Admission to Dedicated Parkinson's Unit Helps Outcomes

Kate Johnson

October 14, 2013

MONTREAL, Quebec, Canada — Patients with Parkinson's disease (PD) who are hospitalized for general medical reasons have improved outcomes if they are admitted to a specialized PD ward, suggests a British pilot study presented at the 3rd World Parkinson Congress (WPC).

"Care on a specialized Parkinson's unit reduced the omission of PD medication, improved the amount of PD medication given on time, was more highly rated by patients and carers, and was linked to a shorter length of stay," said lead investigator Rob Skelly, MD, consultant physician at the Royal Derby Hospital, a National Parkinson Foundation Centre of Excellence in Derby, United Kingdom.

PD support groups "have drawn attention to the problem of omitted and delayed PD medication when patients are admitted urgently to hospital," he told Medscape Medical News. "A desire to improve the situation was the motivation for our study."

"The issue of hospitalization is absolutely critical for Parkinson's patients," agreed Michael Okun, MD, national medical director of the US-based National Parkinson Foundation, who was not connected to the study. "Patients are being admitted to hospitals all over the world and not getting appropriate treatment. There are all sorts of preventable medical errors that are not being addressed," he said in an interview.

This single-center pilot study involved the establishment of a specialized PD ward within a general medical ward in a 1100-bed acute general hospital.

"The ward continued to act as a general medical ward as well as a Parkinson's unit. We typically have between 2 and 6 Parkinson's patients on the ward at any one time."

The ward kept a large stock of PD medications, and mandatory training by a geriatrician with a PD specialty was provided for about 60 people who staffed the ward, including nurses, nursing assistants, therapists, pharmacists, and junior doctors.

Training included four 1-hour sessions on recognition of Parkinson's symptoms, education about communication and swallowing problems, and education about therapy and medication, "in particular the importance of not omitting medication and which medications are contraindicated," Dr. Skelly said. "We also had an electronic prescription and administration system on the ward which allowed us to collect accurate data on medication and timing."

The study included 44 patients with PD: 24 admitted to the specialty ward and 20 admitted to the general medical wards.

"The PD patients were acute medical patients coming into hospital with most commonly pneumonia in about 25%-30% of cases, or urinary tract infections," said Dr. Skelly. "Their PD was a comorbidity."

Both groups were well-matched in terms of age, sex, disease stage, comorbid conditions, and preadmission Parkinson's medication, he reported.

The study found that median length of hospital stay was significantly shorter for patients on the PD ward than the general ward (9 vs 13 days; P = .043) and that there were fewer omissions of PD medication on the specialty ward (13% vs 20%).

"This represents a 7% absolute improvement or a 35% relative improvement," Dr. Skelly said.

"Of medication that was given, 50% was given on time in the general wards and 64% on the specialist unit," he added. "On the PD unit, no contraindicated medication was administered."

A satisfaction survey completed by patients and their caregivers rated care in the PD unit significantly better than care on the general ward.

 
These little details are not little — they add up to changes in length of stay, to economic problems for healthcare systems, and to lots of morbidity and even mortality. Dr. Michael Okun
 

"This study is a great testament to both identifying the problem and constructing an intervention that can make a difference in people's lives, and sometimes that is the difference between walking out of the hospital and not walking out of the hospital," said Dr. Okun, who is co-director of the Movement Disorders Center at the McKnight Brain Institute and the University of Florida College of Medicine in Gainesville.

"Timing means everything to Parkinson's patients and it can lead to aspiration pneumonia, or falls or fractures if they don't get their medications on time. These little details are not little — they add up to changes in length of stay, to economic problems for healthcare systems, and to lots of morbidity and even mortality."

He said the National Parkinson Foundation has been focused on researching the problem and helping patients advocate for themselves with the help of the Aware in Care kit.

"We've given 35,000 of these kits away for free and it has all the information a patient needs to survive hospitalization," he said. "The UK group is going one step beyond and creating a specialized unit."

Dr. Skelly has disclosed no relevant financial relationships. Dr. Okun reports no industry conflicts or disclosures but he does receive royalties for his recent book, Parkinson's Treatment: 10 Secrets to Happier Life, and other previous books.

3rd World Parkinson Congress (WPC). Abstract #P34.07. Presented October 4, 2013.

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