Pharmacists can help manage patients with Parkinson’s disease

They can assess adherence, identify medication problems, monitor drug therapy, and provide education.

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

Choosing the right treatment can be difficult because it’s usually based on a variety of factors, including age at onset and stage of disease.2 Additionally, patients with PD typically have comorbidities that require medication, which can lead to polypharmacy and drug interactions.

The D-PRESCRIBE randomized clinical trial (NCT02053194) highlighted the importance of having a pharmacist on board. Results showed that, compared to usual care, the pharmacist-led educational intervention for adults aged 65 years or older resulted in greater discontinuation of inappropriate medication prescriptions at 6 months: 106 of 248 patients (43% ) in the pharmacist-led intervention group only filled prescriptions for inappropriate medications compared with 29 of 241 (12%) in the control group.3

By providing medication therapy management (MTM) services that assess adherence, identify medication-related issues, monitor medication therapy, and provide education (Figure), pharmacists can play an important role in multidisciplinary patient care with PD (Figure).2-4

A prospective study evaluated the involvement of a clinical pharmacy specialist (CPS) in the outpatient neurology clinic at 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 medication were eligible to participate in the MTM telephone consultation. During these calls, patients were assessed for neuropsychiatric symptoms, and the CPS ordered and monitored lab work, provided patient education, primary care, and medication adjustment. CPS also provided in-person medication education to 24 PD patients and their caregivers, and all participants said it was beneficial. Pill dispensers were ordered during 4 (25%) of consultations to help with adherence, and 49 non-pharmacological and pharmacological interventions were performed for 10 patients during the study period. The neurology telephone clinic was a success.4

A meta-analysis assessed 19 studies involving 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 review. Most pharmacy services were provided in outpatient clinics. Some have been offered in inpatient and outpatient clinical practices. The results of the study showed that the most reported drug-related problem was adverse drug reactions. Here are the most common pharmaceutical interventions for patients with PD2:

  • Adherence assessment: 12 studies
  • Evaluation of adverse drug effects: 12 studies
  • Drug review: 12 studies
  • Identification of drug interactions: 11 studies
  • Identification of inappropriate drug treatment: 11 studies
  • Drug therapy monitoring: 11 studies
  • Educate the 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 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 pharmaceutical 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 prescribing 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 the management of Parkinson’s disease in a neurology telephone clinic led by an outpatient clinical pharmacist. Mental health clinic. 2018;8(3):159-162. doi:10.9740/mhc.2018.05.159

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