Bruno Michiko K, Watanabe Gina, Gao Fay, Seto Todd, Nakagawa Kazuma, Trinacty Connie, Brown Stacy, Taira Deborah A
Queens Medical Center, Honolulu, HI, USA.
John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
Clin Park Relat Disord. 2022 Apr 22;6:100144. doi: 10.1016/j.prdoa.2022.100144. eCollection 2022.
Medical management of Parkinson's Disease (PD) is becoming complex. Increasing evidence suggests that patients have better outcomes when they are managed by neurologists. However, access to neurologists can be limited in rural areas. Analysis of prescription pattern can provide insight into access gap rural patients face.
This retrospective observational study used National Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use Files from 2013 to 2018. Query was made for levodopa, dopamine agonists and other antiparkinsonian medications. The data elements obtained included drug name, number of prescribers, prescriber specialty, number of claims, number of standardized 30-day Part D prescriptions, and number of Medicare beneficiaries in the state of Hawai'i. Individual prescribing providers were categorized as urban or rural based on their cities of practice. Prescription patterns of urban and rural providers in Hawai'i as well as difference in provider specialty were compared, using standardized 30-day prescriptions as the primary measure of utilization.
Practice patterns differed between rural and urban areas. In rural Hawai'i, Rytary, Rotigoitne and selegiline were rarely prescribed. Levodopa percentage was higher in urban Hawai'i. In urban Hawai'i, 74.4% of the prescriptions were provided by movement disorders and general neurologists. In rural Hawai'i, 25.1% of the prescriptions were written by neurologists and 74.9% by general practitioners.
In the state of Hawai'i, there is an urban-rural access gap to neurologists as evidenced by Medicare prescription pattern. Further study is needed to understand the reasons for rural-urban differences in prescription patterns and their impact on outcomes.
帕金森病（PD）的药物治疗正变得日益复杂。越来越多的证据表明，由神经科医生管理患者时，患者会有更好的治疗效果。然而，农村地区患者接触神经科医生的机会可能有限。对处方模式的分析可以深入了解农村患者面临的就医差距。
这项回顾性观察研究使用了2013年至2018年的国家医疗保险提供者利用和支付数据：D部分处方医生公共使用文件。查询了左旋多巴、多巴胺激动剂和其他抗帕金森药物。获得的数据元素包括药物名称、处方医生数量、处方医生专业、索赔数量、标准化30天D部分处方数量以及夏威夷州医疗保险受益人的数量。根据其执业城市，将个体处方提供者分为城市或农村。以标准化30天处方作为利用的主要衡量指标，比较了夏威夷城市和农村提供者的处方模式以及提供者专业的差异。
农村和城市地区的执业模式不同。在夏威夷农村地区，很少开具缓释左旋多巴胶囊（Rytary）、罗替戈汀（Rotigoitne）和司来吉兰。夏威夷城市地区的左旋多巴处方比例更高。在夏威夷城市地区，74.4%的处方由运动障碍和普通神经科医生开具。在夏威夷农村地区，25.1%的处方由神经科医生开具，74.9%由全科医生开具。
在夏威夷州，医疗保险处方模式表明农村和城市地区在接触神经科医生方面存在差距。需要进一步研究以了解农村和城市处方模式差异的原因及其对治疗效果的影响。
