You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration.
One of the most common questions we hear from patients is, “what can I do to be sure I am getting the best possible treatment for my Parkinson’s disease?” Most doctors focus on treatment-based recommendations (e.g. drugs, exercise, diet, etc.). The initial answer to this patient question should probably simply be “make sure you are co-managed by both a neurologist and a primary care physician.”
In the August 30, 2011 issue of Neurology, Willis and colleagues asked a provocative question: Will involving a neurologist in the care of a Parkinson’s disease patient makes a difference in outcome? From 2002-2005, they carefully reviewed 138,000 PD Medicare beneficiaries and discovered that only 68% of patients received neurologist care, with the remainder receiving primary care. The authors observed that neurologist-treated patients were “less likely to be placed in a skilled nursing facility, had a lower risk of hip fracture, and had a lower adjusted likelihood of death.” Another interesting finding was that women and minorities received less specialty care compared to white males. The diagnosis of PD was not confirmed by a PD specialist in this study, and data was not available as to whether patients actually saw a movement disorders or Parkinson’s disease specialist.
In an age where patients and clinicians seek more and more expensive diagnostic tests, it is intriguing to consider that a simple referral to a neurologist for co-management with a primary care physician may have the biggest and most important impact on a Parkinson’s disease patient’s outcome. In a way, this finding should not be surprising. After all, the best diagnostic test for Parkinson’s disease remains an expert neurological examination, and it would follow that the best clinical optimization of the patient should therefore be placed in the hands of a neurologist. A Parkinson’s disease patient is complex and motor, non-motor, behavioral, and, in some cases, surgical options must be considered for best management. The pharmacological strategies for Parkinson’s disease are also complicated, and often require multiple medications, multiple doses and medication intervals as close as every 2-3 hours. Despite the limitations in the methodology of this type of study (drawing data from Medicare beneficiaries), if the findings are true and confirmed, there could be a tremendous economic savings to the healthcare system by simply executing a referral, and co-managing Parkinson’s disease patients with primary care physicians. An even better recommendation would be for co-management by a movement disorders neurologist (expert in Parkinson’s disease treatment and care) and a primary care physician (if both are available in your area).
Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA. Neurologist care in Parkinson disease: A utilization, outcomes, and survival study. Neurology. 2011 Aug 30;77(9):851-7. Epub 2011 Aug 10.
Posted: 10/3/2011 6:00:01 AM by
Browse current and archived What's Hot in PD? articles, the National Parkinson Foundation's monthly blog for people with Parkinson's written by our National Medical Director, Dr. Michael S. Okun.
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Halting of the Creatine Study
The Importance of Identifying and Treating Caregiver Strain
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What Parkinson’s Disease Patients Need to Know about H. Pylori Gastrointestinal Infections
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Another Setback for Trophic Factor Treatment in Parkinson's Disease
IPX066 and What Patients Really Want in New Carbidopa/Levodopa (Sinemet) Formulations
The Weather Forecast for Parkinson’s Disease Calls for Worldwide Economic Storm
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When should you start medication therapy for Parkinson’s disease?
Neurologist Care Reduces Hospitalizations in Parkinson's Disease
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Given the recent FDA announcement about Mirapex (pramipexole), should I be worried about dopamine agonists?
What about the new Parkinson’s Disease Vaccine? What should I know?
Caffeine as a Potential Treatment for Parkinson’s Disease
Time to Consider GPi DBS for Parkinson’s Disease: A Shift in the Practice of Patient Selection for DBS
A New Treatment for Parkinson’s Disease-Related Constipation
Too Many Pills: Improving Delivery Systems for Parkinson’s Disease Drugs
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Watch out for Unexpected Obstacles if You Use a Cueing Strategy to Break Freezing of Gait in Parkinson’s Disease
Pill Color, Generic Medications and Insurance Issues: Important Medication-Related Tips for the Parkinson’s Disease Patient
Are Blood Tests for Parkinson’s Disease on the Horizon?
Placing Stem Cells in Animal Models of Parkinson’s Disease: Another Important Step
Important News for the Parkinson’s Disease Community: More Evidence that Sinemet and Madopar are Not Toxic and do Not Accelerate Disease Progression
The Case for All Parkinson’s Disease Patients to be Co-managed by a Primary Care-Neurologist Team
Scientists say Research on Brain Proteins Involved in Parkinson’s Disease is “Shaping” Up
Who Actually Takes Care of Most of the Parkinson’s Patients Worldwide: The Need for Education and the Parkinson’s Toolkit
If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications
How Will Group Visits for Parkinson’s Disease Fit into the Future of Parkinson’s Disease Care?
Why Patients Should be Wary of Chelation Therapy for Parkinson’s Disease
Opening the Door to Gene Therapy in Parkinson’s Disease: The Need for Refinement of the Technology and Approach
Does it Matter if I Can’t Get Brand Sinemet?
Should I get a DaTscan or PET scan to confirm my diagnosis of Parkinson’s disease?
A Critical Reappraisal of the Worst Drugs in Parkinson’s Disease
Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism
Calling for the FDA to Revise the Eight Sinemet a Day Rule
Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease
Maintaining the Balance: Why Parkinson’s Disease Patients Need to Understand Drug Recalls, Withdrawals, and Safety Alerts
Shining a Light on Parkinson’s Disease: Optogenetics Has a Bright Future in Research
Poor Medication Management of Parkinson's Disease During Hospital Admissions: Patients and Families Can Improve Their Hospital-Based Management
Why Are Patches and Continuous Release Technology a Big Deal to Parkinson's?
Is the PD SURG Trial Another Surge Forward for DBS Therapy?
Cycling in PD in Those Who Can’t Walk: Is it Possible?
New iPS Stem Cells for PD: What Does it Mean?
Time for Comprehensive Care Networks for PD
Is Parkinson's Disease a Prion Disease?
Parkinson's Disease Linked to Gaucher's Disease
Brain Cells Keep Time Stamps: Implications for Parkinson's Disease Therapies
Is it Safe to Have an MRI with a DBS in Place?
Take Care of Your Bones as They Are Affected in Parkinson's Disease (Even in Men)
Is it Time to Start Paying Attention to Pain Symptoms in Parkinson's Disease Patients?
Glutathione Fails to Demonstrate Significant Improvement in PD Symptoms
Keeping an Eye on Trials Important to the Parkinson's Disease Patient
Increased Risk of Melanoma in Parkinson's Disease
Finally a DBS Expert Consensus Statement Aimed at Their True Customers: The Patients
Pesticides and Environmental Exposure in Parkinson's disease: Should We Stay Away From the Stink Truck?
Is Exercise Effective Treatment and Protection Against PD?
Why are Transplant Trials Struggling to Succeed in the Treatment of PD?
Are Monoamine Oxidase Inhibitors Disease Modifying or Neuroprotective in PD?
Update on Gene Therapy for Parkinson's Disease