pearson's correlations and a 4-block hierarchical regression analysis were performed to assess the relationship between the variables. RESULTS Perceived control explained a slightly higher amount of variance in medication adherence compared to medication variables when entered in the last block. Unexpectedly, depression was not significantly related with adherence. Internal locus of control was an independent negative predictor of adherence, while external dimensions of locus of control emerged as independent positive predictors. CONCLUSIONS In people with Parkinson's, perceptions of control may have a larger impact on adherence compared to medication variables. Implications for clinical practice and future research are discussed.Implications for RehabilitationPerceived control and depression are considered important constructs for medication adherence in Parkinson's, which in turn is often problematic for affected individuals.The specific predictive value of different aspects of perceived control on medication adherence in Parkinson's is currently unclear.This large-scale study found that perceptions of control may have a larger impact on adherence compared to medication variables, while depression was unrelated to it.A need for psychologically-informed interventions, person-centred approaches to medication management, and Parkinson-specific measures of adherence are highlighted.
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Affiliation(s)
- Nicolò Zarotti
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Catherine Elaine Longworth Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Tosin MH, de Oliveira BGR, Goetz CG, Morisky D, McConvey V, Skorvanek M, Schrag A, Martinez‐Martin P, Stebbins GT. Rating Scales for Medication Adherence in Parkinson's Disease: A Systematic Review for Critique and Recommendations. Mov Disord Clin Pract 2023; 10:175-189. [PMID: 36825050 PMCID: PMC9941935 DOI: 10.1002/mdc3.13586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background Behaviors interfering with medication adherence (MA) are common and often complex in Parkinson's disease (PD), negatively affecting quality of life and undermining the value of clinical trials. The Clinical Outcome Assessments (COA) Scientific Evaluation Committee of the International Parkinson and Movement Disorder Society (MDS) commissioned the assessment of MA rating scales to recommend the use in PD. Objective Critically review the measurement properties of rating scales used to assess MA in PD and to issue recommendations. Methods We conducted systematic review across seven databases to identify structured scales to assess MA in PD. Eligible studies were critically appraised for methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias checklist. Standards for good measurement properties of the selected scales were summarized narratively using the COSMIN, the MDS-COA Committee methodology, the World Health Organization concepts, and the Ascertaining Barriers to Compliance taxonomy. The certainty of the evidence was determined using the modified Grades of Recommendation, Assessment, Development and Evaluation approach with final assessments (highest to lowest) of "Recommended," "Suggested" and "Listed". Results Of the nine reviewed scales, none met the designation "Recommended". The Morisky Medication Adherence Scale (MMAS-8); Beliefs Related to Medications Adherence questionnaire, Beliefs about Medication Questionnaire, Medication Adherence Rating Scale, and Satisfaction with Information on Medicines Scale were rated "Suggested". Conclusions We suggest further work focusing on resolving the problems of the suggested scales or developing a new scale meeting all required criteria.
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Affiliation(s)
| | | | - Christopher G. Goetz
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Donald Morisky
- Department of Community Health SciencesUCLA Fieldling School of Public HealthLos AngelesCaliforniaUSA
| | | | - Matej Skorvanek
- Department of Neurology, Faculty of MedicineP. J. Safarik UniversityKosiceSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Anette Schrag
- Department of Clinical NeurosciencesUCL Institute of NeurologyLondonLondonUK
| | - Pablo Martinez‐Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED)Carlos III Institute of HealthMadridSpain
| | - Glenn T. Stebbins
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
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Sumbul-Sekerci B, Hanagasi HA, Bilgic B, Tufekcioglu Z, Gurvit H, Emre M. Medication management and treatment adherence in Parkinson's disease patients with mild cognitive impairment. Acta Neurol Belg 2022:10.1007/s13760-022-01916-1. [PMID: 35325434 DOI: 10.1007/s13760-022-01916-1] [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: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The key feature that distinguishes mild cognitive impairment (MCI) from dementia is the absence of significant functional decline because of cognitive impairment. In Parkinson's disease patients (PD) with MCI (PD-MCI), the effect of cognitive impairment on complex instrumental daily activities, such as medication management, is not well established. METHOD 26 patients with PD-MCI (diagnosed to Level 2 Movement Disorders Society diagnostic criteria) and 32 idiopathic PD patients without cognitive impairment participated in the study. A detailed neuropsychological testing battery (including tests for attention and working memory, executive functions, language, visuospatial functions, episodic memory) and various prospective memory tasks were applied to the patients. Medication taking behaviors were evaluated using two different methods based on the performance (medication management ability assessment) and self-reporting (adherence scale). RESULTS The PD-MCI group obtained significantly lower scores in medication management assessment and made more mistakes on following prescription instructions (e.g., they took more or less tablets and did not use medications as instructed with regard to meal times). Cognitive areas predicting success in medication management performance were language, event-based prospective memory and visuospatial functions. There was no significant difference between the two groups' self-reporting of adherence. CONCLUSION Mild cognitive impairment in patients with PD adversely affects medication management. Diagnosing MCI in PD is important to ensure that the appropriate measures can be taken to provide support and improve the medication management process. Adherence assessments based on self-reporting may not provide reliable and sensitive information in patients with PD-MCI.
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Affiliation(s)
- Betul Sumbul-Sekerci
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Hasmet A Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Effect of Pillbox Organizers with Alarms on Adherence to Pharmacotherapy in Parkinson Disease Patients Taking Three and More Daily Doses of Dopaminergic Medications. J Pers Med 2022; 12:jpm12020179. [PMID: 35207667 PMCID: PMC8879586 DOI: 10.3390/jpm12020179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
Improvement of adherence to pharmacotherapy in patients with Parkinson’s disease (PD) is a challenge in routine clinical practice. Our study was aimed at the effect of pillbox organizers with alarms improving adherence to pharmacotherapy and its impact on clinical outcomes. Forty nonadherent patients with PD being treated with ≥ 3 daily doses of levodopa and/or dopamine agonists were pseudorandomized and consecutively ranked to groups A (early-start intervention) and B (delayed-start intervention). We used the following validated diagnostic instruments: MMAS-8 (adherence), PDQ-8 (quality of life, QoL), GDS (depression), NMSS (non-motor symptoms), MDS-UPDRS III (motor involvement), MDS-UPDRS IV, and WOQ-9 (motor and non-motor fluctuations and dyskinesias). We proved a significantly improved rate of adherence with the use of pillbox organizers with alarms. Moreover, after only four weeks of using the pillbox organizer, we detected an improvement in QoL scores, motor involvement, motor-, and non-motor fluctuations. Our study showed that pillbox organizers with alarms are efficient in improving adherence to pharmacotherapy in PD. It also could contribute to better motor states, less severe fluctuations, and improved QoL.
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Radojević B, Dragašević-Mišković NT, Milovanović A, Svetel M, Petrović I, Pešić M, Tomić A, Stanisavljević D, Savić MM, Kostić VS. Adherence to Medication among Parkinson's Disease Patients Using the Adherence to Refills and Medications Scale. Int J Clin Pract 2022; 2022:6741280. [PMID: 35685562 PMCID: PMC9159199 DOI: 10.1155/2022/6741280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Adherence to medication is an important factor that can influence Parkinson's disease (PD) control. We aimed to explore patients' adherence to antiparkinsonian medication and determine factors that might affect adherence to medications among PD patients. METHODS A cross-sectional, exploratory survey of PD patients treated with at least one antiparkinsonian drug and with a total score of MoCA (Montreal Cognitive Assessment) ≥26 was conducted. The final sample included 112 PD patients. A patient's adherence was assessed through ARMS (Adherence to Refills and Medications Scale). ARMS scores higher than 12 were assumed lower adherence. In addition, each patient underwent neurological examination, assessment of depression, anxiety, and evaluation of the presence of PD nonmotor symptoms. RESULTS The mean ARDS value in our cohort was 14.9 ± 2.5. Most PD patients (74.1%) reported lower adherence to their medication. Participants in the lower adherence group were younger at PD onset, had significantly higher UPDRS (Unified PD Rating Scale) scores, as well as UPDRS III and UPDRS IV subscores, HARS (Hamilton Anxiety Rating Scale), and NMSQuest (Non-Motor Symptoms Questionnaire for PD) scores compared to the fully adherent group (p=0.013, p=0.017, p=0.041, p=0.043, and p=0.023, respectively). Among nonmotor PD symptoms, the presence of cardiovascular, apathy/attention-deficit/memory disorders, hallucinations/delusions, and problems regarding changes in weight, diplopia, or sweating were associated with lower adherence. Multivariate regression analysis revealed depression as the strongest independent predictor of lower adherence. CONCLUSION Depressed PD patients compared to PD patients without clinical depression had a three times higher risk for lower adherence to pharmacotherapy. Recognition and adequate treatment of depression might result in improved adherence.
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Affiliation(s)
| | | | - Andona Milovanović
- Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Svetel
- Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Petrović
- Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maja Pešić
- Special Hospital for Cerebrovascular Disorders “Saint Sava”, Belgrade, Serbia
| | - Aleksandra Tomić
- Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejana Stanisavljević
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Vladimir S. Kostić
- Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
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Zaman MS, Ghahari S, McColl MA. Barriers to Accessing Healthcare Services for People with Parkinson's Disease: A Scoping Review. JOURNAL OF PARKINSON'S DISEASE 2021; 11:1537-1553. [PMID: 34308913 PMCID: PMC8609702 DOI: 10.3233/jpd-212735] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 12/18/2022]
Abstract
Parkinson's disease is a complex condition that affects many different aspects of a person's health. Because of its complexity, people with Parkinson's disease require access to a variety of healthcare services. The aim of the present study was to identify the barriers to access healthcare services for people with Parkinson's disease. We conducted a scoping review according to guidelines posed by Arksey & O'Malley (2005). A search of MEDLINE, Embase, CINHAL, and PsycINFO databases was conducted, and 38 articles were selected based on the inclusion criteria. The review findings identified person-level and system-level barriers. The person-level barriers included skills required to seek healthcare services, ability to engage in healthcare and cost for services. The system-level barriers included the availability of appropriate healthcare resources. Based on the existing barriers elucidated in the scope review, we have discussed potential areas in healthcare that require improvement for people with Parkinson's disease to manage their healthcare needs more equitably.
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Affiliation(s)
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
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Zipprich HM, Mendorf S, Schönenberg A, Prell T. The impact of poor medication knowledge on health-related quality of life in people with Parkinson's disease: a mediation analysis. Qual Life Res 2021; 31:1473-1482. [PMID: 34797508 PMCID: PMC9023397 DOI: 10.1007/s11136-021-03024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to determine how limited medication knowledge as one aspect of health literacy contributes to poorer health-related quality of life (HRQoL) in people with Parkinson's disease (PD). METHODS Demographical data, PD-specific data (MDS-Unified Parkinson's Disease-Rating Scale, Nonmotor symptom scale), and data about depressive symptoms (Beck's depression inventory), cognition (Montreal cognitive assessment), HRQoL (Short-Form Health Questionnaire-36, SF-36), and medication knowledge (names, time of taking, indication, dosage) were assessed in 193 patients with PD. Multivariate analysis of variance (MANOVA), multivariate analysis of covariance, and mediation analyses were used to study the relationship between medication knowledge and HRQoL in combination with different mediators and covariates. RESULTS Overall, 43.5% patients showed deficits in at least one of the 4 knowledge items, which was associated with higher age, number of medications per day and depression level, and poorer cognitive function, motor function, and lower education level. Using one-way MANOVA, we identified that medication knowledge significantly impacts physical functioning, social functioning, role limitations due to physical problems, and role limitations due to emotional problems. Mediation models using age, education level, and gender as covariates showed that the relationship between knowledge and SF-36 domains was fully mediated by Beck's Depression Inventory but not by Montreal Cognitive Assessment. CONCLUSIONS Patients who expressed unawareness of their medication did not necessarily have cognitive deficits; however, depressive symptoms may instead be present. This concomitant depressive symptomatology is crucial in explaining the contribution of nonadherence and decreased medication knowledge to poor quality of life.
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Affiliation(s)
- Hannah M Zipprich
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Aline Schönenberg
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
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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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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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12
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Kim SR, Kim JY, Kim HY, So HY, Chung SJ. Factors Associated with Medication Beliefs in Patients with Parkinson's Disease: A Cross-Sectional Study. J Mov Disord 2021; 14:133-143. [PMID: 33915673 PMCID: PMC8175818 DOI: 10.14802/jmd.20147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/02/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Medication beliefs are a significant determinant of medication adherence in chronic illness. This study aimed to identify demographic, clinical, and medication-related factors associated with medication beliefs in patients with Parkinson's disease (PD). METHODS We used a descriptive cross-sectional design with a convenience sample of 173 PD patients who had been taking antiparkinson drugs for more than one year. RESULTS The subjects who believed PD medication was more necessary had more severe illness, younger age of onset, longer illness duration, and longer duration of levodopa therapy. They had higher levels of non-motor symptoms and depression, number of medication uses, number of drugs, and levodopa equivalent dose, and they reported fluctuation of motor symptoms and dyskinesia. The subjects who used catechol-O-methyltransferase (COMT) inhibitors, dopamine agonists, amantadine, and monoamine oxidase-B (MAO-B) inhibitors had significantly higher necessity scores than those who did not use them. The subjects who had higher concerns about PD medications had higher levels of non-motor symptoms and depression. The subjects using amantadine and anticholinergics had significantly higher concern scores than those who did not use them. Positive necessity-concerns differentials were associated with severe illness, the presence of motor fluctuation and dyskinesia, and the use of COMT inhibitors. Based on stepwise multiple regression, the most significant factors influencing necessity beliefs were severe illness, followed by depression and motor fluctuation. CONCLUSION Severe illness, higher levels of depression, and motor fluctuation are independent factors influencing patients' beliefs regarding medication necessity. Therefore, these characteristics should be considered in medication belief assessment and interventions for PD patients.
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Affiliation(s)
- Sung Reul Kim
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Korea
| | - Ji Young Kim
- College of Nursing, Jeonbuk National University, Jeonju, Korea
| | - Hye Young Kim
- College of Nursing, Jeonbuk National University, Jeonju, Korea
| | - Hui Young So
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Kruse C, Kretschmer S, Lipinski A, Verheyen M, Mengel D, Balzer-Geldsetzer M, Lorenzl S, Richinger C, Schmotz C, Tönges L, Woitalla D, Klebe S, Schrag A, Dodel R. Resource Utilization of Patients with Parkinson's Disease in the Late Stages of the Disease in Germany: Data from the CLaSP Study. PHARMACOECONOMICS 2021; 39:601-615. [PMID: 33738776 PMCID: PMC8079299 DOI: 10.1007/s40273-021-01011-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The Care of Late-Stage Parkinsonism (CLaSP) study aimed to collect qualitative and standardized patient data in six European countries (France, Germany, Netherlands, Portugal, UK, Sweden) to enable a detailed evaluation of the underexplored late stages of the disease (Hoehn and Yahr stage > 3) using clinical, neuropsychological, behavioral, and health economic data. The aim of this substudy was to provide a health economic evaluation for the German healthcare system. METHODS In Germany, 228 patients were included in the study. Costs were calculated from a societal perspective for a 3-month period. Univariate analyses were performed to identify cost-driving predictors. Total and direct costs were analyzed using a generalized linear model with a γ-distributed dependent variable and log link function. Indirect costs were analyzed using a binomial generalized linear model with probit link function. RESULTS The mean costs for the 3-month period were approximately €20,000. Informal care costs and hospitalization are approximately €11,000 and €5000. Direct costs amounted to 89% of the total costs, and the share of indirect costs was 11%. Independent predictors of total costs were the duration of the disease and age. The duration of the disease was the main independent predictor of direct costs, whereas age was an independent predictor of indirect costs. DISCUSSION Costs in the late stage of the disease are considerably higher than those found in earlier stages. Compared to the latter, the mean number of days in hospital and the need for care is increasing. Informal caregivers provide most of the care. CLINICAL TRIAL REGISTRATION The protocol was registered at ClinicalTrials.gov as NCT02333175 on 7 January, 2015.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
| | - Sabrina Kretschmer
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Anna Lipinski
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Malte Verheyen
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
| | - David Mengel
- Department of Neurodegenerative Diseases, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Monika Balzer-Geldsetzer
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Stefan Lorenzl
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- Krankenhaus Agatharied GmbH, Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Carmen Richinger
- Krankenhaus Agatharied GmbH, Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Christian Schmotz
- Krankenhaus Agatharied GmbH, Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Krankenhaus Kupferdreh, Essen, Germany
| | - Stephan Klebe
- Department of Neurology, Essen University Hospital, Essen, Germany
| | | | - Richard Dodel
- Department of Geriatric Medicine, University of Duisburg-Essen, Germaniastrasse 1-3, 45356, Essen, Germany.
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.
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14
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Mendorf S, Witte OW, Zipprich H, Prell T. Association Between Nonmotor Symptoms and Nonadherence to Medication in Parkinson's Disease. Front Neurol 2020; 11:551696. [PMID: 33192983 PMCID: PMC7604271 DOI: 10.3389/fneur.2020.551696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Nonadherence to medication is a common and serious issue in the treatment of patients with Parkinson's disease (PD). Among others, distinct nonmotor symptoms (NMS) were found to be associated with nonadherence in PD. Here, we aimed to confirm the association between NMS and adherence. Methods: In this observational study, the following data were collected: sociodemographic data, the German versions of the Movement Disorder Society-sponsored revision of the unified Parkinson's disease rating scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Becks depression inventory II (BDI-II), nonmotor symptoms questionnaire (NMSQ), and the Stendal adherence to medication score (SAMS). Results: The final sample included 137 people with PD [54 (39.4%) females] with a mean age of 71.3 ± 8.2 years. According to SAMS, 10.9% of the patients were fully adherent, 73% were moderately nonadherent, and 16.1% showed clinically significant nonadherence. Nonadherence was associated with LEDD, BDI-II, education level, MDS-UPDRS III, and the NMSQ. The number of NMS was higher in nonadherent patients than in adherent patients. In the multiple stepwise regression analysis, the items 5 (constipation), 17 (anxiety), and 21 (falls) predicted nonadherence to medication. These NMSQ items also remained significant predictors for SAMS after correction for LEDD, MDS-UPDRS III, BDI-II, age, education level, gender, and disease duration. Conclusion: Our study, in principle, confirms the association between NMS burden and nonadherence in PD. However, in contrast to other clinical factors, the relevance of NMSQ in terms of nonadherence is low. More studies with larger sample sizes are necessary to explore the impact of distinct NMS on adherence.
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Affiliation(s)
- Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Hannah Zipprich
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
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15
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Specialized Staff for the Care of People with Parkinson's Disease in Germany: An Overview. J Clin Med 2020; 9:jcm9082581. [PMID: 32784969 PMCID: PMC7463847 DOI: 10.3390/jcm9082581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growing number of people with PD and the lack of general practitioners and neurologists, particularly in rural areas in Germany, specialized PD staff (PDS), such as PD nurse specialists and Parkinson Assistants (PASS), will play an increasingly important role in the care of people with PD over the coming years. PDS have several tasks, such as having a role as an educator or adviser for other health professionals or an advocate for people with PD to represent and justify their needs. PD nurse specialists have been established for a long time in the Netherlands, England, the USA, and Scandinavia. In contrast, in Germany, distinct PDS models and projects have been established. However, these projects and models show substantial heterogeneity in terms of access requirements, education, theoretical and practical skills, principal workplace (inpatient vs. outpatient), and reimbursement. This review provides an overview of the existing forms and regional models for PDS in Germany. PDS reimbursement concepts must be established that will foster an implementation throughout Germany. Additionally, development of professional roles in nursing and more specialized care in Germany is needed.
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16
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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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17
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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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18
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Schmidt SJ, Wurmbach VS, Lampert A, Bernard S, Haefeli WE, Seidling HM, Thürmann PA. Individual factors increasing complexity of drug treatment-a narrative review. Eur J Clin Pharmacol 2020; 76:745-754. [PMID: 32239242 PMCID: PMC7239823 DOI: 10.1007/s00228-019-02818-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/08/2019] [Indexed: 12/11/2022]
Abstract
Purpose Complexity of drug treatment is known to be a risk factor for administration errors and nonadherence promoting higher healthcare costs, hospital admissions and increased mortality. Number of drugs and dose frequency are parameters often used to assess complexity related to the medication regimen. However, factors resulting from complex processes of care or arising from patient characteristics are only sporadically analyzed. Hence, the objective of this review is to give a comprehensive overview of relevant, patient-centered factors influencing complexity of drug treatment. Methods A purposeful literature search was performed in MEDLINE to identify potential complexity factors relating to the prescribed drug (i.e. dosage forms or other product characteristics), the specific medication regimen (i.e. dosage schemes or additional instructions), specific patient characteristics and process characteristics. Factors were included if they were associated to administration errors, nonadherence and related adverse drug events detected in community dwelling adult patients. Results Ninety-one influencing factors were identified: fourteen in “dosage forms”, five in “product characteristics”, twelve in “dosage schemes”, nine in “additional instructions”, thirty-one in “patient characteristics” and twenty in “process characteristics”. Conclusions Although the findings are limited by the non-systematic search process and the heterogeneous results, the search shows the influence of many factors on the complexity of drug treatment. However, to evaluate their relevance for individual patients, prospective studies are necessary. Electronic supplementary material The online version of this article (10.1007/s00228-019-02818-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steffen J Schmidt
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Viktoria S Wurmbach
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Simone Bernard
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | | | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Petra A Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany
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19
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Mendorf S, Witte OW, Grosskreutz J, Zipprich HM, Prell T. What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease? Front Med (Lausanne) 2020; 7:103. [PMID: 32269998 PMCID: PMC7109286 DOI: 10.3389/fmed.2020.00103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Detailed knowledge about nonadherence to medication could improve medical care in elderly patients. We aimed to explore patterns and reasons for nonadherence in people with Parkinson's disease (PD) aged 60 years and older. Methods: Detailed clinical data and adherence (German Stendal Adherence with Medication Score) were assessed in 230 patients with PD (without dementia). Descriptive statistics were used to study reasons for nonadherence in detail, and general linear models were used to study associations between clusters of nonadherence and clinical parameters. Results: Overall, 14.2% (n = 32) of the patients were fully adherent, 66.8% (n = 151) were moderately nonadherent, and 19.0% (n = 43) showed clinically meaningful nonadherence. In the multivariable analysis, nonadherence was associated with a lower education level, higher motor impairment in activities of daily living, higher number of medications per day, and motor complications of PD. Three clusters of nonadherence were observed: 59 (30.4%) patients reported intentional nonadherence by medication modification; in 72 (37.1%) patients, nonadherence was associated with forgetting to take medication; and 63 (32.5%) patients had poor knowledge about the prescribed medication. A lower education level was mainly associated with modification of medication and poorer knowledge about prescribed medication, but not with forgetting to take medication. Patients with motor complications, which frequently occur in those with advanced disease stages, tend to be intentionally nonadherent by modifying their prescribed medication. Increased motor problems and a higher total number of drugs per day were associated with less knowledge about the names, reasons, and dosages of their prescribed medication. Conclusions: Elderly patients with PD report many reasons for intentional and non-intentional nonadherence. Understanding the impact of clinical parameters on different patterns of nonadherence may facilitate tailoring of interventions and counseling to improve outcomes.
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Affiliation(s)
- Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Julian Grosskreutz
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | | | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
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20
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Vitturi BK, Pellegrinelli A, Valerio BCO. Medication adherence in patients with myasthenia gravis in Brazil: a cross-sectional study. Acta Neurol Belg 2020; 120:83-89. [PMID: 31555980 DOI: 10.1007/s13760-019-01209-0] [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: 04/22/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Advances in the treatment of MG have allowed most patients to effectively treat their disorder with oral medications. In parallel, non-adherence to medication treatment regimens is a worldwide health problem. Other chronic neurological disorders have already been associated with low adherence to treatment. However, the literature regarding adherence among patients with MG is definitely poor. The purpose of this study was to capture the prevalence and the associated factors of non-adherence to pharmacological treatment in patients with MG. We carried out a cross-sectional cohort study with 58 consecutive patients with MG from a university-affiliated referral hospital in São Paulo, Brazil. We registered clinical and sociodemographic data and patients were classified according to the MGFA classification. Clinical severity was assessed with myasthenia gravis composite (MGC) scale. Neuropsychiatric symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS) and quality of life with the 15-Item Quality Of Life Instrument for myasthenia gravis scale (MG-QOL15). Adherence to pharmacological treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8). There were 26 (44.8%) patients adherent to treatment. Low adherence was associated with poor educational attainment, longer time of disease and greater daily number of pills (p < 0.05). Patients with poor compliance to treatment presented worse quality of life and increased neuropsychiatric symptoms (p < 0.05). Adherence can be relatively challenging in patients with MG. Medical approach should recognize that therapeutic success in the treatment of MG goes through adherence to treatment.
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21
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Lim KE, Kim SR, Sung YH, Oh SY, Kim MS, Chung SJ. Factors influencing self-management in Parkinson's disease: A cross-sectional study. Geriatr Nurs 2019; 41:254-260. [PMID: 31784296 DOI: 10.1016/j.gerinurse.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022]
Abstract
This study aimed to identify factors influencing self-management in patients with Parkinson's disease (PD) based on social cognitive theory. A cross-sectional design was used; data were collected at three tertiary medical centers in Korea from a convenience sample of 356 PD patients. Higher self-management scores were associated with higher education level, having a religion, and higher family income. Self-management score was positively correlated with activities of daily living, self-efficacy, and social support, and negatively correlated with non-motor symptoms. Hierarchical regression analysis revealed that demographic factors and non-motor symptoms explained 26.2% of the variance in self-management in PD. The explanatory power increased by 7.5% when self-efficacy was added, and by 6.7% when social support was added. Assessment of self-management in patients with PD should consider self-efficacy and social support, along with demographic factors and non-motor symptoms. Self-management programs that reflect these factors may be useful for improving self-management in PD patients.
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Affiliation(s)
- Kyeung Eun Lim
- College of Nursing, Chonbuk National University, Jeonju, Republic of Korea.
| | - Sung Reul Kim
- College of Nursing, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea.
| | - Young Hee Sung
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Republic of Korea.
| | - Sun-Young Oh
- Department of Neurology, Medical School of Chonbuk National University, Jeonju, Republic of Korea.
| | - Mi Sun Kim
- Department of Nursing, Asan Medical Center, Seoul, Republic of Korea.
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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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: 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: 09/14/2018] [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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Straka I, Minár M, Škorvánek M, Grofik M, Danterová K, Benetin J, Kurča E, Gažová A, Boleková V, Wyman-Chick KA, Kyselovič J, Valkovič P. Adherence to Pharmacotherapy in Patients With Parkinson's Disease Taking Three and More Daily Doses of Medication. Front Neurol 2019; 10:799. [PMID: 31417484 PMCID: PMC6684743 DOI: 10.3389/fneur.2019.00799] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/11/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Once-daily treatment formulation is associated with better adherence in comparison to more complex medication regimens. The study aimed to detect the extent of adherence to pharmacotherapy in Parkinson disease (PD) patients who take a minimum of three daily doses of drugs, and to identify factors associated with lower levels of adherence. Methods: The cohort was selected from non-demented PD patients. The 8-Item Morisky Medication Adherence Scale (MMAS-8), 8-Item Parkinson's Disease Questionnaire (PDQ-8), Geriatric Depression Scale (GDS), Non-Motor Symptom Assessment Scale (NMSS), 9-Item Wearing-off Questionnaire (WOQ-9), MDS-UPDRS III (motor examination), and IV (motor complications) scales were used in this study. Results: From a total of 124 subjects, 33.9% reported a high level of adherence, 29.8% reported a medium level of adherence, and 36.3% reported a low level of adherence to their pharmacotherapy. The level of non-adherence correlated with gender, longer disease duration, higher scores of PDQ-8, NMSS, WOQ-9, and MDS-UPDRS IV. Detailed analysis of NMSS demonstrated a correlation between the level of adherence and domains sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, and urinary symptoms. Independent risk factors for non-adherence were excessive daytime sleepiness, anhedonia, and forgetfulness. Conclusion: Non-adherence to more complicated medication regimens is frequent in PD patients and is associated with gender, longer PD duration, poorer quality of life, frequency and severity of non-motor symptoms, and more severe motor and non-motor fluctuations. Non-adherence was predicted by non-motor symptoms including fatigue, mood disturbances, and subjective cognitive complaints.
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Affiliation(s)
- Igor Straka
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Michal Minár
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Matej Škorvánek
- Department of Neurology, Pavol Jozef Safarik University in Kosice Faculty of Medicine, University Hospital of Louis Pasteur, Košice, Slovakia
| | - Milan Grofik
- Department of Neurology, Comenius University in Bratislava Jessenius Faculty of Medicine in Martin, University Hospital Martin, Martin, Slovakia
| | - Katarína Danterová
- Department of Neurology, University Hospital Bratislava, Slovak Medical University, Bratislava, Slovakia
| | - Ján Benetin
- Department of Neurology, University Hospital Bratislava, Slovak Medical University, Bratislava, Slovakia
| | - Egon Kurča
- Department of Neurology, Comenius University in Bratislava Jessenius Faculty of Medicine in Martin, University Hospital Martin, Martin, Slovakia
| | - Andrea Gažová
- Comenius University in Bratislava Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Bratislava, Slovakia
| | - Veronika Boleková
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.,Pan-European University Faculty of Psychology, Institute of Clinical Psychology, Bratislava, Slovakia
| | | | - Ján Kyselovič
- Fifth Department of Internal Medicine, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Valkovič
- Second Department of Neurology, Comenius University in Bratislava Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.,Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
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24
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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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25
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Balzer-Geldsetzer M, Ferreira J, Odin P, Bloem BR, Meissner WG, Lorenzl S, Wittenberg M, Dodel R, Schrag A. Study protocol: Care of Late-Stage Parkinsonism (CLaSP): a longitudinal cohort study. BMC Neurol 2018; 18:185. [PMID: 30396331 PMCID: PMC6217790 DOI: 10.1186/s12883-018-1184-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a chronic progressive disorder leading to increasing disability. While the symptoms and needs of patients in the early stages of their disease are well characterized, little information is available on patients in the late stage of the disease. METHODS/DESIGN The Care of Late-Stage Parkinsonism (CLaSP) study is a longitudinal, multicenter, prospective cohort study to assess the needs and provision of care for patients with late stage Parkinsonism and their carers in six European countries (UK, France, Germany, Netherlands, Portugal, Sweden). In addition, it will compare the effectiveness of different health and social care systems. Patients with Parkinsonism with Hoehn and Yahr stage ≥IV in the "On"-state or Schwab and England stage 50% or less are evaluated at baseline and three follow-up time-points. Standardised questionnaires and tests are applied for detailed clinical, neuropsychological, behavioural and health-economic assessments. A qualitative study explores the health care needs and experiences of patients and carers, and an interventional sub-study evaluates the impact of specialist recommendations on their outcomes. DISCUSSION Through the combined assessment of a range of quantitative measures and qualitative assessments of patients with late stage parkinsonism, this study will provide for the first time comprehensive and in-depth information on the clinical presentation, needs and health care provision in this population in Europe, and lay the foundation for improved outcomes in these patients. TRIAL REGISTRATION The protocol was registered at ClinicalTrials.gov as NCT02333175 on 07/01/2015.
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Affiliation(s)
- Monika Balzer-Geldsetzer
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Joaquim Ferreira
- Instituto de Medicina Molecular Universidad di Lisboa, Lisboa, Portugal
| | - Per Odin
- Department of Neurology, Lund University Hospital, Lund, Sweden
| | - Bastiaan R. Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wassilios G. Meissner
- Service de Neurologie, CHU de Bordeaux, 33000 Bordeaux, France
- Institut des Maladies Neurodégénératives, University de Bordeaux, UMR 5293, 33000 Bordeaux, France
| | - Stefan Lorenzl
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München - Klinikum Großhadern, Munich, Germany
- Institute of Nursing Science and –Practice, Salzburg, Austria
| | - Michael Wittenberg
- Coordinating Centre for Clinical Trials (KKS), Philipps-University Marburg, Marburg, Germany
| | - Richard Dodel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Anette Schrag
- UCL Institute of Neurology, University College London, Royal Free Campus, Rowland Hill street, NW3 2PF, London, UK
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26
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Straka I, Minár M, Gažová A, Valkovič P, Kyselovič J. Clinical aspects of adherence to pharmacotherapy in Parkinson disease: A PRISMA-compliant systematic review. Medicine (Baltimore) 2018; 97:e10962. [PMID: 29879046 PMCID: PMC5999496 DOI: 10.1097/md.0000000000010962] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Parkinson disease (PD) is the second most common neurodegenerative disease with various motor and nonmotor symptoms. Progressive course of PD requires frequent medication adjustments. Various combinations of drugs and dose regimens could be used to control symptoms. Thus, not surprisingly, adherence to pharmacotherapy is frequently suboptimal in these patients having negative effect on motor control and patient's quality of life. METHODS In this article, we offer up-to-date review of adherence in PD compared with other chronic conditions. In addition, we summarize factors influencing level of adherence, ways of measuring, and methods of adherence optimization. For the review of adherence in PD, a literature search was undertaken using PubMed database and relevant search terms. Articles were screened for suitability and data relevance. RESULTS PubMed and Scopus databases were systematically searched in 2016 and data extraction was a multistep process based on the PRISMA Guidelines. CONCLUSION According to the recent data, sufficient control of motor symptoms and adequate quality of life are primary goals in the treatment of PD. Adherence to pharmacotherapy play a key role in this process, thus the medication should be tailored for each patient. In order to improve level of suboptimal adherence, these patients should have got recommended various dosing devices or alarms. Good communication with the patients and their relatives or caregivers is also essential.
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Affiliation(s)
- Igor Straka
- Second Department of Neurology, Faculty of Medicine Comenius University and University Hospital Bratislava
| | - Michal Minár
- Second Department of Neurology, Faculty of Medicine Comenius University and University Hospital Bratislava
| | - Andrea Gažová
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine Comenius University
| | - Peter Valkovič
- Second Department of Neurology, Faculty of Medicine Comenius University and University Hospital Bratislava
- Institute of Normal and Pathological Sciences, Slovak Academy of Sciences
| | - Ján Kyselovič
- Department of Internal Medicine, Faculty of Medicine in Bratislava, Comenius University, Slovakia
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27
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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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Tripathi RK, Kapse SV, Potey AV. Prescription pattern and awareness of disease and treatment in patients of Parkinson's disease. Neurodegener Dis Manag 2017; 7:299-306. [PMID: 29043907 DOI: 10.2217/nmt-2017-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This cross-sectional study aimed to evaluate the prescription pattern, awareness of disease and treatment in patients with Parkinson's disease (PD). MATERIALS & METHODS A total of 100 PD patients, attending a tertiary care hospital in Mumbai were included. Prescriptions were analyzed and awareness was evaluated using a questionnaire. RESULTS The mean number of anti-Parkinson agents (APA) prescribed was 1.52 ± 0.65. Number of APA strongly correlated with disease duration (ρ = 0.818; p < 0.001). Many APA were underutilized (prescribed daily dose/defined daily dose < 1). There was no awareness of all items on symptoms and alternative therapeutic options. Awareness of disease impairments (32%), long-term complications (28%), dosing regimen (46%) and follow-up (36%) was poor. CONCLUSION More than one APA is commonly prescribed in PD patients. Awareness of disease and treatment of PD is poor among the patients.
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Affiliation(s)
- Raakhi K Tripathi
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Sandip V Kapse
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Anirudha V Potey
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
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29
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Effect on Gait Speed, Balance, Motor Symptom Rating, and Quality of Life in Those with Stage I Parkinson's Disease Utilizing LSVT BIG®. Rehabil Res Pract 2017; 2017:9871070. [PMID: 28331638 PMCID: PMC5346384 DOI: 10.1155/2017/9871070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/22/2016] [Accepted: 01/09/2017] [Indexed: 11/17/2022] Open
Abstract
Individuals with Parkinson's Disease (PD) are often not referred to Physical Therapy (PT) until there are issues with mobility in later Hoehn and Yahr Stages. There have been no studies outlining the benefits of PT intervention in Stage I only. For persons with PD, deficits in motor function increase over time due to destruction of dopamine-producing cells. LSVT BIG, an exercise program for PD, has been shown to be effective in improving mobility. The purpose of this study was to assess participants functional improvement at a level of minimal clinically important difference (MCID) in one of four outcome measures: Gait Speed, Berg Balance Assessment, Functional Gait Assessment, and Unified Parkinson's Disease Rating Scale Motor Section. Case Description. Nine participants with Stage I PD received LSVT BIG 4x/week for 4 weeks followed by bimonthly participation in a community class. Outcome measurement occurred at baseline, after LSVT BIG, and three months after LSVT BIG. Outcomes. Eight of nine participants (88.9%) achieved MCID in at least one of the four measures at both after and 3 months after LSVT BIG training indicating improvement based on our criteria. Participants in Stage I of PD in this study completed LSVT BIG and demonstrated improved function.
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30
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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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31
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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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32
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Hilsabeck RC, Holdnack JA, Cullum CM, Drozdick LW, Edelstein B, Fiske A, Lacritz L, McCoy KJM, Wahlstrom D. The Brief Cognitive Status Examination (BCSE): Comparing Diagnostic Utility and Equating Scores to the Mini-Mental State Examination (MMSE). Arch Clin Neuropsychol 2015; 30:458-67. [PMID: 26085478 DOI: 10.1093/arclin/acv037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
Abstract
The study purpose was to compare the diagnostic utility of the Brief Cognitive Status Exam (BCSE) to that of the Mini-Mental State Examination (MMSE) and to develop equated scores to facilitate comparisons. One hundred and eighty-two patients underwent cognitive evaluation and were placed into three groups: dementia (DEM), cognitive impairment, no dementia (CIND), and no cognitive impairment (NCI). One hundred and eighty-two healthy controls from the BCSE standardization sample served as a comparison group. On both measures, the DEM group obtained significantly lower scores than the other two groups, and the CIND group scored significantly lower than the NCI group. The BCSE was more sensitive in all clinical groups, although at extremely low scores, the two tests displayed similar sensitivity. Results indicate the BCSE has diagnostic utility as a cognitive screening measure in a mixed clinical sample and is more sensitive at detecting cognitive impairment, particularly milder levels, than the MMSE.
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Affiliation(s)
- Robin C Hilsabeck
- Psychology Service at South Texas Veterans Health Care System and Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - C Munro Cullum
- Departments of Psychiatry and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Barry Edelstein
- Psychology Department, West Virginia University, Morgantown, WV, USA
| | - Amy Fiske
- Psychology Department, West Virginia University, Morgantown, WV, USA
| | - Laura Lacritz
- Departments of Psychiatry and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karin J M McCoy
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease and pathologically is characterised by a progressive loss of dopaminergic cells of the nigrostriatal pathway. Clinically, PD is mainly defined by the presence of the motor symptoms of bradykinesia, rigidity, rest tremor and postural instability, but non-motor symptoms such as depression, dementia and autonomic disturbances are recognised as integral parts of the disease. Although pharmacotherapy for PD was introduced almost 50 years ago, and has improved significantly over the intervening period, the timing of initiation of treatment in newly diagnosed PD remains controversial. While some physicians favour an early start of pharmacotherapy at or soon after diagnosis, others prefer to delay pharmacological treatment until a certain degree of disability has developed. This article aims to discuss the advantages and disadvantages of both strategies by exploring their effects on symptoms, disease progression and quality of life. Although the data on putative disease-modifying effects of early pharmacological intervention in PD are still inconclusive, we believe that the most important indication for an early initiation of anti-parkinsonian treatment should be to maintain the quality of life of PD patients and to secure their socioeconomic status as long as possible.
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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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Wilski M, Tasiemski T, Kocur P. Demographic, socioeconomic and clinical correlates of self-management in multiple sclerosis. Disabil Rehabil 2014; 37:1970-5. [DOI: 10.3109/09638288.2014.993435] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Daley DJ, Deane KHO, Gray RJ, Clark AB, Pfeil M, Sabanathan K, Worth PF, Myint PK. Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial. Int J Clin Pract 2014; 68:963-71. [PMID: 24750544 DOI: 10.1111/ijcp.12439] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD. METHODS Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle. RESULTS Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT. CONCLUSION Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required.
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Affiliation(s)
- D J Daley
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK; Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Sinn HP, Kreipe H. A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition. ACTA ACUST UNITED AC 2014; 8:149-54. [PMID: 24415964 DOI: 10.1159/000350774] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The WHO Classification of Tumors of the Breast, 4th edition, is an update to the 3rd edition that was published in 2003, and covers all neoplastic and preneoplastic lesions of the breast. Changes to the 4th edition include new aspects and changes to the terminology that reflect our present-day knowledge of these lesions. Definitions for histopathological diagnosis are complemented by a description of clinical features, epidemiology, macroscopy, genetics, and prognostic and predictive features. In this review of the WHO classification, we have focused on invasive carcinomas, precursor lesions, and some benign epithelial proliferations.
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Affiliation(s)
- Hans-Peter Sinn
- Sektion für Gynäkologische Pathologie, Pathologisches Institut, Ruprecht-Karls-Universität Heidelberg, Germany
| | - Hans Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Germany
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Affiliation(s)
- Jori E Fleisher
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, 19107, USA.
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Harbeck N, Blettner M, Hadji P, Jackisch C, Lück HJ, Windemuth-Kieselbach C, Zaun S, Haidinger R, Schmitt D, Schulte H, Nitz U, Kreienberg R. Patient's Anastrozole Compliance to Therapy (PACT) Program: Baseline Data and Patient Characteristics from a Population-Based, Randomized Study Evaluating Compliance to Aromatase Inhibitor Therapy in Postmenopausal Women with Hormone-Sensitive Early Breast Cancer. ACTA ACUST UNITED AC 2014; 8:110-20. [PMID: 24419247 DOI: 10.1159/000350777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Patient's Anastrozole Compliance to Therapy (PACT) program is a large randomized study designed to assess whether the provision of educational materials (EM) could improve compliance with aromatase inhibitor therapy in postmenopausal women with early, hormone receptor-positive breast cancer. PATIENTS AND METHODS The PACT study presented a large, homogeneous dataset. The baseline analysis included patient demographics and initial treatments and patient perceptions about treatment and quality of life. RESULTS Overall, 4,923 patients were enrolled at 109 German breast cancer centers/clinics in cooperation with 1,361 office-based gynecologists/oncologists. 4,844 women were randomized 1:1 to standard therapy (n = 2,402) or standard therapy plus EM (n = 2,442). Prior breast-conserving surgery and mastectomy had been received by 76% and 24% of the patients, respectively. Radiotherapy was scheduled for 85% of the patients, adjuvant chemotherapy for 38%. Reflecting the postmenopausal, hormone-sensitive nature of this population, only 285 patients (7%) had received neoadjuvant chemotherapy. CONCLUSIONS A comparison with epidemiological data from the West German Breast Center suggests that the patients in the PACT study are representative of a general postmenopausal early breast cancer population and that the findings may be applicable to 'real-world' Germany and beyond. Compliance data from PACT are eagerly anticipated.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Dept. OB&GYN, University of Munich, Ulm, Germany
| | - Maria Blettner
- IMBEI, MainzUniversity Hospital Marburg, Munich, Ulm, Germany
| | - Peyman Hadji
- University Hospital Marburg, Munich, Ulm, Germany
| | | | | | | | - Silke Zaun
- AstraZeneca, Wedel, Munich, Ulm, Germany
| | | | | | - Hilde Schulte
- Frauenselbsthilfe nach Krebs e.V., Bonn, Ulm, Germany
| | - Ulrike Nitz
- Niederrhein Breast Centre, Mönchengladbach, Ulm, Germany ; Westdeutsches Brust-Centrum (WBC), Düsseldorf, Ulm, Germany
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Clark AJ, Ritz B, Prescott E, Rod NH. Psychosocial risk factors, pre-motor symptoms and first-time hospitalization with Parkinson's disease: a prospective cohort study. Eur J Neurol 2013; 20:1113-20. [PMID: 23433314 PMCID: PMC3664243 DOI: 10.1111/ene.12117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Experimental studies support a link between stress and development of parkinsonian symptoms, but prospective population studies are lacking. The aim of the current study is to determine the effects of several psychosocial factors on the risk of Parkinson's disease (PD), as well as to identify potential pre-motor symptoms for PD in a large prospective cohort study. METHODS In 1991-1993, a total of 9955 women and men free of PD from the Copenhagen City Heart Study were asked about major life events, economic hardship, social network, impaired sleep and vital exhaustion. The participants were followed for first-time hospitalization with PD in nationwide registers until 2011. RESULTS Vital exhaustion was associated with a higher risk of PD hospitalization in an exposure-dependent manner (P(trend) = 0.001), with high vs. low vital exhaustion being associated with a hazard ratio of 2.50 [95% confidence interval (CI): 1.28-4.89]. A slightly higher risk of PD hospitalization (hazard ratio = 1.49; 95% CI: 0.87-2.56) was suggested in participants with impaired sleep at baseline. No more than weak associations were observed for economic hardship, major life events or inadequate social network in the current study. CONCLUSIONS Overall, the hypothesis that psychosocial risk factors affect the risk of PD is not supported. The results, however, suggest that vital exhaustion may be a pre-motor marker of the neurodegenerative process eventually leading to motor symptoms and clinical PD. Vital exhaustion may be useful for screening aimed at early detection and when considering disease-modifying therapies in people at high risk of clinical PD.
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Affiliation(s)
- A J Clark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Adherence to anti-Parkinson drug therapy in the “REASON” sample of Italian patients with Parkinson’s disease: the linguistic validation of the Italian version of the “Morisky Medical Adherence scale-8 items”. Neurol Sci 2013; 34:2015-22. [DOI: 10.1007/s10072-013-1438-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Nyholm D, Ehrnebo M, Lewander T, Trolin CG, Bäckström T, Panagiotidis G, Spira J, Nyström C, Aquilonius SM. Frequent administration of levodopa/carbidopa microtablets vs levodopa/carbidopa/entacapone in healthy volunteers. Acta Neurol Scand 2013; 127:124-32. [PMID: 22762460 DOI: 10.1111/j.1600-0404.2012.01700.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES An oral dispersible microtablet formulation of levodopa/carbidopa 5/1.25 mg (LC-5) was developed for individualized repeated dosing. The aim was to compare pharmacokinetic profiles of LC-5 and levodopa/carbidopa/entacapone (LCE). MATERIALS AND METHODS A randomized, crossover study was carried out in 11 healthy subjects. Plasma concentrations of levodopa, carbidopa and 3-O-methyldopa were determined after intake of 300 mg levodopa during the day, either as three intakes of 100/25/200 mg LCE or as a morning dose of 75/18.25 mg followed by five repeated doses of 45/11.25 mg LC-5. RESULTS Repeated dosing (2.4-hourly) with LC-5 microtablets compared to LCE (6-hourly) avoided long periods with low plasma levodopa levels. Time to maximum plasma concentrations was significantly shorter for LC-5. LC-5 showed lower fluctuation index (FI) in plasma compared to LCE (ANOVA P = 0.0028). FI for dose 2-5 was on average 1.26 for levodopa in LC-5, and 2.23 for dose 1-2 of LCE. The ratio between the two mean FI:s is 0.565; that is, LC-5 gave nearly half the FI as compared to LCE. CONCLUSIONS Fractionation of levodopa with LC-5 into small, frequent administrations as compared to standard administrations of LCE decreased the FI in plasma for both levodopa and carbidopa by nearly half.
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Affiliation(s)
- D. Nyholm
- Department of Neuroscience, Neurology; Uppsala University; Uppsala; Sweden
| | | | | | - C. G. Trolin
- Life Science Management Laboratories i Uppsala AB (LSM Lab); Uppsala; Sweden
| | - T. Bäckström
- Division of Clinical Pharmacology, Department of Laboratory Medicine; Karolinska Institutet; Huddinge; Sweden
| | - G. Panagiotidis
- Division of Clinical Pharmacology, Department of Laboratory Medicine; Karolinska Institutet; Huddinge; Sweden
| | | | | | - S.-M. Aquilonius
- Department of Neuroscience, Neurology; Uppsala University; Uppsala; Sweden
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Brion JM, Leary MR, Drabkin AS. Self-compassion and reactions to serious illness: the case of HIV. J Health Psychol 2013; 19:218-29. [PMID: 23300046 DOI: 10.1177/1359105312467391] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To test the hypothesis that self-compassion buffers people against the emotional impact of illness and is associated with medical adherence, 187 HIV-infected individuals completed a measure of self-compassion and answered questions about their emotional and behavioral reactions to living with HIV. Self-compassion was related to better adjustment, including lower stress, anxiety, and shame. Participants higher in self-compassion were more likely to disclose their HIV status to others and indicated that shame had less of an effect on their willingness to practice safe sex and seek medical care. In general, self-compassion was associated with notably more adaptive reactions to having HIV.
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Pirogovsky E, Woods SP, Vincent Filoteo J, Gilbert PE. Prospective memory deficits are associated with poorer everyday functioning in Parkinson's disease. J Int Neuropsychol Soc 2012; 18:986-95. [PMID: 22846463 PMCID: PMC3698041 DOI: 10.1017/s1355617712000781] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although individuals with Parkinson's disease (PD) evidence moderate deficits in prospective memory (PM), it is not known whether PM deficits confer an increased risk of poorer everyday functioning. In the current study, 33 individuals with PD and 26 demographically similar normal controls (NC) were administered performance-based and self-report measures of PM and everyday functioning, including medication and financial management. As compared to NC, PD participants demonstrated significantly lower scores on performance-based measures of PM and financial capacity, worse performance at a trend level on performance-based medication management and endorsed significantly greater self-reported declines in PM and instrumental activities of daily living (iADLs). In the PD sample, the laboratory measure of PM significantly correlated with performance-based measures of financial capacity and medication management and a self-report measure of medication management. Self-reported PM failures significantly correlated with perceived declines in iADLs, worse medication management, and poorer health-related quality of life. Although future studies are needed to examine the incremental ecological validity of PM in PD, findings from this study extend prior research by providing preliminary evidence that PM impairment may play a significant role in a range of critical everyday functions in PD.
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Affiliation(s)
- Eva Pirogovsky
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California 92120, USA
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Abstract
OBJECTIVE To describe a new form of anxiety in patients with Parkinson disease (PD). METHODS We retrospectively reviewed 100 consecutive charts of patients with PD to identify those who did not adhere to their medication schedule owing to irrational fear of taking their medication. Information pertaining to their PD and comorbid medical conditions was collected. RESULTS We identified 6 patients with PD who had severe disability, yet anxiety from taking the medication caused avoidance of taking appropriate oral medication. This avoidance persisted in the face of reassurance that the medication is not dangerous and that taking the medication would improve their disability. CONCLUSION This study describes a new form of anxiety in patients with PD. We propose the term ``medication phobia'' to describe these patients.
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Santos-García D, Prieto-Formoso M, de la Fuente-Fernández R. Levodopa dosage determines adherence to long-acting dopamine agonists in Parkinson's disease. J Neurol Sci 2012; 318:90-3. [DOI: 10.1016/j.jns.2012.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/25/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
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Daley DJ, Deane KH, Gray RJ, Worth PF, Clark AB, Sabanathan K, Pfeil M, Myint PK. The use of carer assisted adherence therapy for people with Parkinson's disease and their carers (CAAT-PARK): study protocol for a randomised controlled trial. Trials 2011; 12:251. [PMID: 22122912 PMCID: PMC3235063 DOI: 10.1186/1745-6215-12-251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharmacological intervention is essential for managing the symptoms of Parkinson's disease. Adherence to medication regimens however is a major problem. Poor adherence leads to significant motor deterioration and inadequate symptom control. This results in poor quality of life. Whilst interventions to improve medication adherence have shown considerable benefit in other chronic conditions, the efficacy of such treatments in Parkinson's disease is less well researched. Many people with Parkinson's disease require substantial support from spouse/caregivers. This often extends to medication taking. Consequently, spouse/caregiver's support for timely medication management is paramount. We aim to investigate the benefit of a novel intervention, Carer Assisted Adherence Therapy, for improving medication adherence and quality of life in people with Parkinson's disease. Adherence therapy may help to optimise the efficacy of anti-parkinsonian agents, subsequently improving clinical outcomes. METHODS/DESIGN A parallel, randomised controlled trial will be conducted to investigate whether carer assisted adherence therapy is effective for improving medication adherence and quality of life. We aim to recruit 40 patient/carer pairs into each group. Participants will be randomly assigned by the Clinical Research Trials Unit at the University of East Anglia. Adherence therapy is a brief cognitive-behavioural approach aimed at facilitating a process of shared decision making. The central theory is that when patients make shared choices with a professional they are more likely to continue with those choices because they are personally owned and meaningful. Outcomes will be rates of adherence and quality of life, determined by the Morisky Medication Adherence Scale-4 and the Parkinson's disease Questionnaire-39 respectively. Assessments will take place post randomisation, immediately post intervention and 12-weeks post randomisation. Primary outcomes are adherence and quality of life at 12-week follow-up. Efficacy will be determined using intention-to-treat analysis. Independent samples t-tests will compare mean changes between groups from baseline to follow-up. Per protocol analysis will be conducted based on individuals with no major protocol deviation. Where imbalances in baseline characteristics are identified, an adjusted analysis will be performed using a regression model. Analysis will be masked to treatment allocation. TRIAL REGISTRATION ISRCTN: ISRCTN07830951.
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Affiliation(s)
- David J Daley
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK.
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