Pharmacists Can Help Manage Patients With Parkinson Disease

Each year, about 60,000 people receive a diagnosis of Parkinson disease (PD), a progressive nervous system disorder that affects movement. By 2030, approximately 1.2 million individuals in the United States will be living with PD.¹

Appropriate therapy selection can be challenging because it is typically based on a variety of factors, including age at onset and disease stage.² In addition, patients with PD usually have comorbidities that require medication, which can lead to polypharmacy and drug interactions.

The D-PRESCRIBE randomized clinical trial (NCT02053194) showcased the importance of having a pharmacist on board. Findings showed that compared to usual care, pharmacist-led educational intervention for adults aged 65 years or older resulted in greater discontinuation of prescriptions for inappropriate medications at 6 months: 106 of 248 patients (43%) in the pharmacist-led intervention group no longer filled prescriptions for inappropriate medications vs 29 of 241 (12%) in the control group.³

By offering medication therapy management (MTM) services that assess for adherence, identify drug-related problems, monitor pharmacotherapy, and provide education (Figure), pharmacists can play an important role in the multidisciplinary care of patients with PD (Figure).^2-4

One prospective study evaluated the involvement of a clinical pharmacy specialist (CPS) in the outpatient neurology clinic of the West Palm Beach Veterans Affairs Medical Center in Florida. Patients with both PD and a mental health diagnosis who were receiving at least 1 psychotropic drug were eligible to participate in the MTM telephone consultation. During these calls, patients were evaluated for neuropsychiatric symptoms, and the CPS ordered and monitored laboratory work, provided patient education, and primary care, and adjustment the medication. The CPS also offered medication education in person for 24 patients with PD and their caregivers, and all participants reported that these were beneficial. Pill boxes were ordered during 4 (25%) of the consultations to assist with adherence, and 49 nonpharmacologic and pharmacologic interventions were made for 10 patients during the study period. The neurology telephone clinic was found to be a success.⁴

One meta-analysis evaluated 19 studies with a total of 1458 patients with PD from 9 countries to explore the role of pharmacists and the impact of their interventions. Studies using randomized controlled trials or observational designs that reported on pharmacy services for patients with PD were included in the analysis. Most pharmacy services were provided in outpatient clinics. Some were offered in inpatient and outpatient clinical practices. Study results showed that the most reported drug-related problem was adverse drug reactions. The following were the most common pharmacist interventions for patients with PD²:

• Evaluating adherence: 12 studies
• Assessing adverse drug reactions: 12 studies
• Reviewing medication: 12 studies
• Identifying drug interactions: 11 studies
• Identifying inappropriate drug therapy: 11 studies
• Monitoring pharmacotherapy: 11 studies
• Educating patient: 10 studies

About the Author

Jennifer Gershman, PharmD, CPh, PACS, is a drug information pharmacist and Pharmacy Times® contributor who lives in South Florida.

References

1. Statistics. Parkinson’s Foundation. Accessed May 4, 2022. https://www.parkinson.org/Understanding-Parkinsons/Statistics

2. Yi ZM, Li TT, Tang QY, Zhang Y, Willis S, Zhai SD. Content and impact of pharmacy services for patients with Parkinson’s disease: a systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(27):e20758. doi:10.1097/MD.0000000000020758

3. Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial. JAMA. 2018;320(18):1889-1898. doi:10.1001/jama.2018.16131

4. Stefan TC, Elharar N, Garcia G. Implementation and evaluation of Parkinson disease management in an outpatient clinical pharmacist-run neurology telephone clinic. Ment Health Clin. 2018;8(3):159-162. doi:10.9740/mhc.2018.05.159