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Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers.

ABSTRACT: To explore current practices and opinions regarding hospital management of Parkinson disease (PD) patients in specialized PD Centers.Fifty-one out of 54 National Parkinson Foundation (NPF) Centers worldwide completed an online survey regarding hospitalization of PD patients.Many Centers were concerned about the quality of PD-specific care provided to their patients when hospitalized. Primary concerns were adherence to the outpatient medication schedule and poor understanding by hospital staff of medications that worsen PD. Few Centers had a policy with their primary hospital that notified them when their patients were admitted. Rather, notification of hospitalization came often from the patient or a family member. Several Centers (29%) reported not finding out about a hospitalization until a routine clinic visit after discharge. Quick access to outpatient PD care following discharge was a problem in many Centers. Elective surgery, fall/fracture, infection, and mental status changes, were identified as common reasons for hospitalization.There is a perceived need for PD specialists to be involved during hospitalization of their patients. Improvement in communication between hospitals and PD Centers is necessary so that hospital clinicians can take advantage of PD specialists' expertise. Education of hospital staff and clinicians regarding management of PD, complications of PD, and medications to avoid in PD is critical. Most importantly, outpatient access to PD specialists needs to be improved, which may prevent unnecessary hospitalizations in these patients.

SUBMITTER: Chou KL

PROVIDER: S-EPMC3895941 | biostudies-literature | 2011 Jul

REPOSITORIES: biostudies-literature

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Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers.

Chou Kelvin L KL Zamudio Jorge J Schmidt Peter P Price Catherine C CC Parashos Sotirios A SA Bloem Bastiaan R BR Lyons Kelly E KE Christine Chadwick W CW Pahwa Rajesh R Bodis-Wollner Ivan I Oertel Wolfgang H WH Suchowersky Oksana O Aminoff Michael J MJ Malaty Irene A IA Friedman Joseph H JH Okun Michael S MS

Parkinsonism & related disorders 20110401 6

<h4>Objectives</h4>To explore current practices and opinions regarding hospital management of Parkinson disease (PD) patients in specialized PD Centers.<h4>Methods</h4>Fifty-one out of 54 National Parkinson Foundation (NPF) Centers worldwide completed an online survey regarding hospitalization of PD patients.<h4>Results</h4>Many Centers were concerned about the quality of PD-specific care provided to their patients when hospitalized. Primary concerns were adherence to the outpatient medication s ...[more]

PMID: 21458353

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Project description:ImportanceOptimizing assessments of rate of progression in Parkinson disease (PD) is important in designing clinical trials, especially of potential disease-modifying agents.ObjectiveTo examine the value of measures of impairment, disability, and quality of life in assessing progression in early PD.Design, setting, and participantsInception cohort analysis of data from 413 patients with early, untreated PD who were enrolled in 2 multicenter, randomized, double-blind clinical trials.InterventionsParticipants were randomly assigned to 1 of 5 treatments (67 received creatine, 66 received minocycline, 71 received coenzyme Q10, 71 received GPI-1485, and 138 received placebo). We assessed the association between the rates of change in measures of impairment, disability, and quality of life and time to initiation of symptomatic treatment.Main outcomes and measuresTime between baseline assessment and need for the initiation of symptomatic pharmaceutical treatment for PD was the primary indicator of disease progression.ResultsAfter adjusting for baseline confounding variables with regard to the Unified Parkinson's Disease Rating Scale (UPDRS) Part II score, the UPDRS Part III score, the modified Rankin Scale score, level of education, and treatment group, we assessed the rate of change for the following measurements: the UPDRS Part II score; the UPDRS Part III score; the Schwab and England Independence Scale score (which measures activities of daily living); the Total Functional Capacity scale; the 39-item Parkinson's Disease Questionnaire, summary index, and activities of daily living subscale; and version 2 of the 12-item Short Form Health Survey Physical Summary and Mental Summary. Variables reaching the statistical threshold in univariate analysis were entered into a multivariable Cox proportional hazards model using time to symptomatic treatment as the dependent variable. More rapid change (ie, worsening) in the UPDRS Part II score (hazard ratio, 1.15 [95% CI, 1.08-1.22] for 1 scale unit change per 6 months), the UPDRS Part III score (hazard ratio, 1.09 [95% CI, 1.06-1.13] for 1 scale unit change per 6 months), and the Schwab and England Independence Scale score (hazard ratio, 1.29 [95% CI, 1.12-1.48] for 5 percentage point change per 6 months) was associated with earlier need for symptomatic therapy.ConclusionsAND RELEVANCE In early PD, the UPDRS Part II score and Part III score and the Schwab and England Independence Scale score can be used to measure disease progression, whereas the 39-item Parkinson's Disease Questionnaire and summary index, Total Functional Capacity scale, and the 12-item Short Form Health Survey Physical Summary and Mental Summary are not sensitive to change.Trial registrationclinicaltrials.gov Identifiers: NCT00063193 and NCT00076492.

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Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers.

Publications

Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers.

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