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.
You can find out more about our National Medical Director, Dr. Michael S. Okun, by also visiting the Center of Excellence, University of Florida Health Center for Movement Disorders and Neurorestoration. Dr. Okun is also the author of the Amazon #1 Parkinson's Best Seller 10 Secrets to a Happier Life and 10 Breakthrough Therapies for Parkinson's Disease.